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Full-time home care now costs more than assisted living. Run the number before you promise Mom she stays home.
Long-term care is the largest expense most families never budget for — and Medicare does not cover custodial care at all. The 2025 CareScout (Genworth) survey puts the national medians at $35 an hour for a non-medical home caregiver, $6,200 a month for assisted living, and $10,798 a month for a private nursing home room. The counterintuitive result: at 44 hours a week, staying home with paid help ($80,080/yr) already costs more than assisted living ($74,400/yr). This calculator prices any setting over any horizon with care-cost inflation (~3% a year historically), so the family conversation happens around a number instead of a guess.
Families use it in the week after a diagnosis or a fall, when the promise "we'll keep Mom at home" meets the math: at 44 hours a week home care already beats assisted living on price, Medicare pays for none of it, and the total over three years is the number that decides whether the house gets sold.
Almost none of it. Medicare covers short skilled-nursing stays after a hospitalization (up to 100 days, with copays from day 21) but explicitly excludes custodial care — help with bathing, dressing, and eating — which is most of what people need. Long-term custodial care is paid from savings, long-term care insurance, VA benefits for qualifying veterans, or Medicaid after spending down assets. Per HHS, 56% of people turning 65 will need paid long-term care at some point.
At full-time hours, yes. The 2025 national median for a non-medical caregiver is $35/hour — 44 hours a week is $80,080 a year versus $74,400 for assisted living. Home care wins at part-time hours (20 hrs/wk ≈ $36,400), but agency minimums, weekend rates, and the need for two-person assists push real schedules up. Adult day health care at $95/day is the budget option for families providing nights and weekends themselves.
The hourly rate drops, but you become a household employer: pay any one caregiver $3,000 or more in 2026 and you owe Social Security and Medicare taxes plus FUTA, filed on Schedule H with your own 1040 — and "1099 contractor" is misclassification when you control the schedule. Our nanny tax calculator prices the employer side. Agencies charge more per hour precisely because they carry that payroll, insurance, and replacement coverage.