Comparing settings
Is home care cheaper than a nursing home?
At the national medians, 44 hours a week of in-home care costs $6,673 a month, against $9,581 for a semi-private nursing home room and $10,798 for a private one — so at that many hours, home care is the cheaper setting. The catch is the billing clock. Home care is charged by the hour and keeps rising as hours are added, while a nursing home bed is a flat daily rate that already contains round-the-clock staffing. Divide one by the other and the answer flips at roughly 63 hours a week.
Data: CareScout Cost of Care Survey — 2025 national medians
Data: CareScout Cost of Care Survey — 2025 national medians — fieldwork July–November 2025.
The two settings side by side
The figures below are the national medians from the same cost survey for every care type, which is what makes them comparable to each other. What is not comparable is how they are billed — and that difference decides almost every case.
| Setting | Billed as | Monthly median | Annual |
|---|---|---|---|
| In-home caregiver | $35/hour × 44 hours a week | $6,673 | $80,080 |
| Adult day health care | $95/day × 5 days a week | $2,058 | $24,700 |
| Nursing home — semi-private room | $315/day, all 365 days | $9,581 | $114,975 |
| Nursing home — private room | $355/day, all 365 days | $10,798 | $129,575 |
Read the middle row first. A nursing home is billed every day of the year including weekends, so its monthly figure is a daily rate multiplied by 365 and divided by twelve. Home care for 44 hours a week is billed for those 44 hours and nothing else. The two numbers look like a comparison of settings; they are really a price for hours compared with a price for days.
That is also why the 44 hours matter. It is the survey's own assumption for its in-home figure, not a typical week for a person with high needs — and it is roughly halfway between the 28 hours a week Medicare's home health benefit covers and the 168 hours a week that round-the-clock care requires.
Where the numbers cross
Because one side is hourly and the other is not, there is a specific number of hours at which they cost the same. It comes from dividing the nursing home monthly median by the survey's hourly caregiver rate — arithmetic on the two published figures, not a separate statistic.
| Your hours of paid help each week | Monthly cost of those hours | Cheaper setting |
|---|---|---|
| 44 hours (the survey's assumption) | $6,673 | Home care |
| 63 hours (semi-private break-even) | $9,581 | Equal |
| 71 hours (private-room break-even) | $10,798 | Equal |
| 168 hours (24 hours a day, 7 days) | $25,480 | Nursing home |
In hours rather than months: about 274 hours a month — roughly 63 hours a week — of paid in-home care equals a month in a semi-private room, and 309 hours a month equals a private room. Above those points, paying hourly for help costs more than a bed that comes with staffing included. Round-the-clock hourly care is not a close call: 168 hours a week comes to $25,480 a month, about two and a half times the semi-private median.
Two honest qualifications. First, a nursing home bed includes nursing, meals, laundry and the building itself, while an hourly caregiver may not — so the comparison prices the care hours, not the whole arrangement. Second, agencies price overnight shifts, live-in arrangements and 24-hour coverage differently from ordinary hourly visits, so the hourly rate multiplied by 168 is a ceiling that shows the shape of the problem rather than a quote anyone will give you. When asking an agency, ask for its 24-hour weekly rate.
What Medicare pays in each setting
Medicare covers both settings and covers them unequally, which is often what decides between them. The rules below are from Medicare.gov's coverage pages for home health services and skilled nursing facility care, re-checked for this page.
| Question | Home health (at home) | Skilled nursing facility |
|---|---|---|
| Which part of Medicare | Part A and Part B | Part A |
| What opens the door | A provider must see the person in person, confirm they need home health care, and a Medicare-certified agency must provide it — and the person must be homebound | A qualifying inpatient hospital stay of at least 3 days in a row, entering the facility generally within 30 days of leaving hospital |
| How much care is covered | Part-time or intermittent: up to 8 hours a day combined skilled nursing and home health aide care, maximum 28 hours a week in most cases (up to 35 hours a week for a short period if the provider decides it is necessary) | Limited to 100 days per benefit period, on a short-term basis |
| What you pay in 2026 | Nothing for covered home health services; 20% of the Medicare-approved amount for covered medical equipment after the Part B deductible | $1,736 deductible per benefit period, then $0 a day for days 1–20, $217 a day for days 21–100, and all costs from day 101 |
| What is excluded | Medicare.gov lists 24-hour-a-day care at home, home meal delivery, homemaker services unrelated to the care plan, and custodial or personal care when that is the only care needed | Custodial care — help with bathing, dressing or using the bathroom — when that is the only care needed |
Put the ceilings next to the costs and the practical problem appears. Medicare's home health benefit reaches 28 hours a week in most cases, the survey's in-home benchmark assumes 44 hours a week of non-medical caregiving, and a person who cannot be left alone needs 168. Three very different numbers, and only the smallest one is a benefit. Everything above it is private pay or another programme, which is covered in does Medicare pay for assisted living and does Medicaid pay for nursing home care.
One detail from the SNF page is worth knowing before assuming a hospital stay qualifies: time spent in hospital as an outpatient, or under observation in the emergency room, does not count toward the three inpatient days — even if it happened overnight. Medicare.gov notes there may be an exception if the doctor participates in an approved Skilled Nursing Facility 3-Day Rule Waiver, or the person is in a Medicare Advantage plan that waives the requirement, and that if there is no qualifying stay the right question to ask is whether other settings or other programmes can cover the care.
The middle option families miss
The comparison is usually framed as home versus facility, but the medians contain a third arrangement: adult day health care during the week, plus paid help at home for the hours that remain. Adult day care is billed per day of attendance, so five days a week is 260 days a year rather than 365.
| Arrangement | How it is built | Monthly |
|---|---|---|
| Adult day care, 5 days a week | $95 a day × 260 days a year | $2,058 |
| Plus in-home care, 20 hours a week | $35 an hour × 20 hours × 52 weeks | $3,033 |
| Combined | Adult day weekdays, help mornings and evenings | $5,092 |
| For comparison: semi-private nursing home | $315 a day × 365 | $9,581 |
That combination is $5,092 a month, or $61,100 a year, against $9,581 a month for the semi-private room. It fits the person who cannot safely be alone during working hours but does not need overnight nursing care — and it depends on an adult day centre within travelling distance, weekday availability, and a family or paid carer who can cover evenings. Where those conditions hold, it is the least expensive arrangement in the survey by a wide margin, and it is also the one that most often goes unmentioned in a discharge conversation.
Two constraints worth checking in advance: adult day centres may have their own eligibility and capacity rules, and the daily rate covers attendance rather than transport or any nursing service. The adult day care cost page breaks the same daily rate down by attendance pattern.
Which one is rising faster
A comparison decided on one year's figures can be undone by different rates of increase. The same survey reports a year-over-year change for each care type, and this site applies those figures on its cost increase page.
| Care type | Change reported by the survey | Direction over time |
|---|---|---|
| In-home caregiver | +3% | The hourly side of the comparison is getting dearer |
| Adult day health care | -5% | The cheapest setting also moved down |
| Assisted living | +5% | The fastest-rising of the five |
| Nursing home — semi-private room | +3% | Moving at the same rate as hourly care |
| Nursing home — private room | +1% | The slowest-rising of the five |
The two settings in this comparison moved at the same rate, so the crossover above does not move much from year to year — which is the useful part. What breaks the arithmetic is not general inflation but a change in the number of hours a person needs: a fall, a hospital stay or a new diagnosis can move a household across the crossover in a single month, and that is the moment to redo the sum rather than rely on last year's answer.
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Working out your own number
Take the weekly hours of help a person actually needs — not what they need today, but what they will need on a bad week — and put them against the crossover above. Under roughly 63 hours a week, the hourly cost is the lower one. Over 71, the private-room figure is. Between the two, the answer depends on which room type is actually available in the market being considered, which is a question for the buildings themselves.
The care cost calculator does this with the same medians: enter a care type and, for in-home care, the hours a week, and it returns the monthly and annual figures. The in-home care cost page and the nursing home cost page show the same medians in the context of each setting, and the cost of care hub lists every page. If a facility or an agency quotes a number, the medians are a sanity-check on it rather than a target to argue with: they are national, and any single market can sit above or below them.
Frequently asked questions
Is home care cheaper than a nursing home?
At the national medians and the hours the cost survey itself assumes — 44 hours a week — yes: in-home care comes to $6,673 a month against $9,581 for a semi-private nursing home room and $10,798 for a private room. But the two are billed on different clocks. Home care is billed by the hour, so its cost rises with every hour added, while a nursing home bed is a flat daily rate that already includes round-the-clock staffing. Divide the nursing home monthly figure by the hourly caregiving rate and you get the point where they meet: about 274 hours of paid help a month, or roughly 63 hours a week.
How many hours a week makes a nursing home cheaper?
About 63 hours a week of paid in-home care costs the same as a month in a semi-private nursing home room, and about 71 hours a week matches a private room, using the national medians and the survey's hourly rate. Below those numbers home care costs less; above them the flat nursing home rate wins. Real schedules rarely sit neatly on one side, which is why the useful exercise is adding up the hours a person actually needs per week and comparing that single number to the crossover rather than comparing two monthly totals.
What does round-the-clock home care cost?
Priced at the survey's hourly rate, 24 hours a day, 7 days a week comes to 168 hours a week — $5,880 a week, or $25,480 a month. That is roughly two and a half times the semi-private nursing home median, and it is the reason 'keep them at home' is a budget question and not only a preference: at some number of hours, paying hourly for care stops being the cheaper way to buy the same coverage. Live-in arrangements and agency contracts are priced differently from hourly shifts, so the number to ask an agency for is the 24-hour weekly rate, not the hourly rate.
Does Medicare pay for either one?
Medicare covers both, under different rules with different ceilings. Home health services are covered through Part A and Part B if the person needs part-time or intermittent skilled care and is homebound; Medicare.gov states that most people can get up to 28 hours a week of skilled nursing and home health aide care combined. SNF care is covered through Part A for a limited time, but only after a qualifying inpatient hospital stay of at least three days in a row, and it is capped at 100 days per benefit period. Neither setting is covered for custodial care alone — Medicare.gov lists 24-hour-a-day care at home, home meal delivery and custodial personal care as things Medicare does not pay for.
What are the 2026 Medicare costs for a nursing home stay?
For skilled nursing facility care in 2026, Medicare.gov gives the deductible as $1,736 per benefit period, then $0 a day for days 1 through 20, $217 a day for days 21 through 100, and all costs from day 101. That is a short-term rehabilitation benefit and not a long-stay payment: a benefit period ends when there has been no inpatient hospital or skilled nursing care for 60 days in a row, and there is no limit on the number of benefit periods, but each one starts with the deductible again.
Is there a middle option between the two?
There is, and it is the one families most often overlook: adult day health care five days a week plus part-time in-home help. At the medians that combination comes to $5,092 a month — $2,058 for adult day care at five days a week and $3,033 for 20 hours a week of in-home care — well below the semi-private nursing home median. It works when the person cannot safely be alone during the day but does not need overnight clinical care. Medicare.gov also notes that attending adult day care does not disqualify someone from receiving home health care.
Which of the two is getting more expensive faster?
The same survey reports year-over-year changes for each care type, and in-home care rose 3% while the semi-private nursing home rate also rose 3% and the private room rose 1%. Adult day care was the one category the survey recorded as falling, by 5%. Those are the survey's reported changes rather than projections, and they are worth reading as direction rather than as a forecast: the two settings families compare most often moved at the same rate, while the cheapest setting moved down.
Where these numbers and rules come from
Every dollar figure on this page comes from the national cost survey named at the top of the page — the monthly medians for in-home care, adult day health care, assisted living and both nursing home room types. The hourly in-home figure, the daily adult day and nursing home rates and the year-over-year changes are that survey's published inputs, and the monthly and annual totals are its own arithmetic: annual equals the daily or hourly rate multiplied by the days or hours in a year, using the survey's stated assumptions of 44 hours a week for in-home care and 5 days a week (260 days a year) for adult day care, with nursing homes billed for all 365 days. The crossover figures and the combination of adult day care with 20 hours of in-home help are derived from those published values and nothing else; no figure on this page is an estimate, a projection or a quote from a provider.
The Medicare rules and the 2026 cost-sharing amounts for skilled nursing facility care are taken from Medicare.gov's coverage pages for home health services and skilled nursing facility care, re-checked when this page was published. Medicare covers services rather than care settings, so what is described here is the coverage rule and its ceiling, not a prediction of what any individual's care will cost. Nothing on this page is medical or financial advice, and eligibility rules for state programmes vary — for those, the relevant state agency is the authority.