Help at Home: What It Is and Who Pays

Imagine your mother is a retired nurse in her early 80s who manages fine most days. Since her knee surgery, though, laundry, showers, and the weekly grocery run have started to feel like too much. You live three hours away, and you ask her, "What would it cost to get you some help?"

For many older adults, a few hours of help a week is what makes staying home work. This guide explains the kinds of help at home, what they cost, who may help pay, and how to choose between an agency and hiring someone yourself.

Rules and programs vary by state, so we also show you how to find what is available where you live.

What help at home means

"Help at home" usually means non-medical help with daily life. It comes in a few kinds, and one person often does more than one:

• Homemaker help: light housekeeping, laundry, meals, and errands such as grocery shopping.
• Companion help: company, conversation, outings, and someone to notice if something seems wrong.
• Personal care: hands-on help with bathing, dressing, grooming, eating, or using the toilet. These are often called "activities of daily living."

This is different from home health care, which is medical care at home, such as skilled nursing or physical therapy, ordered by a doctor. Our guide Home Health Care: What Medicare Covers at Home explains that benefit.

How the cost is set

Most help at home is priced by the hour. Agencies set their own rates, based on local wages, training, insurance, and their other business costs. Many also have a minimum number of hours per visit.

As of March 2026, the national median (the middle rate) for a non-medical caregiver from an agency was $35 an hour in 2025, up 3% from the year before¹. Rates are higher in some places and lower in others.

The hours are what add up. At $35 an hour, four hours a day, three days a week comes to about $420 a week. Full-time help, 44 hours a week, came to a national median of $80,080 a year².

What you get for the money

An agency rate usually buys a worker the agency has screened, trained, and insured, and a replacement when that worker is sick or on vacation. The agency handles payroll and taxes.

What it does not buy is medical care. A homemaker or companion is not a nurse, and agencies differ in what their aides are allowed to do, such as reminding someone to take medicine versus handing it to them. Ask before you sign.

Who pays, and ways to lower the cost

Most people pay for help at home out of pocket, at least at first. Several programs may help, depending on your needs, income, and state:

• Medicare generally does not. Medicare does not cover homemaker services such as shopping and cleaning, or personal care when that is the only care you need, and it does not cover 24-hour care at home³. It also does not pay for long-term custodial care, meaning help with daily activities like bathing and dressing, unless medical care is needed⁴.
• Medicaid home and community-based services. Through programs called waivers, states can use Medicaid to pay for homemaker, home health aide, and personal care services, so people can stay home instead of moving to a nursing home. States choose how many people a waiver serves⁵. In 2025, 41 states had waiting lists, and waits for waivers serving older adults and people with physical disabilities averaged 15 months⁶. Ask your state Medicaid agency, and apply early.
• Older Americans Act services. Federal funds go through your Area Agency on Aging for in-home services, including homemaker help⁷, for people 60 and older⁸. Services and waits vary by area. The Eldercare Locator, 1-800-677-1116, finds your local agency.
• Help for family caregivers. The National Family Caregiver Support Program funds respite care (short breaks while someone else steps in), counseling, and training for family caregivers⁹. Ask your Area Agency on Aging.
• VA Homemaker and Home Health Aide care. A trained aide comes to a veteran's home to help with tasks such as bathing, dressing, and grocery shopping. Enrolled veterans can qualify if they have the health need and the service is offered nearby. A copay, a set amount you pay, may apply, depending on whether you have a disability from your service¹⁰. Start with a VA social worker.
• Long-term care insurance. These policies can pay a daily amount, up to a set limit, for help with daily activities at home¹¹. If you have a policy, call the insurer to ask what it pays for at home and how to start a claim.

For help with other costs of keeping your home, such as repairs, utility bills, and property taxes, see Help with housing costs, state by state.

Hiring through an agency or on your own

Some people hire a worker directly instead of using an agency. Compare the hourly rates, but know that more of the work then falls to you. You find, check, schedule, and replace the worker yourself.

You may also become a household employer, with the tax duties of any boss. The IRS says a worker is generally your employee if you control not only what work is done but how it is done. If an agency provides the worker and controls the work, the worker is not your employee¹².

If you pay one household employee $3,000 or more in cash wages in 2026, you generally must take out and pay Social Security and Medicare taxes, and file Schedule H, a tax form, with your return¹³. State wage and tax rules may also apply. Ask a tax professional, and check with your state labor office.

What can change it

Needs change, and so do hours. A fall, a hospital stay, or a new diagnosis can turn a few hours a week into many. Check in every few months on whether the help still fits.

Changes in the household matter too. If someone moves in and pays rent, ask each program if you still qualify. Our guide Will Sharing My Home Affect My Benefits? covers what to ask.

An extra set of hands

Not every hour of help needs to be hired. A family member, friend, neighbor, or another person in the home can cover some of the small things, if they want to and you both agree.

• What it accomplishes: carrying in groceries, taking out the trash, changing a light bulb within reach, or a ride to the pharmacy. Each errand covered is an hour you may not need to pay for, at about $35 an hour through an agency¹⁴.
• What it protects: someone who notices a change in appetite, mood, or balance, and suggests a call to the doctor or the family.
• What it preserves: paid hours saved for the help that needs training, and the shape of family relationships. When routine chores are covered, a daughter or son can visit as family, not as the one on duty. You stay the one who decides what help comes in.
• What it offers: company at dinner, and a reason to get out for a walk.

The line matters. Help is optional and agreed in advance. Personal care, such as bathing, dressing, or toileting, and medical tasks belong to trained, paid workers. Skilled or risky work, such as roofs, trees, electrical, plumbing, gas, and anything on a ladder above the first floor, belongs to licensed professionals. Being present is not caregiving. Our guide Help Around the House Is Not Caregiving explains where help ends and care begins.

Watch for

• Unclear contracts. Get the hourly rate, minimum hours, cancellation terms, and any rate increases in writing.
• Cash-only hiring with no paperwork. It can leave you with tax problems and no record of what was agreed.
• Money and access. Keep checkbooks, cards, and passwords out of reach, and never give a worker power over your accounts.

Conversation starters

If you are an adult child or friend talking with an older adult:

• "Which part of the week feels hardest right now?"
• "Would you be open to someone coming in a few hours a week, just for the heavy chores?"
• "Can we call the Area Agency on Aging together and see what's available?"

If you are an older adult talking with family or caregivers:

• "I'd like help with the cleaning and the shopping, but I want to choose who comes."
• "Before we hire anyone, I want to know what it costs and who would pay."
• "I'd rather have a little help now than wait until something goes wrong."

For many older adults, a few hours of help a week is what makes staying home work.

Last reviewed October 14, 2026