After the decision to hire a home health aide for yourself or an elderly family member has been made, the next question will likely be ‘how much does home health care cost?’. This article breaks down the most important points on in-home care costs to help you make an informed decision. We also suggest that you inquire from relatives or friends who have opted for at-home caregivers about their experiences.
According to 2018 data from PayScale.com:
- The average hourly rate for elderly care by a home health aide is $10.40
- Tips can range from $0.05-$10.07
- Overtime costs are $9.83-$20.53
Experience also affects home health aide pay, although not very much. An entry-level aide with less than five years of experience earns an average pay of $21,000. Home health aides with 5-10 years of experience make $22,000, those with 10-20 years of experience take home a slightly higher compensation of $23,000, and in-home caregivers who have dedicated over 20 years to this profession make $25,000 on an average. 
Independent home health aide versus agency
You have the option to engage a home health aide working for a home care agency or an independent caregiver who offers his/her services directly to clients. Private caregivers typically charge 20%-30% lesser than their agency counterparts.
If you are interested in hiring an independent in-home care agent, the onus of performing a background check and managing payroll and withholdings falls on you (caregivers are classified as employees, not independent contractors). A home health agency will take care of both.
Independent agents may offer a broader range of services, although note that home health aides are not full-time housekeepers. On the other hand, if the agent calls in sick, then it is impossible to get a back-up on short notice. This is not the case with a home health care business, who you can count on to provide backup caregivers.
Regardless of who you hire, check if they are covered by general liability and professional liability insurance. Their policy will compensate you for financial loss caused by acts of negligence and mishaps at the place of care.
Home care costs vary by state
Location plays an important role in dictating home health aide salaries. PayScale.com’s survey indicates that in-home caregivers in Washington have a 28% higher pay than the national average, while Rochester, NY and St. Paul, Minnesota also register higher-than-average pay for home health aides. In contrast, at-home caregivers in Dallas make 20% lesser than the national average, while Jacksonville and Cleveland professionals in this occupation also see a 11% drop from the national average pay.
According to 2018 state-wide data from PayingforSeniorCare.com, a website assisting individuals plan long-term senior care and maintained by the American Elder Care Research Organization (AECRO), home care cost per hour is highest in Alaska ($26), Minnesota ($26), North Dakota ($27.96), Washington ($26.50) and Wyoming ($26). At the lower end of the pay spectrum are Alabama ($16.85), Louisiana ($15.00), North Carolina ($18), Tennessee ($18.60), Texas ($19.50) and West Virginia ($17.00). 
Types of home health care rates
Hourly rates: This is the most common way to calculate home health aide wages. Seniors may not need round-the-clock assistance and opt for the services of an at-home caregiver for a few hours each day. Home health care agencies set a specific, pre-determined minimum number of hours that home health aides can spend at their client’s place, usually 2-4 hours.
Daily rates: Seniors who require round-the-clock assistance calculate daily rates for caregivers, with appropriate allowances for rests and breaks. It is possible that some amount of medical care will be needed. A non-medical home health aide will be unsuitable to this role. A home health aide who has acquired further qualifications to serve as a Certified Nurse Assistant (CNA) or Licensed Practical Nurse (LPN) will be able to deliver the medical care required by the patient.
Overnight rates: If the patient requires overnight caregiving, the hourly rate is often lesser than the daily rate. As the home health aide will also rest for a few hours at night, the calculations are a bit different to daily and hourly rates. Federal law mandates a minimum wage for all hours worked and no pay for hours of rest as long as the caregiver is given proper sleeping accommodation such as their own room and a private bed and is able to sleep undisturbed. If the caregiver provides assistance during this time, they must be paid for the hour(s) spent working.
How to pay for in-home care
There are a number of self-payment and financial assistance options to manage in-home care costs. Medicare does not pay for non-medical home care, but Medicaid does. If you are not eligible for Medicaid, you can consider non-Medicaid home care financial assistance programs offered by most states. Those who already have long-term care insurance can more comfortably pay towards in-home care costs. If you haven’t opted into a long-term care plan but have a life insurance policy, you can convert your policy to home care services or cash. Read this article for helpful information on home care payment and financial assistance options.