Cost of In-Home Care for Elderly in 2026: Hourly Rates by State

Quick answer: In-home care runs $35 an hour nationally, per the 2025 CareScout Cost of Care Survey. That is $80,080 a year at 44 hours a week. State medians range from $24 an hour in Mississippi to $46 in Wyoming, and Medicare pays none of it.

Home care is priced by the hour, so the bill depends entirely on how many hours you buy. Families almost always underestimate that number.

Here are the published medians, the state spread, and the four places the money actually comes from.

What in-home care costs in 2026

The most useful national source is the CareScout Cost of Care Survey, formerly the Genworth survey. CareScout collected data from providers nationwide between July and November 2025.

Rates as of September 2026, from the 2025 CareScout Cost of Care Survey.

CareScout now folds homemaker and home health aide services into one category. It calls that category “non-medical caregiver,” and it is the number most families need.

The survey defaults to 44 hours a week. That works out to $80,080 a year at the national median. Private duty nursing is separate, at $90 an hour or a median of $160 per visit.

Rates by state

Location drives price more than anything else. These are published 2025 medians for a non-medical caregiver, hourly.

Rates as of September 2026, from CareScout’s 2025 median cost data tables.

The spread is nearly two to one. A family in Mississippi and a family in Wyoming face very different math for the same care plan.

Rates within a state also vary by metro area. CareScout reports at the Metropolitan Statistical Area level, so ask local agencies for their own number.

What different hour counts actually cost

Multiply before you commit. At the $35 national median:

• 4 hours a day, 5 days a week is about $36,400 a year
• 8 hours a day, 5 days a week is about $72,800 a year
• 44 hours a week is $80,080 a year
• 24-hour care is roughly $840 a day, or about $306,000 a year

Compare that last figure to assisted living at a median of $6,200 a month, or $74,400 a year. Round-the-clock home care is rarely the cheapest option.

The crossover point sits near 40 hours a week. Below that, home usually wins on cost.

Agency vs private hire

Both routes are legitimate. They shift risk in different directions.

Hiring through an agency

The rate above is an agency rate. It includes payroll taxes, workers’ compensation, liability insurance, background checks, supervision and backup coverage.

The agency is the employer. If your caregiver quits or gets sick, filling the shift is their problem.

Expect minimum shift lengths, often three or four hours. Ask about that before you plan around two-hour visits.

Hiring privately

You will pay less per hour. You also become a household employer.

IRS Topic 756 sets the 2026 threshold at $3,000 in cash wages. Above that, you generally withhold Social Security and Medicare tax.

Employer and employee each pay 7.65%.

Federal unemployment tax applies if you pay household employees more than $1,000 in any calendar quarter. It runs 6% on the first $7,000 of wages, with a credit of up to 5.4% for state unemployment payments.

You also file Schedule H with your tax return. Many families use a payroll service to handle this for a monthly fee.

Budget for the gaps too. There is no backup caregiver, no supervisor and no liability policy unless you buy one.

What Medicare actually pays

Medicare pays for skilled care at home, not for help with daily life.

Medicare covers part-time or intermittent skilled nursing care, physical therapy, occupational therapy, speech-language pathology and medical social services. A home health aide is included only if you are also getting one of those skilled services.

You must be homebound and a doctor must order the care. A Medicare-certified home health agency must provide it.

You pay $0 for covered home health services. You pay 20% of the Medicare-approved amount for durable medical equipment.

The limits are strict. Medicare defines part-time or intermittent as up to 8 hours a day combined. The weekly maximum is 28 hours. Your provider can approve up to 35 hours a week for a short time if necessary.

Medicare explicitly does not pay for 24-hour care at home or home meal delivery. It also excludes homemaker services unrelated to your care plan.

Custodial care is excluded too, when that is the only care you need.

Medicare’s own long-term care page says it plainly: Medicare does not pay for long-term care.

Who does pay

Four sources cover most of the private-pay gap.

Medicaid. If income and assets are low enough, home and community based services pay for personal care. Many states let the person self-direct, hiring and supervising their own worker. Our guide to getting paid as a family caregiver explains how that works.

PACE. The Program of All-inclusive Care for the Elderly covers home care, personal care and support services. You must be 55 or older, need a nursing-home level of care, and live in a PACE service area. With Medicaid there is no premium and no copay for approved services.

VA Aid and Attendance. A qualifying veteran with no dependents has a Maximum Annual Pension Rate of $29,093. With one dependent it is $34,488. Those rates run from December 1, 2025 through November 30, 2026. The payment is the difference between countable income and that rate.

Long-term care insurance. Read the policy’s elimination period and daily benefit cap before you count on it.

Five ways to cut the bill

Small changes move this number more than negotiating an hourly rate.

1. Buy fewer, better hours. Cover mornings, evenings and bath days instead of full shifts.
2. Use adult day health care for part of the week. The 2025 national median was $95 a day.
3. Ask your Area Agency on Aging for respite through the National Family Caregiver Support Program.
4. Start with lower-cost companion care before paying personal care rates.
5. Make the house safer so less supervision is needed, using our aging in place checklist.

Also check whether a Medicare Advantage plan offers in-home support benefits. Our guide to Medicare and home modifications explains those supplemental benefit rules.

Bottom line

Plan on $35 an hour as a national median. Get three local quotes before you assume that applies to you. In low-cost states the real number may be $25, and in high-cost states it may be $45.

Use an agency if you need reliability and no employer paperwork. Hire privately only if you are ready to run payroll and cover your own gaps.

Above about 40 hours a week, price assisted living and PACE side by side before committing. If income is limited, apply for Medicaid home and community based services now. Waiting lists are long in most states.