24/7 in Home Care Cost: Prices With & Without Insurance

Round-the-clock home care means a person needs help at any hour, day or night, and wants to stay in their own home instead of moving to a facility. It is the most intensive form of non-medical home care, and it is priced accordingly. Families usually arrive at this decision after a fall, a diagnosis, or a long stretch of gradually increasing needs.

Because a single caregiver cannot work around the clock, 24/7 care is built from shifts, and the way those shifts are arranged has a large effect on cost. This page explains how the monthly figure is put together, what the hourly rates behind it look like, and what to ask an agency before you commit.

The monthly figure above comes from A Place for Mom. It is a national median, which means half of the situations it describes cost more and half cost less. Use it as a planning number.

The monthly total is not a standard price list item. It is the result of an hourly rate applied to a very large number of hours, plus any add-ons. That is why two families in the same city can receive very different estimates. Small differences in the hourly rate, in how overnight hours are billed and in whether extra help is needed on certain days add up quickly over a month.

Agencies bill hourly, and 24/7 care is priced from those hourly rates. The table below shows the rates for non-medical caregivers reported by two sources.

Both sources land close together, which gives you a reasonable sense of the going rate for a non-medical caregiver. Keep the units straight when you compare quotes: these are hourly figures, while the national median at the top of the page is a monthly figure. An hourly rate cannot be converted into a dependable monthly total without knowing the exact hours, the staffing model and any overtime or holiday rules, so ask the agency to put the full monthly number in writing.

Non-medical care covers help with bathing, dressing, meals, mobility, companionship, light housekeeping and reminders. It does not include nursing procedures. If skilled nursing is part of the picture, the cost structure is different, so ask your doctor or a care manager what kind of provider is required.

• How the hours are staffed: some families use awake caregivers in shifts around the clock. Others use a live-in caregiver who sleeps at the home. Agencies often bill these models differently, and state labor rules can affect them.
• Overnight needs: if the person needs help repeatedly during the night, an awake overnight caregiver is likely to cost more than a caregiver who is on site but sleeps.
• Condition and care level: dementia, mobility limits and lifting needs can raise the hourly rate or call for two caregivers at certain times.
• Location: hourly rates vary by metro area and by state.
• Agency or independent caregiver: agencies handle screening, scheduling, backup coverage and payroll taxes. Hiring an independent caregiver directly can reduce the hourly rate, but you may become the employer, with tax, insurance and coverage responsibilities.
• Holidays and weekends: some agencies charge a higher rate on holidays.

Each way of arranging 24/7 care has trade-offs.

Agency with shift caregivers

• Backup coverage when a caregiver is sick or unavailable
• Background checks and training handled by the agency
• Usually the highest hourly rate

Live-in caregiver

• One consistent person in the home, which can help with continuity
• The caregiver needs breaks and sleeping quarters, and rules on rest and time off apply
• Some arrangements need a second person to cover days off

Independent caregiver hired directly

• Often a lower hourly rate
• You may handle payroll taxes, workers' compensation and backup coverage yourself
• Ask a licensed accountant or attorney about your obligations as an employer

For some families, round-the-clock home care is the right fit. For others, a different setting may cost less or provide more support. Assisted living and nursing homes charge a monthly fee that bundles housing, meals and care, while home care keeps the person at home but adds the household expenses on top of the caregiver bill. Ask a doctor or a geriatric care manager which level of care suits the person's needs, and then compare actual written quotes.

Coverage is a common surprise. Many families find that they pay a large share themselves, so check each source before you plan around it.

• Medicare: whether Medicare covers any part of non-medical, long-term home care is a question for the program. Check with Medicare directly before assuming anything is covered.
• Medicaid: home and community-based services vary by state, with different eligibility rules and waitlists. Check with your state Medicaid office or Area Agency on Aging.
• Long-term care insurance: policies differ on daily limits, waiting periods and covered services. Call the insurer and ask how a 24/7 arrangement would be reimbursed.
• Veterans benefits: the Department of Veterans Affairs can explain whether a veteran or surviving spouse qualifies for in-home support.
• Private pay: savings and retirement income are a common source for this type of care.

For questions about eligibility, taxes or estate planning, talk to a licensed elder law attorney or financial advisor.

• What is the hourly rate, and does it change overnight, on weekends or on holidays?
• Are overnight caregivers awake or asleep, and how is that billed?
• What happens if a caregiver calls out?
• Are caregivers employees of the agency, and are they bonded and insured?
• Is there a minimum number of hours or a contract length?
• Can I get the full monthly estimate in writing before service begins?