There is an hour in the week where the arithmetic flips. Below it, paying for care at home costs less than moving to a facility. Above it, the facility is cheaper — often dramatically so. Almost every page that compares these two options talks about warmth, familiarity and dignity, and never tells you where that line sits. This page does, and it shows you how to find your own line using the two quotes in front of you.
The short version, using the most recent published national figures: at the median in-home care rate of $35 an hour, home care costs about the same as the median assisted living community at roughly 41 hours of paid care a week. Past that, every additional hour at home is money you could have spent on a facility that never sleeps.
The 2026 numbers that are actually published
These come from the CareScout Cost of Care Survey, released 2 March 2026, covering rates collected from providers between July and November 2025. CareScout (a Genworth subsidiary) has run this survey since 2004 and collected more than 25,000 rates for this edition. It is the figure set the rest of the industry quotes, usually without saying so.
- In-home care (non-medical caregiver): $35 an hour. Up 3% year over year. At 44 hours a week that is $80,080 a year, or about $6,673 a month. Note that CareScout merged “homemaker” and “home health aide” into one category this year because the prices had converged — so the old trick of budgeting a cheaper rate for non-personal care no longer reflects the market.
- Skilled nursing in the home (private duty nurse): $90 an hour, or a median $160 per visit. New to the survey this year.
- Assisted living: $6,200 a month, up 5%, or $74,400 a year.
- Adult day health care: $95 a day, down 5% — the only category that fell. At five days a week that is $24,700 a year.
- Nursing home, semi-private room: $315 a day, up 2%, or $114,975 a year. Private room $355 a day, or $129,575 a year.
Two things to hold onto. First, these are medians collected at metropolitan-area level, so your local number can sit a long way from them. Second, one line is conspicuously missing.
Why nobody can tell you what memory care costs
The most comprehensive long-term care pricing survey in the United States does not publish a memory care figure at all. Not a low one, not a high one. The category is not in it.
This is the single most useful thing to know before you read any other page on this question, because it explains why the memory care numbers you find vary so wildly. They are not being drawn from a common source, because there is no common source. Every figure you see is one of three things: a senior-living company aggregating its own listings, a placement service aggregating the communities that pay it, or someone taking the assisted living median and applying a markup they chose.
That last one is worth naming plainly. Memory care is priced as assisted living plus a dementia-care premium, because the staffing ratio is higher, the building is secured, and the staff need training that assisted living staff do not. The premium is real. But its size is set community by community, and a national average of it would be averaging numbers that were themselves estimated.
It is also worth knowing who is telling you. The pages that rank highest for memory care pricing are largely operated by placement services, which are paid a commission by the community when a family moves in. That is a legitimate business and their cost content is often carefully done. It does mean, though, that the organisations with the best data on facility pricing are structurally the least likely to publish a page whose conclusion is “stay home.” We have the opposite interest, which you should weigh the same way — so everything below is built on figures you can check yourself, and the arithmetic is shown rather than asserted.
What to do instead of hunting for a national number: get two or three written quotes from communities within driving distance, and ask each one for the base rate, the care-level surcharge that applies at your relative’s current stage, what triggers a move to the next level, and how much that move costs. The gap between the advertised base rate and the all-in rate at a middle care level is routinely a third or more.
The hour where the cost flips
Once you have a real monthly quote, the comparison becomes a single division. You are converting a facility’s monthly price into the number of hours of home care that costs the same.
Monthly quote divided by $35, divided by 4.33 = the break-even hours per week.
Using the published medians:
- Against assisted living at $6,200 a month: the break-even is about 41 hours a week of paid care at home.
- Against a semi-private nursing home room at $114,975 a year: about 63 hours a week.
- Against a private nursing home room at $129,575 a year: about 71 hours a week.
- Against a memory care quote of $8,000 a month (an illustrative figure, not a published median): about 53 hours a week.
And the number that ends most of these conversations: around-the-clock paid care at home, at the median rate, is roughly $305,760 a year — about $25,480 a month. There is no arrangement of facility pricing anywhere in the country that this competes with. Families almost never set out to buy 24-hour care; they arrive at it one added shift at a time, which is exactly why the running total deserves to be written down early.
Adjust the rate for your own market before you trust the output. Agency rates in high-cost metros run well above $35, and there are structural costs the hourly rate hides: most agencies impose a minimum shift of about four hours, overnight and live-in arrangements are priced differently from daytime hours, and weekends and holidays usually carry a premium. If you are hiring privately rather than through an agency, the hourly figure falls but you take on the employer obligations — payroll taxes, workers’ compensation, and cover when your caregiver is ill.
What Medicare pays in each setting
Here is the part that surprises people, and it is the same surprise in both directions.
Medicare does not pay for long-term care. Its own coverage page states it flatly: long-term care is “not covered,” and “you pay all costs.” Long-term care means help with the activities of daily living — dressing, bathing, using the bathroom — which is precisely the help dementia creates a need for.
Critically, Medicare draws no distinction between where that care happens. In its own words, you can receive non-medical long-term care “at home, in the community, in an assisted living facility, or in a nursing home.” None of those four is covered. So “we should move her to memory care because Medicare will help” is wrong in exactly the same way, and for exactly the same reason, as “we should keep her home because Medicare will help.” Room and board in a memory care community is private pay. Custodial help at home is private pay.
Medigap does not fill this gap either. It follows Medicare, and Medicare is not paying.
The 28-hour ceiling
Medicare does cover home health, which is a different and much narrower thing. It is worth understanding precisely, because it is the benefit families most often assume will carry them and it almost never does.
To qualify you must be homebound and need part-time or intermittent skilled services — skilled nursing, physical therapy, occupational therapy or speech-language pathology. If you qualify, visits are unlimited and you pay nothing for the covered services. But the volume is capped: in most cases skilled nursing and home health aide services combined run up to 8 hours a day and a maximum of 28 hours a week, stretching to 35 hours a week for a short period if the provider documents that it is necessary.
Three limits inside that benefit matter enormously for dementia:
- The aide is conditional. Medicare pays for a home health aide only if you are simultaneously receiving skilled nursing, physical therapy, speech-language pathology or occupational therapy. A person with dementia who is medically stable often has no qualifying skilled need — and with no skilled need, there is no aide.
- Custodial-only care is excluded outright. Medicare explicitly does not pay for personal care with daily living activities “when this is the only care you need.” For a great many families that is the entire need.
- Needing more disqualifies you. You do not qualify for home health if you need more than part-time or intermittent skilled care. The benefit is designed around recovery and maintenance, not around continuous supervision.
Medicare also does not pay for 24-hour care at home, home-delivered meals, or homemaker services unrelated to the care plan. One genuinely useful detail that is easy to miss: attending adult day care does not break your homebound status, so an adult day programme at $95 a day can sit alongside a Medicare home health episode.
If your relative is on a Medicare Advantage plan rather than Original Medicare, the rules are the same at the floor but the administration differs, and the denial and appeal mechanics become the thing to understand. We cover those separately in does Medicare Advantage cover home health care.
What Medicaid pays, and why the answer is a state answer
Medicaid is the programme that actually funds long-term care in the United States, and unlike Medicare it does pay for custodial help — in a nursing facility, and, through home and community based services waivers, at home.
The catch is that home and community based services are not an entitlement the way nursing facility care is. States run them under waivers with fixed slots, which is why waiting lists exist in much of the country. Financial eligibility is tight and set state by state.
For the specific question of what Medicaid will pay to make a house workable, the variation is larger than almost anyone expects: published ceilings run from $1,000 a year in West Virginia to $40,000 every three years in Alaska, and roughly two in five states publish no figure at all. We keep the primary-source figures in a 50-state table, and there is a state-by-state checker if you want only your own. The underlying rules are covered in does Medicaid pay for home modifications.
Why dementia breaks the home-care math faster than other conditions
The break-even calculation above treats an hour as an hour. Dementia is the condition where that assumption fails, and understanding why will tell you more about your own case than any national average.
For most conditions, paid care hours track tasks: someone comes to help with a shower, prepare meals, manage medication, and leaves. The hours are bounded because the tasks are bounded.
Dementia care is frequently not about tasks at all. It is about someone being present — awake, in the building, watching — whether or not anything needs doing. A person who is exit-seeking needs supervision continuously, not for the forty minutes that bathing takes. That is the mechanism by which families cross the 41-hour line without ever deciding to: they are not buying more help, they are buying more presence.
Nights are where this becomes acute. Overnight supervision is the single most expensive thing to buy at home and the single thing a facility provides at no marginal cost, because the staff are there regardless. If your honest assessment is that someone needs to be awake and available at night, the arithmetic has usually already flipped.
The other cost that never appears in either quote is the unpaid one. When a family member is providing the supervision that is not being purchased, the home option is being subsidised by that person’s health, income and sleep. That subsidy is real, it is finite, and its exhaustion — rather than any calculation — is what ends most home care arrangements.
The variable almost nobody prices: how many hours the house itself costs you
Here is what falls out of the arithmetic above, and it is the reason this page exists on this site rather than somewhere else.
If the break-even sits at roughly 41 hours a week, then anything that reduces the hours of required supervision moves you back below the line. And a meaningful share of those hours are not demanded by the illness. They are demanded by the building.
Some of the hours a caregiver spends are spent on hazards a different house would not have:
- Exit-seeking and wandering. Door and window alarms, secured perimeters, and disguised or delayed-egress door hardware convert a risk that requires a person watching into one that requires a device alerting. This is the highest-leverage change available, because it is the one that most directly attacks the need for continuous presence.
- Bathrooms. Bathing is when falls happen and when a second person is most often needed. Grab bars, a curbless or roll-in shower, a shower seat and a raised toilet can turn a two-person task into a supervised one, or a supervised one into an independent one.
- Stairs. Moving sleeping and bathing to a single floor removes a category of risk entirely. Where the layout will not allow it, a stair lift is the usual route — and it is worth knowing up front what Medicare will and will not do there.
- Night-time navigation. Motion-activated path lighting between bed and bathroom addresses a disproportionate share of night falls, at trivial cost relative to everything else on this page.
None of this is a claim that modification substitutes for care. It does not. What it does is change the number of hours in the week where a person must physically be there — and since those hours are priced at $35 and up, a few of them each day is the difference between the two columns of your comparison.
This is also the part that has funding attached. Medicaid waivers, the VA, and a range of state and local programmes pay for exactly this category of work, which is the subject of the rest of this site. Start with aging in place home modifications for what the work involves, or go straight to who pays for home modifications for the programmes.
When memory care is the right answer
We have an obvious interest in the home option, so it is worth being direct about the cases where it is the wrong one. In our reading of the cost structure, memory care is the better answer when any of the following is true:
- Required supervision exceeds roughly 40 to 60 hours a week, depending on which facility quote you are comparing against. Past that point you are paying a premium for the address.
- Someone needs to be awake at night. Overnight is where home care pricing is least competitive and facility staffing is most efficient.
- The primary family caregiver’s own health is deteriorating. This is a cost, and it is one that gets paid whether or not it appears in a spreadsheet.
- Behaviours require trained staff. Aggression, severe sundowning and resistance to personal care are handled better by people who have been trained for them and who hand over at the end of a shift.
- The house cannot be economically made safe. A multi-storey home with a single upstairs bathroom and no ground-floor plumbing may cost more to adapt than the difference the adaptation buys.
- Isolation is doing damage. Staying home is not automatically the humane option if home means one room and no company.
How to run this on your own two quotes
- Get a written memory care quote with the base rate and the care-level surcharge that applies now, plus what the next level costs.
- Get an hourly rate from two local agencies, and ask about minimum shift length, overnight rates and holiday premiums.
- Estimate required supervision honestly, in hours per week, counting hours where someone must simply be present.
- Divide the facility’s monthly quote by the hourly rate, then by 4.33. That is your break-even in hours per week.
- Compare it to step 3. If your estimate is close to the break-even, look at what modifications would remove from the estimate before you decide.
- Check what your state publishes for home modification funding, since that changes the cost of step 5.
Frequently asked questions
Is memory care more expensive than home care?
It depends entirely on hours. Against the median assisted living price of $6,200 a month, home care at the median $35 an hour is cheaper below about 41 hours a week and more expensive above it. Because memory care is priced above assisted living, its break-even sits somewhat higher — but the structure of the comparison is the same, and the hours estimate is what decides it.
Will Medicare pay for memory care?
No. Medicare does not cover long-term care in any setting, and it says so explicitly — not at home, not in the community, not in assisted living, not in a nursing home. It will cover a limited, skilled home health benefit if the person is homebound and has a qualifying skilled need, capped in most cases at 28 hours a week.
Why do memory care cost figures vary so much between websites?
Because the survey the industry relies on for long-term care pricing does not publish a memory care category. Every national memory care figure you encounter is somebody’s own aggregation or estimate, built on a different sample with different assumptions.
Does Medicaid pay for memory care?
Medicaid pays for nursing facility care for those who meet its clinical and financial rules, and many states cover services within assisted living or memory care settings through waivers — though generally the services rather than the room and board, and usually with a waiting list. What is covered, and whether a slot exists, is a state-by-state answer.
Can home modifications really reduce the cost of care?
They reduce the hours in which a person must be physically present, which is the thing being priced. That is a real effect but a bounded one: modification addresses hazards, not supervision needs created by the illness itself. Where it changes the outcome is for families sitting near the break-even rather than far above it.
Figures on this page come from the CareScout Cost of Care Survey released 2 March 2026 (rates collected July to November 2025) and from Medicare’s own coverage pages for long-term care and home health services. Our sourcing rules are set out in how we source our data. Last verified 2026-08-20.
If you are still deciding between types of in-home help rather than facilities, start with home health care vs. home care.
Related: when the care plan turns toward comfort rather than cure, the payment rules change entirely. See does Medicare cover palliative care.
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