In-Home Dementia Care: Types, Hours, Costs and Who Pays

In-home dementia care is help that comes to the house so a person living with dementia can keep living there. The Alzheimer's Association describes in-home care as a wide range of services provided in the home rather than in a hospital or care community, and says it can allow a person with dementia to stay in their own home while also helping caregivers.

Not all of it is the same. The National Institute on Aging (NIA) separates home care services, which send an aide to help with personal care and company, from home health care, which is part-time medical care ordered by a doctor. The Alzheimer's Association adds that needs change at different stages of the disease and that each family's situation is unique.

Companion and homemaker services. The Alzheimer's Association lists companion services as help with supervision, recreational activities or visiting, and homemaker services as help with housekeeping, shopping or meal preparation. A home care agency or a privately hired worker provides them. Our guide to dementia companion care covers what a companion does day to day.

Personal care. This is hands-on help with bathing, dressing, toileting and eating. NIA says home care aides help with daily activities such as bathing and dressing, may help with light housekeeping and errands, and do not provide skilled medical care. CareScout groups this work with homemaker services under one heading, the non-medical caregiver.

Home health care. This is medical care at home, such as wound care, injections and therapy, given by a nurse or therapist. The Alzheimer's Association says a home health agency often coordinates it once a doctor has ordered it, and NIA says it is typically part-time and for a specific condition, such as recovery from surgery or an illness.

Hospice. Hospice focuses on comfort at the end of life. The Alzheimer's Association says the team includes doctors, nurses, home health aides, social workers, counselors, clergy and volunteers, and that most hospice care is provided at home or in a nursing facility.

Adult day programs. A center is not care at home, but it often works alongside it. The Alzheimer's Association says some centers are open seven to 10 hours a day and often provide transportation and meals. Our guide to adult day care for dementia explains how to choose one.

Early stage. The Alzheimer's Association says most people in the early stage function independently and may still drive, volunteer and even work, and that this stage can last for years. The hardest tasks may be managing a daily schedule or a household budget. It is also the time to make legal, financial and long-term care plans together.

Middle stage. This stage is typically the longest and can last for many years. The person may have trouble dressing or refuse to bathe, and routines need more structure. The Alzheimer's Association says that early in the middle stage it becomes too difficult or dangerous for the person to be left alone. Regular weekly hours of companion and personal care can cover the times the family cannot be there.

Late stage. The late stage may last from several weeks to several years, and the Alzheimer's Association says intensive care is usually needed at all hours, including help with eating and toileting. Hospice may become an option at the end of life. Our guide on when to hire a dementia caregiver covers the signs that it is time to bring in help.

There is no standard number. NIA says home care aides may come for a few hours or stay for a full day and overnight, and that home care services generally charge by the hour, with some charging a flat rate overnight. CareScout uses 44 hours a week as its standard example for a paid caregiver at home.

Start by listing when the person is alone and when the day tends to go wrong. Families who need someone present at night, or at every hour, can read our guides to overnight care for dementia at home and 24-hour dementia care at home.

Medicare home health is much shorter. Medicare.gov says part-time or intermittent care usually means skilled nursing and home health aide services combined of up to 8 hours a day and a maximum of 28 hours a week.

The CareScout Cost of Care Survey put the 2025 national median for a non-medical caregiver in the home at $35 an hour, up 3 percent from 2024. That covers homemaker and home health aide services, which CareScout now reports together. At that rate, 20 hours a week comes to $700 a week, and CareScout's 44-hour week comes to $80,080 a year.

CareScout reported a 2025 national median of $90 an hour for a private duty nurse, and $95 a day, or $24,700 a year for five days a week, for adult day health care. It stresses that any one provider's price may differ significantly from the median. Our guide to in-home dementia care costs in 2026 compares rates in more detail.

Medicare.gov says home health is covered when the person needs part-time or intermittent skilled services and is homebound, a doctor or other provider sees them in person and orders the care, and an agency that Medicare approves provides it. Covered home health costs nothing. Aide care is covered only alongside skilled nursing or therapy.

Medicare does not pay for ongoing daily help. Medicare.gov lists 24-hour-a-day care at home, homemaker services unrelated to the care plan, and personal care such as bathing and dressing when that is the only care needed among the things home health does not cover, and says Medicare does not pay for long-term care.

Hospice is covered under Medicare Part A when a hospice doctor and the regular doctor, if there is one, state that the person is terminally ill with a life expectancy of 6 months or less. Room and board is not covered. Our guide to whether Medicare covers dementia care explains the rules.

The Medicare GUIDE model, which CMS began on July 1, 2024, offers dementia care coordination through participating programs and pays them up to $2,500 a year per eligible patient for respite, including in-home care. Our guide to the Medicare GUIDE model explains who qualifies.

Medicaid. Medicaid.gov says states can offer home and community based services (HCBS) through waivers, including homemaker, home health aide, personal care, adult day health and respite care, and that states choose the maximum number of people a waiver serves. The Alzheimer's Association says eligibility and benefits vary from state to state.

Veterans. The VA Homemaker and Home Health Aide program sends an aide to enrolled veterans who need personal care, are isolated, or whose caregiver is under strain, if they meet the clinical criteria; a copay may apply. VA Veteran-Directed Care gives a budget to hire workers, which might include a family member or neighbor. VA Aid and Attendance adds a monthly payment to a VA pension for a veteran or survivor who needs help with daily activities.

Insurance and private pay. NIA says long-term care insurance can cover help with daily activities at home, and the Alzheimer's Association warns that a person cannot apply once diagnosed with Alzheimer's. NIA says many families pay from savings, a pension or the sale of a home. The Alzheimer's Association notes that some states let people with limited resources pay a person of their choosing, including family members, through programs often called cash and counseling.

With an agency, the agency finds and schedules the caregiver. With a private hire, the family does the screening, the scheduling and the planning for days the worker cannot come. The Alzheimer's Association suggests asking any provider whether they are with an agency, whether they are bonded, and whether they can provide back-up if sick.

If you hire directly, you may become an employer. The IRS says that if you pay one household employee $3,000 or more in cash wages in 2026, you generally must withhold and pay Social Security and Medicare taxes.

Rules differ by state. Check whether your state licenses non-medical home care agencies and, if it does, confirm the agency's status with the state. NIA suggests asking for references, checking for complaints, and contacting the community, county or state agencies that regulate health services, or the Better Business Bureau.

Medicare's Care Compare tool rates home health agencies only. CMS says home health agencies in Medicare may receive quality of patient care and patient survey star ratings, updated quarterly. Non-medical agencies that do not bill Medicare are not rated there.

Ask whether the provider has experience with dementia and can manage your specific health and behavioral care needs, as the Alzheimer's Association suggests, and get fees, terms and restrictions in writing before you sign, as NIA advises. Our six-step checklist for finding dementia home care walks through the search.

NIA suggests going through the house room by room, fixing immediate dangers such as loose stair railings and poor lighting first. It recommends smoke and gas detectors, since a person with Alzheimer's may not smell smoke or an unlit gas stove, locking away dangerous items, and listing emergency numbers and the home address near every phone. It also advises reviewing safety again as abilities change. Our room-by-room dementia home safety guide has a full checklist.

NIA says caring for a person with Alzheimer's often exceeds what one person can provide. The Alzheimer's Association says late-stage care needs may exceed what you can provide at home, even with additional assistance, which may mean moving the person into a facility. Signs to discuss with the family and the doctor include needs the family cannot staff or afford, a caregiver whose own health is failing, and safety risks that remain after changes to the home. Our guide to in-home care versus a memory care facility compares the two.

Write down what the person needs and when. The Alzheimer's Association suggests doing this before you call anyone, then screening providers by phone, interviewing at home with a third person present, and checking references. Ask the person's doctor for recommendations, and use the Eldercare Locator at 1-800-677-1116 to find your Area Agency on Aging.

Share who the person is. The Alzheimer's Association says people with dementia keep strong memories from earlier in life, and that telling the care provider about them allows a much greater bond to form. For planned breaks for the family caregiver, see our guide to respite care for dementia.

If you would like help finding a caregiver, Dementia In Home sends 3 video profiles of caregivers with dementia experience within 48 hours, free. This is non-medical help at home. Call (689) 333-6079.