Why is in-home care expensive?

The cost of in-home care has become a growing concern for families across the country. While home care offers comfort, dignity, and personalized support, its price tag often comes as a shock leaving many to wonder: Why is it so expensive? The reality is that several interconnected factors are driving up the cost.

1. Increasing Demand for Services The demand for in-home care is growing steadily driven by the aging population and the increase in chronic diseases and mobility issues. According to Lauren Bowers, chief of the Census Bureau’s Population Estimates Branch, the aging population is outpacing younger generations in many areas particularly in rural communities. With more people needing home care services, the demand naturally pushes up the price.

2. Shortage and High Turn Over of Home Health Workers

According to a report by PHI, the direct care workforce is projected to add over 860,000 new jobs between 2022 and 2032, making it the fastest-growing job sector in the United States. But growth alone doesn't tell the full story.

Over the same decade, an estimated 8.9 million direct care positions will need to be filled. This includes not only new roles, but also a massive number of vacancies created by workers leaving the field, switching careers, or retiring altogether. With such high turnover, maintaining a stable workforce has become increasingly difficult.

The Home Care Association of America, citing the 2024 Activated Insights Benchmarking Report, revealed that the turnover rate for home care workers reached 79.2% in 2023. Even more alarming: nearly 4 out of 5 caregivers leave within their first 100 days on the job. This ongoing instability creates a near-constant staffing crisis. As the demand for caregivers continues to outpace supply, wages are pushed higher costs that ultimately get passed on to the families who rely on home care services.

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3. Other Factors Level of Care Required The type and intensity of care required also play a significant role in determining the cost of home care services. Basic personal care, such as assistance with bathing and meal preparation, tends to cost less than skilled nursing or specialized medical services. Around-the-clock care or 24/7 assistance can be substantially more expensive than part-time care.

Geographic differences and cost of living

Prices vary widely by state and urban vs. rural areas. Urban and high cost-of-living states such as California, New York, and Massachusetts tend to have much higher in-home care costs

You can check the estimated cost of in-home in your stat using Genworth and CareScout's tool. carescout.com/cost-of-care

The Impact of High Home Care Costs As home care costs continue to climb, many families are finding themselves at a difficult crossroads. For some, the rising prices mean having to reduce the number of hours of professional care their loved ones receive. For others, it means turning to unpaid family members often with little to no training, to fill the gap.

This shift places a significant emotional and physical toll on family caregivers, many of whom are juggling full-time jobs, raising children, or managing their own health issues. The responsibility of providing consistent, high-quality care can lead to chronic stress, burnout, and strained relationships. Over time, the emotional weight of caregiving, especially without adequate support, can become overwhelming. Financially, the burden is just as heavy. Many families are forced to pay for care out-of-pocket. This can quickly deplete savings, increase credit card debt, or force difficult decisions about other essential expenses like housing, education, or retirement planning. In some cases, a family member may even leave the workforce entirely to provide full-time care, resulting in lost income and long-term financial consequences. Without more affordable care options or broader policy changes, many middle-class families will continue to face unsustainable choices between financial security and the well-being of their loved ones. Won't Medicare of Medicaid help? As we’ve explained in our previous blog, Medicare is not designed to cover long-term custodial care. This includes essential daily support like help with bathing, dressing, medication reminders and companionship. Because these services are classified as custodial rather than medical they fall outside Medicare’s coverage.

Medicaid does cover custodial care, but eligibility is limited to individuals who meet strict income and asset thresholds.

This leaves millions of Americans in the middle—earning too much to qualify for Medicaid, yet not enough to afford private in-home care. We call this group the forgotten middle. Our Commitment at Elder Love USA At Elder Love USA, we see the toll the cost of care takes on families every day. Our founder started this organization after witnessing it herself motivated by a belief that no one should be denied compassionate care simply because they can’t afford it.

Our mission is clear: To provide affordable, loving in-home care for the forgotten middle.

Through a combination of grants, donations, and community partnerships, we’re working to make high-quality, non-medical care accessible—without forcing families to go broke in the process.

To learn more about our story and how you can get involved, please visit our mission page.

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This article is brought to you by Elder Love USA, a leading nonprofit provider of home care services in Riverside County, CA, San Diego County, CA, San Bernardino County, CA, Orange County, CA, Imperial County, CA, and Phoenix, AZ.

Our mission is to provide compassionate and affordable in-home care for older adults in need.