Many families prefer at-home care because it preserves routines, dignity, and independence. However, choosing between personal care, home health, hospital-at-home, and hospice care at home can be confusing, and the costs add up quickly. This guide explains what custodial care at home includes, who benefits, typical costs, practical ways to pay, and how a life settlement with Harbor Life can unlock funds to keep loved ones at home longer.
What Is Custodial At-Home Care?
Custodial at-home care (personal care) is a specific type of home care focused solely on non-medical, non-licensed assistance with activities of daily living (ADLs) such as bathing, dressing, grooming, toileting, eating, and mobility, as well as meal preparation, light housekeeping, medication reminders, and companionship. High-quality providers begin with an in-home assessment, create a personalized plan, thoughtfully match caregivers, and reevaluate regularly.
Who Benefits From Senior Care at Home?
- Older adults who want to age in place with support for ADLs and household tasks.
- People living with chronic conditions, mobility limitations, or dementia.
- Those recovering after hospitalization who do not need facility care.
- Families seeking respite or overnight supervision without moving to adult assisted living or a nursing home.
- Certain assisted living for disabled adults needs that can be met safely at home when well coordinated.
Red flags that care needs are escalating include falls and bruising, medication mistakes, missed appointments and bills, hygiene and dressing challenges, confusion with familiar tasks, weight change, and isolation. Signs an elderly parent may need 24-hour care also include mobility issues, continence problems, and reliance on assistive devices.
Types of Care at Home and When They Fit
1) Personal Care (Custodial)
Non-medical help with ADLs, routines, and household tasks. Programs often include companion support, safe escorting and transport, fall prevention, and optional private skilled tasks such as wound and ostomy care when needed, delivered under a tailored plan with 60 to 90-day reviews.Â
2) Primary and Palliative Care at Home
Home-based clinicians manage conditions, medications, and symptoms while aligning care with the patient’s goals. Teams often include physicians, nurse practitioners, social workers, RNs, and coordinators with geriatrics expertise. UCSF Health notes support for dementia, arthritis, cardiac disease, and safer transitions from hospital to home.
3) Hospital at Home for Acute Needs
For select, stable conditions that require hospital-level treatment at home, programs blend 24/7 virtual care, remote vital monitoring, daily rounding, and in-person clinical visits. Mayo Clinic reports benefits such as lower infection and fall rates, improved outcomes and satisfaction, and fewer readmissions while delivering IV therapy, lab tests, mobile X-rays, and ultrasound, and pharmacy support.
4) Hospice Care at Home
When the focus turns to comfort for a life-limiting illness, hospice emphasizes symptom control, emotional support, and family guidance at home when possible. For eligible patients under Medicare Part A, routine home care is reimbursed at benchmark rates near 218 dollars per day for days 1 to 60 and about 172 dollars per day for days 61 and beyond. Specialized levels, such as continuous home care and general inpatient, are paid at higher daily or hourly amounts. Some non-covered prescriptions may carry a small copay up to $5, respite care may involve about 5 percent coinsurance, and room and board are generally excluded unless the level of care changes. If any gaps remain, Medicaid, private insurance, VA benefits, and provider charity programs can help, consistent with the specifics summarized in this explanation of hospice costs and ways to pay.
At-Home Care vs. Nursing Homes
- At-home care: Best for safety and ADL support without constant clinical oversight. Highly customizable and preserves independence.
- Nursing home: Continuous nursing and specialized equipment for complex medical needs.
Recent national medians show at-home care costs around 5,350 dollars per month and nursing home private rooms around 9,733 dollars per month, with long-term cost trends moving upward, according to the American Health Care Association. More budget-conscious options include homemaker services at about 30 dollars per hour, home health aides at about 33 dollars per hour, and adult day care at about 95 dollars per day, in case you need to pay for senior living with little to no money.
How Much Does Senior Care at Home Cost?
Custodial at-home care is typically billed hourly and scales with need. Live-in support that includes mandated rest can start in the low to mid four figures per month for daytime help, but true 24-hour shift coverage costs more. For families weighing all levels, monthly estimates often span from roughly 4,400 dollars for live-in custodial support up to about 9,500 dollars for nursing homes, with inflation pushing costs higher.
Ways to Pay for Care at Home
Medicare and Medicaid
Medicare covers medically necessary home health and typically covers most hospice services, but it does not fund ongoing custodial care. Medicaid can support long-term services at home through state programs and waivers, with coverage details that vary by state. When Medicaid helps with facility-level care, understand the Medicaid Estate Recovery Program.Â
After death, states may seek reimbursement from the estate. Planning tools include long-term care insurance, using home health when appropriate, timing of asset changes within the five-year lookback, Medicaid Asset Protection Trusts, life estates, and Medicaid-compliant annuities. These are among the strategies for protecting your home from estate recovery. Consult an elder law attorney for state-specific rules.
VA Benefits
Veterans and survivors may qualify for healthcare and income-linked programs. Eligibility and copays depend on VA priority groups, service history, disability rating, income, and other benefits. Countable income for VA benefits generally includes wages, pensions, Social Security, investment income, and life insurance proceeds, while certain payments, such as SSI and specific caregiver or disaster payments, are excluded.Â
You may reduce countable income by deducting unreimbursed medical expenses above 5 percent of the Maximum Annual Pension Rate, which can improve access to home and long-term supports.
Long Term Care Insurance
LTC policies can pay daily or monthly allowances for senior care at home once ADL or cognitive triggers are met. Review elimination periods, covered services, and lifetime caps before you rely on the benefit.
Private Pay with Cost Controls
Blend family caregiving with part-time aides, schedule heavier hours during riskier times such as evenings and bathing, and use remote monitoring to reduce overnight staffing.Â
Life Insurance, Including Life Settlements
Existing life insurance can be a major funding source. Depending on the policy and health status, you might access living benefits, borrow against cash value, surrender the policy, execute a 1035 exchange to long-term care coverage, or sell the policy for a lump sum that is typically higher than surrender value.Â
In many cases, sellers receive up to about 60 percent of the death benefit. Families often use settlement proceeds to pay for care at home and delay or avoid facility moves.
Upgrading Support When Needs Change
If confusion, nighttime wandering, frequent falls, complex medication regimens, or hygiene risks escalate, consider live-in coverage, 24-hour shifts, or a transition to assisted living or a nursing home.Â
Side-by-side comparisons of care types, admission criteria, and costs, plus payment tactics such as Medicaid, VA benefits, LTC insurance, and life settlements, are reflected in the resources linked above, including the practical checklist of when 24-hour care is needed.
Conclusion
At-home care can be safe, effective, and deeply personal when you blend the right services and a smart funding plan. If budget is the barrier, a life settlement can turn an existing life insurance policy into funds for care so your loved one can remain where they thrive most, which is home.
