Personal Finance & Estate › Medicare, Medi-Cal & long-term care › Long-term care (custodial care Medicare won't pay)
Home care vs. assisted living vs. nursing home: costs
· Concept or strategy
Standard practiceWhat most planners, CPAs and attorneys recommend.
What long-term care costs depends on where it happens: at home, in assisted living, or in a nursing home.
See it on the Personal Finance & Estate map →How it works
National medians from the 2024 CareScout (Genworth) survey: a home health aide runs about $34 an hour, so 44 hours a week is roughly $6,500 a month; assisted living about $5,900 a month; a private nursing-home room about $10,600 a month, near $128,000 a year. California costs run higher, especially in coastal metros. Medicare covers none of this long term. Medi-Cal covers nursing homes and some home care (IHSS) but little assisted living.
Why it matters for you
The setting drives the bill more than anything else; home care is preferred and cheaper only until round-the-clock help is needed.
Rules, limits and sources (2026)
CareScout's (formerly Genworth's) annual Cost of Care Survey. California licenses assisted living through Community Care Licensing and nursing homes through the Department of Public Health; check inspection records before choosing.
Watch out for
Costs have risen faster than general inflation amid caregiver shortages; how far they climb by the 2030s is uncertain.
Connections (2)
▸Home care vs. assisted living vs. nursing home: costs are the price tags of Long-term care (custodial care Medicare won't pay)Standard practice
How they connect
Long-term care happens in three main places, each with its own price: hourly home care, monthly assisted living, and daily-rate nursing homes. Needs usually escalate, so many people move through all three.
When it applies
Measured nationally each year by the CareScout (formerly Genworth) Cost of Care Survey, which began in 2004.
How sure?
Annual surveys of thousands of providers; costs vary widely by region, and California's coastal metros are among the highest.
Watch out for
Whether home care stays cheaper as needs grow, and how staffing shortages push prices, varies case by case.
▸In-Home Supportive Services (IHSS) subsidizes the home option in Home care vs. assisted living vs. nursing home: costsLaw or rule (2026)
How they connect
Private home care in California often costs $35 or more an hour, roughly $6,500–7,500 a month at 44 hours a week (estimates vary). For Medi-Cal members, IHSS pays for an approved number of those hours, making staying home far cheaper than assisted living, which Medi-Cal covers only through limited waiver slots.
When it applies
IHSS runs in all 58 California counties; family members are common caregivers, and pay rates are set county by county.
The rule
CareScout (formerly Genworth) Cost of Care surveys for private rates; CDSS data on IHSS hours and county wage rates.
Watch out for
Whether paid family caregiving saves Medi-Cal money by delaying nursing-home moves is plausible but hard to measure precisely.