In-home care for dementia

Most people living with dementia want to stay in their own home for as long as they can. Paid help that comes to the house can make that possible. It can also give a family caregiver time to sleep, work, or simply rest.

But "in-home care" means different things to different people. Some of it is medical and some is not. Some is paid by Medicare and most is not. This page sorts out the words, the choices, and the costs so you can plan.

Home care and home health are not the same

These two terms sound alike, but they cover very different services. Knowing which one you need helps you ask the right questions and find the right payer.

The Alzheimer's Association groups in-home help into four types: companion care, personal care, homemaker help, and skilled care from a licensed health professional.¹ The National Institute on Aging notes that most home care is help with daily activities and watching over a person's safety. Health services such as wound care and therapy are a smaller part.²

For a person with dementia, the biggest need over time is usually supervision and hands-on help. That is home care, not home health.

What Medicare pays for at home

Medicare's home health benefit is real, but it is narrow. To qualify, all of these must be true:^3,4

• You need part-time or occasional skilled care, such as nursing or therapy.
• You are homebound. This means leaving home takes a big effort or someone's help, or a doctor advises against it.
• A doctor or allowed provider sees you in person and orders the care.
• A Medicare-certified home health agency provides the care.

Being homebound does not mean you can never go out. You can still leave for medical visits and short, rare trips, like church or a family event. Going to adult day care does not end your eligibility either.⁴

If you qualify, covered home health services cost you nothing. You pay 20% of the approved amount for medical equipment, after the Part B deductible.³ There is no set end date. Medicare pays in 30-day periods, and your care plan is reviewed at least every 60 days.⁴

Skilled nursing and aide visits together are usually limited to 8 hours a day and 28 hours a week. For a short time, a provider may approve up to 35 hours a week.³

What Medicare does not pay for

Medicare does not cover:^3,6

• Care around the clock at home
• Meal delivery
• Housekeeping and shopping that are not part of the care plan
• Personal care, like bathing and dressing, when that is the only help you need
• Long-term custodial care (ongoing help with daily living), at home or in a facility

Medigap (Medicare supplement) policies do not cover long-term care either.⁶ This surprises many families. A person with dementia who needs daily help but no skilled care will usually pay for home care out of pocket, unless another program steps in.

If the agency plans to give you a service Medicare will not pay for, it must tell you first. It should give you a written notice called an Advance Beneficiary Notice (ABN), which shows what you may owe.⁵

Learn more on What Medicare covers in dementia.

What in-home care costs

Prices depend a lot on where you live and how many hours you need. The CareScout 2025 Cost of Care Survey, done in the second half of 2025, found these national medians:⁷

To picture it, 20 hours a week of help at $35 an hour comes to about $700 a week. That is roughly $3,000 a month. Many agencies also set a minimum visit length, so ask.

Costs rise fast as dementia progresses and more hours are needed. For many families, a mix of home care, adult day care and family help costs less than full-time care at home. See What dementia care costs for more on comparing options.

Hiring through an agency or on your own

You have two main ways to get a paid home caregiver. Each has trade-offs.

Agencies. When an agency sends a worker and controls how the work is done, that worker is not your employee.⁸ The agency handles payroll and taxes. In Virginia, an organization that provides personal care or home health services in people's homes must have a license from the Virginia Department of Health.⁹ Ask to see it.

Private hires. A single person you hire yourself does not need a Virginia home care license.¹⁰ That means no state agency has checked them. You will need to do the checking.

If you hire someone directly, you may owe employer taxes. For 2026, you must handle Social Security and Medicare taxes once you pay a household worker $3,000 or more in cash wages in the year. Federal unemployment tax applies if you pay $1,000 or more in any calendar quarter.⁸ A tax professional can help you set this up. Virginia may have its own employer rules too.

Questions to ask any caregiver or agency

The Alzheimer's Association suggests asking about training and experience before you hire.¹ Use these questions with agencies and private hires alike:

1. Have you had training in dementia care? How long have you cared for people with memory loss?
2. Are you trained in first aid and CPR?
3. Has a criminal background check been done? Are you bonded (insured against theft)?
4. Can you give me references I can call?
5. Can you work the days and hours we need? Who covers if you are sick?
6. Can you handle the care my family member needs, such as toileting, lifting, or confusion late in the day?
7. For agencies: Are you licensed in Virginia? How do you supervise workers? What happens if we are unhappy with a worker?

Ask for a short trial period. Watch how the caregiver speaks to your loved one. Patience, a calm voice and respect matter as much as skills. Our page on talking with someone who has dementia can help you explain what works.

Help paying for in-home care

Most families pay with their own savings at first. NIA lists other sources such as long-term care insurance, reverse mortgages, some life insurance policies, and government programs.² Here are the main programs to check.

Virginia Medicaid (CCC Plus Waiver)

Virginia's CCC Plus Waiver pays for home and community care for people who would otherwise need nursing home level care. It serves all ages and has no waiting list. One option, called consumer-directed services, lets the member hire their own attendant.¹¹ The person must also qualify for Medicaid. As of October 2026, Virginia has proposed changes to how this waiver is managed, starting in 2027.¹¹ See Medicaid and long-term care.

VA benefits for veterans

The VA Homemaker and Home Health Aide program sends a trained aide to help with bathing, dressing, eating and other daily tasks. A nurse supervises the aide. A copay may apply, based on disability status. Ask a VA social worker to get started.¹² See VA benefits for dementia.

Medicare GUIDE dementia program

GUIDE is a Medicare model that began in July 2024. Medicare pays participating care teams up to $2,500 a year per eligible patient for respite. That can include in-home care, adult day programs or a short facility stay.¹³ Ask your doctor whether a GUIDE program serves your area. See Respite care.

Long-term care insurance

If your family member has a policy, read it now. Policies differ in what they pay for and what starts a claim, so ask the insurer whether home care is covered. See Long-term care insurance.

Local help through the Area Agency on Aging

Your local Area Agency on Aging can tell you about low-cost help, meal programs and caregiver support near you. Call the Eldercare Locator at 1-800-677-1116 to find yours.² Some states also let older adults use program funds to pay a person they choose, sometimes including family.¹

Another choice is PACE. It combines medical care, home care and day center services for people who qualify.

Keeping care safe at home

Paid help works best when everyone knows the plan. Write down your loved one's routine, likes, dislikes and calming tips. Keep a list of medicines and doctors by the phone. Tools like the care circle and behavior diary can help share this.

Check in often, sometimes without warning. Lock up valuables, checkbooks and credit cards. Review bank statements each month.

When home care is no longer enough

Home care may not be enough when your loved one needs help around the clock, wanders at night, or needs two people to move safely. It also may not be enough when the family caregiver is worn out or getting sick.

Needing more care is not a failure. It is a change in the illness. Learn about memory care, assisted living and nursing homes, and how to choose a care place.

If you feel overwhelmed, you are not alone. The Alzheimer's Association 24/7 Helpline is free at 1-800-272-3900, day or night.¹⁴ If you are in crisis or thinking about harming yourself, call or text 988. Read more about caregiver stress and burnout.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.