In-Home Care for Dementia: Types, Costs and How to Hire Help

In-home help can let a person with dementia stay at home longer and give family caregivers a break; learn the difference between companion care, personal care and home health, what Medicare does and doesn't cover, and how to hire and work with a caregiver.

By Jim Pavlish, Editor · Last updated: October 24, 2026 · Editorial policy

Most people with dementia live at home, and most of their care comes from family. As needs grow, paid help at home can fill gaps: a few hours a week so you can work or rest, help with bathing, or someone overnight. Knowing the types of in-home care, and what each costs and covers, makes it easier to get the right help before you're exhausted.

Types of in-home care

• Companion or homemaker services. Company, supervision, light housekeeping, meal preparation, errands and reminders. Good for early and middle stages, or when the main need is someone present.
• Personal care (home care aides). Hands-on help with bathing, dressing, toileting, eating and moving around (see Bathing, Dressing and Grooming and Incontinence). This is the most common paid help for dementia.
• Home health care. Skilled, medical services ordered by a doctor, such as nursing, physical therapy, occupational therapy or speech therapy, usually for a limited time after an illness, injury or hospital stay.
• Overnight or live-in care. For people who wander, are up at night or can't be left alone (see Sleep Problems in Dementia and Wandering).
• Hospice at home. Comfort-focused care near the end of life, usually covered by Medicare (see Hospice and End-of-Life Care).

What Medicare covers, and what it doesn't

This surprises many families. Original Medicare covers home health care (part-time skilled nursing and therapy) when a doctor certifies that the person is homebound and needs skilled care under a plan of care. It does not pay for 24-hour care, or for companion or personal care alone when that's the only help needed. Most ongoing dementia care at home falls into that second group.

Other ways families pay:

• Medicaid home- and community-based services (waiver) programs in many states, for people who qualify financially and medically (see Medicare, Medicaid and Dementia Care).
• Long-term care insurance, if the person has a policy. Check the waiting period and what counts as a covered need.
• Veterans benefits such as VA home care and Aid and Attendance (see Resources for Veterans).
• Local Area Agency on Aging programs, which may offer limited free or sliding-scale help. Find yours through the Eldercare Locator at 800-677-1116.
• Programs that pay family members in some states (see Getting Paid as a Family Caregiver).
• Private pay. Agencies usually charge by the hour, often with a minimum visit length. Costs vary widely by state; CareScout's annual Cost of Care survey lists local averages.

Agency or independent caregiver?

Hiring through an agency usually costs more per hour, but the agency handles screening, background checks, training, payroll taxes and insurance, and sends a substitute when the regular aide is sick. Ask whether aides have dementia training.

Hiring someone directly (for example, through a referral) can cost less and give you more choice, but you become the employer. That can mean checking references and background yourself, handling taxes and possibly workers' compensation, and finding backup. The Family Caregiver Alliance's guide walks through these steps.

Questions to ask before hiring

• Is the agency licensed in our state (where licensing applies), bonded and insured?
• What dementia-specific training do caregivers get?
• How are caregivers screened? Are background checks done?
• Will we usually have the same caregiver? What happens if it's not a good fit?
• What are the minimum hours and the cost for nights, weekends and holidays?
• How do you handle emergencies, falls or a missed shift?
• Can we interview the caregiver first?

Helping the first weeks go well

Many people with dementia resist "a stranger in the house." These steps often help:

• Start small, with short visits while you're home, then gradually lengthen them.
• Introduce the caregiver as a friend or helper, if that's easier for the person to accept than "someone who's here to look after you."
• Write a one-page guide to the person: their preferred name, routine, favorite foods and music, topics they love, what upsets them and what calms them. Ask the caregiver to read it before the first visit.
• Keep the same caregiver when possible. Familiar faces matter.
• Be clear about tasks, and keep a shared notebook where you and the aide leave notes.
• Check in regularly and trust your instincts. Unexplained bruises, missing money or a person who seems frightened of a caregiver are reasons to act at once (see Protecting Against Scams).

When home care is no longer enough

In-home care can work for years. It may stop being enough when the person needs two people to move safely, needs supervision around the clock that you can't arrange or afford, or when the caregiver's own health is suffering. Exploring options early is not giving up (see Choosing Memory Care or a Nursing Home and Caregiver Guilt: Why It Happens and How to Ease It).

Where to start

Call your local Area Agency on Aging through the Eldercare Locator (800-677-1116 or eldercare.acl.gov), or the Alzheimer's Association Helpline (800-272-3900), and ask what in-home programs exist near you. If a hospital stay is ending, ask the discharge planner whether Medicare home health is an option.

This article is general information, not legal, financial or medical advice. Coverage rules change; check with Medicare, your state Medicaid office or the insurer for the person's situation.

Sources

1. Alzheimer's Association: In-Home Care
2. Family Caregiver Alliance: Hiring In-Home Help
3. Medicare.gov: Home health services
4. Administration for Community Living: Eldercare Locator
5. CareScout: Cost of Long Term Care by State, Cost of Care Report

Not medical advice. This article is general information, not a diagnosis or treatment plan for any individual. Talk with a doctor about your situation.

Related articles

• Respite Care
• Adult Day Programs for People with Dementia
• Medicare, Medicaid and Dementia Care
• Getting Paid as a Family Caregiver
• Choosing Memory Care or a Nursing Home