Home Care May Not Be Cheaper than Assisted Living or a Nursing Home

When it comes to long-term care, which type of care is cheaper? A common misperception is that receiving care at home is less expensive than receiving care at an assisted living facility or a nursing home. According to Andrea Cohen, CEO of Houseworks, a private home care agency in Boston, Massachusetts, which type of care is the cheapest depends on the amount of care needed. Cohen, who spoke at a recent Margolis & Associates First Thursday breakfast, explained that home care starts out being the most cost effective, but if continuous care is needed, a nursing home ends up being the least expensive option.

The following chart breaks down the differences in expenses, depending on whether the senior requires just a few hours of assistance a day, many hours a day, or around-the-clock attention. (Figures are based on average costs of care in the Boston area.)

Costs of Care (Annual)

Home Assisted Living Skilled Nursing Facility
Intermittent Care (16 hrs/wk) $18,500 plus household expense $60,500 $114,000
Daily Care (40 hrs/wk) $46,000 plus household expenses $88,000 $114,000
Continuous Care (24hrs x 7days/wk) $192,000 plus household expenses $234,500 $114,000
Source: Houseworks

One reason that assisted living can become more expensive than home care or nursing home care is that most assisted living facilities do not provide personal care as part of the basic fee. Instead, most facilities require residents to purchase such care from the facility or an outside provider at an extra charge.

Home care may be even more expensive if the cost of maintaining one's home is factored in. Of course, money is only one consideration in choosing where to receive care. Many, if not most, seniors would prefer to stay home if at all possible. Other factors include the ability to access quality care, proximity to family members, the regimentation at an institution, and even the quality of food provided.