A non-medical home care agency employs caregivers who help older adults and people with disabilities with bathing, dressing, meals, medication reminders, errands, and companionship in their own homes. The typical buyer is an adult child arranging care for a parent. The agency handles hiring, scheduling, payroll, insurance, and backup coverage, and bills the family by the hour.
25,000 to 35,000
US entities
28 to 40 dollars
Typical hourly rate
3 to 4 hours
Common shift minimum
We estimate 25,000 to 35,000 US entities in this category. Directional estimate, not a census figure.
01
How they make money
Almost everything is billed hourly, and the agency lives on the spread between what it charges the family and what it pays the caregiver. Most agencies also enforce a shift minimum, usually three or four hours, because a caregiver cannot build a workable day out of one hour visits. Overnight and live-in care are usually quoted as flat daily rates instead of hourly ones.
Most families pay out of pocket. Long-term care insurance reimburses when a policy exists, VA Aid and Attendance helps qualifying veterans, and some states pay agencies through Medicaid waiver programs for people who qualify financially. Regular Medicare does not pay for this kind of care, which surprises many families. That gap is exactly what separates this category from Medicare-certified home health, which is clinical, short-term, and doctor-ordered.
02
What good ones have in common
Licensed where the state requires it. Most states license non-medical home care and publish inspection or complaint records. A good agency volunteers its license number. If your state licenses agencies and yours cannot produce one, walk away.
Caregivers are W-2 employees. Employee caregivers are covered by the agency's workers compensation and liability insurance. If a contractor is injured in your parent's home, the claim can land on your family.
A supervisor who shows up. Strong agencies send a nurse or care manager to do an in-home assessment before care starts and follow-up visits after, rather than managing entirely by phone.
A real backup bench. Caregivers get sick and quit. Ask what happened the last time a caregiver called out at 6 a.m. A good agency has a same-day answer, not an apology.
A written care plan that gets updated. The plan should list specific tasks and be revisited as needs change, especially after a fall or hospitalization. A stale plan means nobody is paying attention.
03
Red flags
Caregivers paid as 1099 contractors. Some agencies quote lower rates because they carry no payroll taxes, workers comp, or supervision duty. The savings come with liability that quietly transfers to your family.
Nobody answers after hours. Care problems happen at night and on weekends. If the sales line is warm but the after-hours line goes to voicemail, that is the service you are actually buying.
A rotating cast of strangers. Consistency is most of the value in this category, especially with dementia. If a different caregiver arrives every week, the agency is churning staff and your parent is absorbing the cost.
Quotes that dodge the details. Ask directly about shift minimums, weekend and holiday surcharges, and mileage. Agencies that get vague on the phone tend to get creative on the invoice.
04
How the category is changing
The defining force in this category is the caregiver shortage. Demand keeps climbing as the population ages, caregiver wages have risen sharply, and hourly rates to families have followed. Agencies now compete for workers as hard as they compete for clients, and the ones that pay better and schedule humanely deliver noticeably better consistency.
Two structural shifts matter for buyers. Franchise systems and private equity groups keep consolidating what was a local mom-and-pop industry, which brings better software and worse pricing flexibility. And electronic visit verification, now required for Medicaid-funded care in most states, has spilled into private pay: caregivers clock in and out on an app, so families can finally see whether the hours they bought actually happened. Scheduling software has improved, but nothing on the horizon replaces the labor itself.
05
Frequently asked questions
How much does home care cost per hour?
Most agencies bill 28 to 40 dollars per hour depending on the market and the level of care, with weekend and holiday surcharges common. Live-in and overnight care are usually quoted as flat daily rates instead.
Does Medicare pay for home care?
No. Regular Medicare does not cover non-medical personal care. It covers short-term skilled home health when a doctor orders it. Families pay for home care privately, through long-term care insurance, VA benefits, or Medicaid waivers for those who qualify.
What is the difference between home care and home health?
Home care is non-medical help with daily living, paid mostly by families, and can continue indefinitely. Home health is clinical care like nursing and physical therapy, ordered by a doctor and usually paid by Medicare for a limited period.
Why do agencies have minimum hours?
A caregiver cannot earn a living from scattered one hour visits, so most agencies require three or four hours per shift. Some offer short check-in visits at a premium rate, but the minimum is the industry norm.
How fast can care start?
Usually within a few days to a week: an assessment visit, a care plan, then a caregiver match. Agencies can often move faster for hospital discharges, so say so if that is your situation.
How are caregivers screened?
A good agency runs criminal background checks, verifies references and any required state registry status, checks driving records when transportation is involved, and trains before the first shift. Ask to see the screening checklist in writing.
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Home care operators grow the same way most local service firms do: they buy visibility from marketing agencies, and because caregivers are the scarcest input in the business, many also lean on staffing agencies and recruiters to keep shifts covered.