Most families do not choose a level of care once. They choose it in stages, usually starting with a phone call after a fall, a missed medication, or a visit that felt different than the last one. Knowing what each option actually is, and what it actually costs, before that call happens makes the decision far less overwhelming when it does.
What each option actually is
In-home care brings support into the home a person already lives in: help with bathing, dressing, meals, medication reminders, transportation, and companionship, from a few hours a week up to live-in care. It preserves independence and familiar surroundings, and it scales up or down as needs change.
Assisted living is a residential facility for people who need daily help but not full-time medical supervision. According to the National Institute on Aging, assisted living residents typically get their own apartment or room, up to three meals a day, help with personal care and medications, housekeeping, 24-hour on-site staff, and organized social activities.
Nursing homes (skilled nursing facilities) provide the highest level of non-hospital care: 24-hour nursing supervision, three meals a day, help with all daily activities, and access to physical, occupational, or speech rehabilitation. The NIA is direct about the distinction: nursing home services "focus more on medical care than most assisted living facilities."
What each option costs
United States (2025 CareScout/Genworth Cost of Care Survey, national medians):
| Care type | Typical cost |
|---|---|
| In-home non-medical caregiver | $35/hr (about $80,080/yr at 44 hrs/week) |
| In-home skilled nursing (private duty) | $90/hr, or $160/visit |
| Adult day health care | $95/day (about $24,700/yr at 5 days/week) |
| Assisted living | $6,200/month ($74,400/yr) |
| Nursing home, semi-private room | $315/day ($114,975/yr) |
| Nursing home, private room | $355/day ($129,575/yr) |
Canada: costs are set provincially rather than nationally, so there is no single equivalent survey. As a reference point, families in Ontario needing more home-care support than the public system provides (often just 2 to 4 hours of publicly funded PSW support a day) commonly pay $5,000 to $10,000 a month out of pocket for additional private care, or $15,000 to $21,000 a month for full 24/7 private care. The National Institute on Ageing at Toronto Metropolitan University projects Canada's total long-term care spending will triple, from about $22 billion today to roughly $71 billion by 2050. Check your own province's health ministry for current public coverage and private rate schedules.
What Medicare and Medicaid actually cover (US)
This is where families get caught off guard. Medicare Part A covers a skilled nursing facility stay only after a qualifying 3-day inpatient hospital stay, and only for a limited window: days 1 through 20 are fully covered, days 21 through 100 require a daily coinsurance ($217/day in 2026), and day 101 onward is not covered at all. Medicare does not pay for long-term custodial nursing home care, and it never covers assisted living room and board.
Medicaid is the actual long-term-care safety net for nursing facility care, but it is asset- and income-tested, and coverage for home and community-based services or assisted living varies significantly by state. If cost is a central concern, a conversation with your state's Medicaid office about its specific home and community-based waivers is worth having early, not after a crisis.
Canada: the Canada Health Act leaves each province to decide what home care it funds as a supplemental benefit, but long-term care and retirement (assisted living) homes are not uniformly covered nationally. Families who do not qualify for provincial subsidy generally pay privately or through insurance.
How to actually decide
The American Association of Retired Persons frames this well: act a little earlier in the cycle rather than waiting for a crisis to force the decision. Weigh these factors together, not any single one in isolation:
- Safety and fall risk. Can this person get around the home, the stairs, and the bathroom safely on their own?
- Medical complexity. Do they need daily skilled nursing (wound care, IV therapy, close monitoring of a chronic condition), or mainly help with daily tasks?
- Cognitive status. Is there confusion about time, place, or people that raises safety concerns when alone?
- Social connection. Is isolation itself becoming a health risk, separate from any physical need?
- Caregiver capacity. Family caregivers in the US provided an estimated 18.4 billion unpaid hours of care in 2023, averaging about 31 hours a week each. Burnout is a real and common reason families move faster toward paid support than they originally planned.
- Cost and what insurance or public coverage actually reaches.
In practice, most families start with in-home care because it is the least disruptive way to add support while someone is still safe and reasonably independent at home, and it can be adjusted in hours or scope as needs grow, without an immediate move. Assisted living tends to make sense when daily supervision needs outpace what part-time in-home help can reasonably cover, or when isolation has become the bigger risk. Nursing homes become necessary when medical needs require 24-hour skilled nursing that neither home care nor assisted living staffing can safely provide.
If in-home support looks like the right next step, CareProximity connects families with vetted local specialists across move management, home accessibility, mobile wellness, transportation, and companion care, matched to your actual location rather than a generic national directory.