Assisted Living vs. Home Care: Staying Home or Moving

The National Institute on Aging describes home-based care as health, personal and other support services that help a person stay at home and live as independently as possible. It can include personal care such as bathing, dressing, using the toilet and moving around, household chores, meals, money management, rides and some health care. Much of it is given by family, friends and neighbors.

Assisted living is a place to live. In California, assisted living communities and small board and care homes are licensed as residential care facilities for the elderly (RCFEs). California Advocates for Nursing Home Reform (CANHR) describes them as non-medical facilities that provide a room, meals, housekeeping, supervision, storage and distribution of medication, and personal care help.

Two kinds of help at home are often confused. Home care usually means non-medical help from an aide. Home health means skilled services, such as nursing or physical therapy, ordered by a doctor.

Count the hours in a day when your mother or father cannot safely be alone, not the hours when a task needs doing. Help with a shower and breakfast is two or three hours. Getting up at night, forgetting the stove or walking out the door means someone has to be there nearly all the time.

At home, every one of those hours has to be filled by a paid caregiver or a relative. In an RCFE, they are covered by the home's staff. CANHR notes that state law requires an administrator or a designated substitute to be on the premises 24 hours a day, and at least one staff member trained in CPR and first aid on duty at all times. California does not set a specific staff to resident ratio, so ask each home how many people are on duty at night and whether they are awake.

If you are unsure how much help is needed, the doctor is the place to start. Our guide to the signs it may be time for assisted living lists what families tend to notice first.

The two are priced in different shapes, so compare a full month, not an hour with a month. CareScout's Cost of Care Survey reports a national median of $35 an hour for a non-medical caregiver in 2025. At 44 hours a week, CareScout puts that at $80,080 a year. The same survey reports a national median of $6,200 a month for an assisted living community in 2025, or $74,400 a year.

Those are national medians, not California prices, and CareScout says the cost of any particular provider may differ significantly. They still show the pattern. A few hours a day at home costs much less than a move. By about 40 hours a week the two are close, and care through the night at home costs more again. The home care figure also leaves out rent or a mortgage, food, utilities and upkeep, which an assisted living rate replaces.

The National Institute on Aging puts it this way: home-based services can be expensive, but they may cost less than moving into a residential facility. For California figures, see what assisted living costs in California.

Medicare covers home health services in limited circumstances. As of 2026, Medicare says a person must need part-time or intermittent skilled services and be homebound, and a doctor or other provider must order the care from a Medicare-certified home health agency. In most cases part-time or intermittent means skilled nursing and home health aide services of up to 8 hours a day combined, to a maximum of 28 hours a week.

Medicare lists what it does not pay for: 24-hour care at home, homemaker services unrelated to the care plan, and custodial or personal care such as bathing and dressing when that is the only care a person needs. That last item is what most families mean by home care.

California has its own program tied to Medi-Cal. In-Home Supportive Services (IHSS) gives in-home assistance to eligible aged, blind and disabled people as an alternative to out-of-home care. The Department of Social Services says an applicant must have a Medi-Cal eligibility determination and must live at home, and that a county social worker visits to decide which services and how many hours a month are authorized. A licensed community care facility does not count as the person's own home for IHSS.

If you hire privately, California's Home Care Services Consumer Protection Act has required home care organizations to be licensed since January 2016, and it created a public online registry of home care aides who have been background checked.

No rule fits every family. These are common patterns, not medical advice.

Isolation deserves its own thought. The National Institute on Aging lists staying connected, along with getting around and being safe, among the concerns of people who stay in their own homes. A parent at home with one aide may see very few other people in a week. An RCFE must offer a planned activities program, though a quiet six-bed house and a large community feel very different.

The strain on the family caregiver counts as well. If one person is filling the gaps between paid hours, read our guide to caregiver burnout and respite options before deciding that home is the cheaper choice.

• Home care tends to fit when help is needed for part of the day, the house is safe and manageable, and family or friends are nearby and willing.
• Home care tends to fit when a need is short term, such as recovery after an operation.
• Assisted living or board and care tends to fit when someone must be present day and night, or when a spouse or adult child can no longer fill the hours between visits.
• It tends to fit when memory loss means your parent cannot be left alone, or cannot direct a caregiver or call for help.
• It tends to fit when the cost of the hours needed at home has passed the monthly rate of a home that meets the same needs.

Hamssa Benrekia is a senior living placement specialist in Torrance with a background in home health, hospice and palliative care. She does not arrange home care, though she can share information about home care resources. Her work is helping families in the South Bay and Harbor area of Los Angeles County find licensed assisted living communities and board and care homes when a move is the direction they choose. To talk it through, contact Hamssa. More topics are in the California Assisted Living Placement Guide.