Cost Comparison

Nursing home care is significantly more expensive than home care. The national median cost of a semi-private nursing home room is approximately $8,000–$9,000 per month. A private room averages $9,000–$10,000 per month.

Home care costs vary based on the number of hours needed. For someone needing 40 hours of care per week, private home care costs approximately $4,500–$6,000 per month. For those who qualify, Medicaid covers both options — but the cost difference is why states increasingly prioritize home care.

Medicaid Coverage: Key Differences

Medicaid covers both home care and nursing home care, but the coverage mechanisms differ in an important way. Nursing home care is a mandatory Medicaid benefit — every state must cover it for eligible individuals, and there are no waiting lists.

Home care through HCBS waiver programs is optional and capped — states can limit the number of people served, which is why waiting lists exist in many states. However, standard Medicaid State Plan personal care services (where available) are also mandatory benefits.

• Nursing home: mandatory Medicaid benefit, no waiting list
• HCBS waiver home care: optional, capped, waiting lists common
• State Plan personal care: mandatory where offered, no waiting list
• Both require meeting financial and functional eligibility criteria

Quality of Life

Research consistently shows that most people strongly prefer to remain in their own homes and communities. Home care allows people to maintain their routines, stay connected to family and friends, and preserve a sense of independence and dignity.

Nursing facilities provide 24-hour supervision and access to skilled nursing care, which is essential for some individuals. But the institutional environment can be isolating, and residents have less control over their daily schedules and activities.

When Home Care Is the Right Choice

Home care is typically the right choice when:

• The person's care needs can be safely met with part-time or full-time home care
• The person has a strong preference to remain at home
• Family members or other informal supports are available to supplement paid care
• The home environment can be made safe with modifications if needed
• The person does not require 24-hour skilled nursing supervision

When Nursing Home Care May Be Necessary

Nursing home care may be the more appropriate option when:

• The person requires 24-hour skilled nursing care that cannot be safely provided at home
• Behavioral or safety issues make home care unsafe for the person or caregivers
• The person's medical needs are too complex for home-based management
• No family or informal supports are available and full-time home care is not feasible
• The person prefers the social environment and structured activities of a facility

The "Money Follows the Person" Principle

Many states have adopted "Money Follows the Person" (MFP) programs that help people transition from nursing homes back to home and community-based settings. If a person is currently in a nursing home but would prefer to return home, MFP programs can help fund the transition and set up home care services.