Almost every family starts from the same assumption: keeping Mom at home is the cheaper option. It usually is — but only up to a specific number of paid care hours, and that number is far lower than people expect. Against assisted living, the break-even is roughly three to four hours of hired help a day. Cross it, and the facility you were trying to avoid is the cheaper choice, not the expensive one.
The reason families miss this is that they compare the wrong two numbers. They hear "assisted living is $4,591 a month" and "a home aide is $27 an hour" and conclude that a few hours of help a day is a bargain. It can be. But the comparison only works if you count what each option actually replaces — and once you do, the arithmetic turns over surprisingly fast.
This is a private-pay cost analysis. It uses the median figures behind Elder Care Index's state pages, drawn from the Genworth Cost of Care Survey, 2024. It is about money, not about what's right for your family — plenty of people rightly spend more to keep a parent in their own home. But you should at least know where the line sits before you decide to pay past it.
The break-even nobody actually calculates
A home aide is billed by the hour. A facility is billed by the month, flat, no matter how much care the resident needs. So the two costs move differently: home care rises in a straight line with every hour you add, while the facility price stays level. Somewhere those lines cross. That crossing point — the break-even — is the only number that matters, and it's the one nobody runs.
Here is the naive version, using national medians. Assisted living runs $4,591 a month. A home health aide runs $27 an hour. Divide one by the other and you get about 170 hours a month, or 5.7 hours of paid care a day, before assisted living becomes the cheaper option. Against a semi-private nursing-home room at $11,040 a month, the naive break-even is about 13.6 hours a day.
Those numbers are real, but they flatter home care — because they quietly assume the aide's hours are the only thing you're buying at home. They aren't.
Why the honest number is closer to 3–4 hours, not 6
When your parent lives at home, the aide's wage is an add-on to a household they're already paying to run: the mortgage or rent, property taxes, utilities, groceries, upkeep. Assisted living's $4,591 includes all of that — the room, the board, the meals, the heat. So comparing "aide hours only" to "aide hours + room + board" stacks the deck in home care's favor.
To make it fair, subtract from the facility price the baseline cost of living your parent is already covering at home. Call it their monthly housing-plus-food number — very roughly $1,500 to $2,500 for many older adults, though yours may differ. The break-even math becomes:
Break-even hours per month = (Facility monthly price − your parent's baseline home living cost) ÷ hourly aide rate
Run assisted living through it and the break-even collapses:
- Baseline of $1,500/mo → ($4,591 − $1,500) ÷ $27 ≈ 114 hours/mo ≈ 3.8 hours a day
- Baseline of $2,000/mo → ≈ 96 hours/mo ≈ 3.2 hours a day
- Baseline of $2,500/mo → ≈ 77 hours/mo ≈ 2.6 hours a day
So the honest threshold against assisted living isn't six hours — it's three to four, and less if your parent's home is expensive to keep. Put plainly: once you're hiring a home aide for even half a workday, and you're still paying to keep the house running, assisted living has likely already won on cost. This is the same reasoning behind how families actually pay for assisted living — the "cheaper to stay home" instinct is often already false by the time paid care enters the picture.
The nursing-home line is different — and it's about need, not just price
The nursing-home comparison comes with two honest asterisks that a pure cost chart hides.
First, you can't choose a nursing home simply because it pencils out cheaper than fourteen hours of home aide. Nursing homes require clinical eligibility — a documented need for skilled nursing or round-the-clock supervision. A non-medical home aide and a skilled nursing facility aren't interchangeable services you swap on price; the nursing home is only on the table when the level of need is already there. When it is, the cost comparison becomes decision-relevant — see assisted living versus a nursing home for where each level of care fits.
Second, the "24/7 home care" figure people quote is usually a mirage. You cannot actually buy round-the-clock care at $27 × 24 × 30 = $19,440 a month. Agencies don't bill 168 hours a week at a flat hourly rate. Past roughly one shift a day, you move to live-in day rates (which typically assume the aide sleeps part of the night) or two-shift coverage that can trigger overtime under state labor rules. The effective 24/7 number is lower than the naive multiplication — but it is still, in almost every state, well above a nursing-home room. The takeaway isn't the exact dollar figure; it's that once care needs cross from "a few hours" to "all the time," hourly home care stops being the cheap option and stops being billed hourly at all.
Your state can move the break-even by eighteen hours
National medians hide how much this depends on geography. Because a nursing-home room and an aide's wage are priced by local labor and real-estate markets — and they don't move together — the hourly break-even against a semi-private nursing home swings enormously from state to state. The figures below are the unadjusted hourly thresholds (facility median ÷ aide rate), before the room-and-board adjustment above; read them as a map of how differently the math lands, not as a personalized number.
| State | Home aide (/hr) | Nursing home, semi-private (/mo) | Break-even (hrs/day) |
|---|---|---|---|
| Texas | $25 | $5,639 | 7.5 |
| Oklahoma | $23 | $6,641 | 9.6 |
| Louisiana | $22 | $7,707 | 11.7 |
| Georgia | $23 | $9,086 | 13.2 |
| Florida | $26 | $10,652 | 13.7 |
| National median | $27 | $11,040 | 13.6 |
| Oregon | $31 | $16,292 | 17.5 |
| West Virginia | $23 | $12,845 | 18.6 |
| Alaska | $40 | $31,282 | 26.1 |
In Texas, a semi-private nursing-home room costs so little that anything past about seven and a half hours of daily home care already tips the balance toward the facility. In West Virginia and Alaska, nursing homes are so expensive that even full-time home care stays cheaper — Alaska's break-even of 26 hours a day is a mathematical way of saying you literally cannot hire enough hours to beat the facility's price. Same decision, opposite answer, purely because of the state line. Memory care runs higher still, which shifts these thresholds again for dementia-level needs.
What the facility price does — and doesn't — buy
A break-even is a financial threshold, not a promise that the two options deliver the same care. Two honest limits:
- Assisted living's base price is not 5.7 hours of one-on-one attention. That $4,591 median buys housing, meals, and standard custodial support shared across the building — not dedicated hours. If your parent genuinely needs several hours of hands-on help a day, most facilities move them to a higher care tier (an upcharge) or expect a private aide on top of rent. So the fair comparison at high need isn't always "home aide vs. base AL price" — it can be "home aide vs. AL price plus add-ons."
- A nursing home buys skilled care, not just a room. Its higher price reflects licensed nursing coverage a home aide cannot legally provide. When you only need custodial help, you're not choosing between an aide and a nursing home at all — you're choosing between an aide and assisted living.
In other words: match the comparison to the actual level of need. Custodial need → home aide vs. assisted living. Skilled or 24/7 need → the nursing-home line, with the live-in caveat above.
If Medicaid is in the picture, the math bends
Everything so far assumes private pay. Once Medicaid enters, the incentives flip in a way that quietly pushes families toward facilities. Medicaid covers nursing-home care as a federal entitlement — if your parent qualifies clinically and financially, the bed is guaranteed. Medicaid's coverage of home care, by contrast, runs mostly through Home and Community-Based Services waivers, which are capped and, in many states, carry waiting lists that can run months or years.
That asymmetry distorts the break-even for lower-income families: the cheaper-on-paper option (staying home on a waiver) may not be available when the crisis hits, while the "expensive" nursing home is the one Medicaid will pay for today. The cost math and the access math point in opposite directions — and access usually wins.
How to run your own number in two minutes
You don't need our medians. You need three figures for your own situation:
- Your state's numbers. Pull the local home-aide hourly rate and the facility monthly price from your state's Elder Care Index page, or use a recent local quote.
- Your parent's home baseline. Add up what it costs to keep them in their current home each month — housing, utilities, food, upkeep. This is the number assisted living would absorb.
- The formula. (Facility monthly price − home baseline) ÷ hourly aide rate = break-even hours per month. Divide by 30 for a daily figure. If the paid care you're planning is above that, the facility is the cheaper option.
Run it before, not after, you've spent down the savings on a home-care plan that quietly costs more than the facility you were avoiding. The point isn't that everyone should move — it's that "home is cheaper" is a claim with a number attached, and most families never check it.
Frequently asked questions
Is a home health aide really $27 an hour?
$27 is the national median for a home health aide in the 2024 Genworth data; state medians in our table run from about $22 (Louisiana) to $40 (Alaska), and individual agency quotes vary by market, shift, and whether the arrangement is hourly or live-in. Use your local number — the break-even is sensitive to it.
Why does the break-even against assisted living drop when I add my home baseline?
Because assisted living's price already includes housing and meals, while a home aide's hours don't. If you're paying both the aide and the cost of keeping the house, you're double-paying for room and board that the facility bundles in. Subtracting that baseline from the facility price is what makes the comparison honest — and it pulls the break-even down to roughly three to four hours a day.
Can't I just hire 24/7 home care and still save money?
Rarely, once you price it correctly. True round-the-clock coverage isn't billed at a flat hourly rate — it's live-in day rates or multi-shift staffing with possible overtime. In all but the highest-cost-facility states (Alaska, parts of the Northeast and West), that effective cost sits above a nursing-home room. And 24/7 need usually signals a clinical level of care a home aide can't legally provide anyway.
Does this mean I should move my parent to a facility?
No. This is a cost comparison, not a recommendation. Staying home has real value the arithmetic can't price — familiarity, one-to-one attention, dignity. The purpose here is narrow: so you can see the exact hour at which "cheaper to stay home" stops being true, and decide with your eyes open.
Sources
- Genworth Cost of Care Survey, 2024 — median home health aide, assisted living, and nursing-home costs by state (the dataset behind Elder Care Index's state pages and methodology).
- Elder Care Index state cost pages — per-state home-aide and facility medians used in the break-even table.