Elder Care Index

What It Actually Costs

In Tennessee, the average hourly rate for a home health aide is around $30 per hour, with typical rates ranging between $24 and $35 per hour across the state. This cost can vary by region; for instance, Knoxville sees hourly rates of approximately $20-$21 for 44 hours of weekly care, while Morristown has one of the lowest average costs at about $23.96 per hour. In cities like Nashville, the average starting cost is around $22.00 per hour, though some reports indicate an average hourly pay for aides in the city closer to $16.39. This difference between what you pay (around $24/hr) and the median wage for aides in Tennessee ($14.77/hr) reflects agency markup, which covers essential services like caregiver vetting, training, insurance, and administrative overhead. Home care is usually billed hourly, offering flexibility to manage costs by adjusting the number of hours your loved one receives care each week. Part-time care might range from $1,000 to $3,000 per month, while full-time care can approach the monthly costs of assisted living, which are typically between $4,000 and $6,000 per month in Tennessee.

Tennessee's Home Care Program

The state's primary home care assistance program is the TennCare CHOICES in Long-Term Services & Supports Program, often simply called CHOICES. This Medicaid managed care program helps older adults and individuals with physical disabilities receive long-term care at home or in the community, potentially delaying the need for nursing home care. To qualify for CHOICES, your loved one must be a Tennessee resident, generally age 65 or older, or age 21 or older with a physical disability. They must also meet specific medical and financial eligibility criteria. Medically, this means needing a nursing home level of care or being "at risk" of needing it without home care services. Financially, for 2026, monthly income typically cannot exceed $2,982, and countable assets generally cannot be more than $2,000, with the primary home usually excluded. CHOICES covers services like personal care, attendant care, home-delivered meals, personal emergency response systems, adult day care, and respite care, though it does not cover room and board. To apply, if your loved one is already on TennCare, contact their managed care organization; otherwise, reach out to your local Area Agency on Aging and Disability (AAAD) at 1-866-836-6678, or apply online via TennCare Connect at www.tenncareconnect.tn.gov.

Hiring: Agency vs Independent

When considering home health care in Tennessee, you generally have two paths: hiring through an agency or directly hiring an independent caregiver. Agencies offer significant practical benefits, including conducting thorough background checks, providing backup caregivers if your primary aide is unavailable, and handling liability and payroll. In Tennessee, even non-medical home care services, such as homemaking, errands, and companionship, require agencies to be licensed through the Office of Licensure, ensuring they meet safety and quality standards. This structure offers peace of mind through vetted and trained professionals. The trade-off for these benefits is generally a higher hourly cost. Hiring an independent caregiver, on the other hand, can often mean lower costs since you avoid agency overhead, and it allows for a more consistent, one-on-one relationship with the same caregiver. However, you would be responsible for screening, background checks, managing payroll, taxes, and arranging for backup care yourself. For resources to find caregivers or learn more about services, the Area Agencies on Aging and Disability (AAADs) are valuable points of contact, accessible statewide at 1-866-836-6678. The Tennessee Commission on Aging and Disability and the Tennessee Association for Home Care also provide information and lists of licensed agencies.

Last updated: March 2026. Sources: BLS May 2024, Genworth 2024.