Adult day programs vs in-home aides: the hourly math

Adult day programs quote you a price per day. Home care agencies quote you a price per hour, often with a minimum visit length. Families then try to compare a daily number with an hourly number, in a hurry, and it goes badly.

The fix is to put both on the same weekly sheet. Here is how.

First, what each one is

• An adult day program is a supervised daytime setting outside the home, usually on weekdays: meals, activities, some personal care, and sometimes health services such as medication help or therapy. Your parent goes there; you or a van bring them home.
• An in-home aide comes to your parent's home. Home care agencies employ aides for companionship and personal care. Home health agencies provide skilled care ordered by a doctor, which Medicare may cover in limited cases. This file is about the non-medical aide hours families usually pay for themselves.

They solve slightly different problems. Adult day gives your parent company and structure, and gives a working caregiver a full daytime block. An aide gives one-to-one help in a familiar place, at any hour, including evenings and weekends.

The numbers you need to collect

Call two adult day programs and two home care agencies. Ask each the same questions and write the answers down.

Adult day program:

• Daily rate, and whether a half-day rate exists
• Hours of operation (when can you drop off, when must you pick up?)
• Transportation: offered, and at what cost?
• Extra charges: personal care, bathing, meals, late pickup
• Minimum days per week

Home care agency:

• Hourly rate on weekdays, and on evenings, weekends and holidays
• Minimum hours per visit
• Whether the rate changes for two aides or for heavier care
• Cancellation rules

Fair warning: rates vary a great deal from region to region. If you want a sense of the range before you call, the Bureau of Labor Statistics publishes wage data for home health and personal care aides by state, and private surveys publish median care costs by area. Use them only as a reference; the quotes you collect are what you will pay.

The weekly worksheet

Here is the formula, with blanks for your quotes.

Line	Adult day	In-home aide
Price	daily rate × days per week	hourly rate × hours per visit × visits per week
Minimums	minimum days, if any	minimum hours per visit
Transport	van fee × trips, or your own driving time	none
Extras	personal care, meals, late fees	weekend or holiday premium
Weekly total
Hours of care covered	program hours × days	aide hours
Cost per hour of care	weekly total ÷ hours covered	weekly total ÷ hours covered

The last line is the one that makes them comparable.

A worked example (made-up round numbers)

Let me show how the sheet behaves. These are illustrative numbers only, chosen to make the arithmetic easy, not real rates for any place.

Say your parent needs supervision from 8 a.m. to 4 p.m., five days a week, while you work.

	Adult day	In-home aide
Quote	$100 a day	$30 an hour
Weekly price	$100 × 5 = $500	$30 × 8 hours × 5 = $1,200
Transport	$10 × 10 trips = $100	$0
Weekly total	$600	$1,200
Hours covered	8 × 5 = 40	40
Cost per hour	$15	$30

In this example, adult day covers the same weekday hours for about half the cost. But change the need and the answer flips. If your parent needs only three hours a day of help with bathing and lunch, the aide covers that for $90 a day in this example, less than the day program's $100 plus transport.

That is the general shape: adult day tends to win on long, regular weekday blocks; aides tend to win on short visits, odd hours and care that has to happen at home. Many families end up combining them.

Hiring an aide directly

Some families hire an aide privately instead of through an agency. The hourly rate may be lower, but you take on the employer's jobs: background checks, scheduling backup when the aide is sick, and taxes. If you pay a household employee cash wages above an annual threshold, you may owe Social Security and Medicare taxes and need to file Schedule H. IRS Publication 926, the Household Employer's Tax Guide, lists the current year's threshold and the steps.

Help paying

• Area Agency on Aging. Many adult day programs offer sliding fees or grants. Call the Eldercare Locator at 1-800-677-1116.
• Medicaid. Many states pay for adult day or in-home help through home and community-based services programs for people who qualify.
• VA. Veterans may qualify for adult day health care or home care through VA health benefits.
• Long-term care insurance. Check whether the policy covers adult day and home care, and its elimination period.
• Taxes. If you pay for care so you can work, the Child and Dependent Care Credit can apply to care for a parent who cannot care for themselves and lives with you more than half the year. IRS Publication 503 has the rules.

One more column worth adding

Add a row for how your parent feels about it. A day program a parent refuses to attend costs money and buys nothing. A trial week of each is often worth more than the spreadsheet.