In-home care services: what they include, who provides them and how to choose

What in-home care services are

In-home care services are help delivered in the home of the person who needs it, so they can keep living there rather than move to a care facility. They fall into two groups that families often confuse:

• Non-medical home care (also called home care, custodial care or personal care). California law defines home care services as non-medical services and assistance for a client who, because of advanced age or physical or mental disability, cannot perform those activities, so that the client can remain in their residence. This is help with bathing, dressing, eating, toileting, getting around, meals, housework, errands and company (CDSS).
• Home health care. Skilled services ordered by a doctor or other health care provider and delivered by a Medicare-certified home health agency: part-time or intermittent skilled nursing such as wound care, injections or monitoring of an unstable condition, plus physical, occupational and speech therapy (medicare.gov).

The distinction decides who may do the work and who pays: Medicare does not pay for non-medical care when it is the only care needed.

Types of in-home care services for seniors

Providers use different labels, but the services fall into a small number of types. The non-medical tasks below are the ones the California Department of Social Services lists for registered Home Care Aides.

CDSS is explicit about where non-medical care stops. Home Care Organizations may not arrange, and registered Home Care Aides may not provide, medical services such as insulin shots, catheter care, bedsore treatment, glucose readings, tube feedings, colostomy care, monitoring blood pressure or vital signs, post-surgery wound care or medication administration. If your relative needs those, you need a licensed health professional or a home health agency alongside the home care.

Non-medical in-home care services versus home health care: what Medicare covers

Medicare covers home health, not home care. To qualify, your relative must need part-time or intermittent skilled services and be homebound, meaning leaving home is not recommended or takes considerable effort and help. A doctor or other provider must see them in person, confirm the need and order the care, and a Medicare-certified home health agency must provide it. Covered services cost nothing. Aide visits are included only while skilled nursing or therapy is also being given, and in most cases nursing and aide time combined is limited to 8 hours a day and 28 hours a week (medicare.gov).

In Medicare’s own words, it doesn’t pay for:

• 24-hour-a-day care at your home;
• home meal delivery;
• homemaker services (like shopping and cleaning) unrelated to your care plan;
• custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need.

Medicare’s long-term care page goes further: since most long-term care is non-medical, Medicare and most health insurance, including Medigap, don’t pay for it, at home or anywhere else. It points to Medicaid (in California, Medi-Cal) and private long-term care insurance instead; the VA also helps eligible veterans.

Who provides home care services for the elderly in California

Licensed Home Care Organizations and registered Home Care Aides

Since 1 January 2016 the Home Care Services Consumer Protection Act has required every Home Care Organization (the legal term for a non-medical home care agency) to hold a license from CDSS before providing services, and every aide it employs to be listed on the state Home Care Aide Registry before working with a client. A registered aide employed by an organization (an "affiliated" aide) must meet minimum training requirements, be clear of active tuberculosis and have a background check cleared through CDSS. Registration costs $35 and the background check is done by Live Scan fingerprinting. From 1 January 2027 the annual training for affiliated aides must also cover the special care needs of clients with dementia (CDSS PIN 26-02-HCS). CDSS investigates complaints about licensed organizations and can fine them or revoke a license; it states that it has no authority to investigate complaints against individual aides.

Independent Home Care Aides

An independent aide is not employed by an organization but has chosen to be listed on the registry and works under a direct agreement with a client. Independents must have a CDSS-cleared background check. Registration is voluntary for caregivers you hire directly, so a private caregiver who is not on the registry is not breaking the law; being on it simply tells you a state background check was cleared.

Home health agencies

Home health agencies provide the skilled, prescribed care described above. They are not Home Care Organizations under the Act, and Medicare pays for their services only through a Medicare-certified agency on a provider’s order.

IHSS (In-Home Supportive Services)

For people with Medi-Cal, IHSS pays for in-home help for eligible aged, blind and disabled Californians as an alternative to out-of-home care. You apply to your county IHSS office on form SOC 295; a county social worker visits to assess needs and authorises a number of hours a month; the recipient then hires their own provider. See how to become an IHSS provider and getting paid to care for a family member in California.

Private caregivers you hire directly

You can also hire an individual caregiver yourself, through personal recommendation or a marketplace such as CaregiverConnect. You then become the employer, with the duties set out below and in the guide to hiring a private caregiver.

Agency or private home care services: an honest comparison

The CDSS fact sheet on licensed and unlicensed care sets out the trade-off: a licensed organization screens its aides, employs them, covers sick days with a replacement and carries the employer’s obligations; with a private hire, those jobs and risks are yours.

CaregiverConnect is on the private side of this table. It is a marketplace, not an agency: families post what they need, caregivers apply, and you hire directly. It charges no commission on the caregiver’s pay, it does not employ caregivers and it does not run background checks; caregivers may upload proof of a check for review. Posting is free and optional premium plans exist (see pricing).

Private home care services: what you do yourself

1. Interview two or three caregivers, with your relative present for part of it.
2. Check references by phone, ideally former clients’ families.
3. Search the Home Care Aide Registry if the caregiver says they are registered: ask for their name as registered and their PER ID, then look them up on the CDSS registry search.
4. Decide on a background check. It is optional for a direct hire but sensible; arrange it with the caregiver’s written consent. A caregiver on the registry has already cleared a state check.
5. Put duties, hours and pay in writing, including tasks that are excluded, such as the medical tasks listed above.
6. Set up payroll. Once you pay $750 or more in cash wages in a calendar quarter you must register with the EDD within 15 days and withhold State Disability Insurance; at $1,000 in a quarter you also pay Unemployment Insurance and Employment Training Tax. Federally, cash wages of $3,000 or more to one household employee in 2026 mean Social Security and Medicare tax, 7.65% from the employee and 7.65% from you, reported on Schedule H (IRS Topic 756).
7. Pay overtime correctly. A caregiver whose work is mainly feeding, dressing and supervising your relative is a personal attendant under the Domestic Worker Bill of Rights and is owed 1.5 times the regular rate for hours over 9 in a day or 45 in a week. The overtime rule does not apply to certain family members of the employer, or where the employer is an IHSS recipient (DIR).

How to choose in-home care services: questions to ask

Start by writing down what your relative needs on a typical day and night, then ask each provider or caregiver:

• To an agency: "What is your Home Care Organization license number?" Then check it on the CDSS facility search. CDSS suggests exactly this question.
• To any aide who says they are registered: "May I have your PER ID and the name as it appears on your registration?" Then search the registry.
• Which of the tasks on our list will you do, and which will you not do? Does anything on the list need a nurse?
• What experience do you have with dementia, transfers or incontinence? Can you give a reference from a family with similar needs?
• Who covers a shift if the regular caregiver is ill, and how much notice will we get?
• How are hours recorded and how will you report on each visit?
• What is the hourly rate, is it different for nights or weekends, and what is the minimum shift?
• For an agency: is the aide your employee, and who carries workers’ compensation? For a private hire: are you comfortable being paid through payroll with taxes withheld?
• What notice is needed to change the schedule or end the arrangement?

Then arrange two or three paid trial shifts before committing.

What in-home care services cost

The price depends far more on who employs the caregiver and how many hours you need than on the type of service. The CareScout Cost of Care Survey 2025, fielded July to November 2025, puts the California median for a non-medical caregiver at $40 an hour against $35 nationally, and $7,627 a month for a 44-hour week. A private caregiver’s rate is set by the caregiver and agreed with you. For hourly reference points, 24-hour and live-in monthly totals with the arithmetic shown, and what Medi-Cal and the VA pay, see how much in-home care costs in California.

Help for families and veterans

• Eldercare Locator. The Administration for Community Living’s public service connects older adults and families with local services, including Area Agencies on Aging. Call or text 1-800-677-1116.
• Veterans. VA Homemaker and Home Health Aide care sends a trained aide, supervised by a registered nurse and employed by an organization under contract with the VA, to help with daily activities; it can also give a family caregiver respite. Enrolled veterans who meet the clinical criteria are eligible where it is available, sometimes with a copay. Start with the VA social worker.
• Complaints about a licensed agency go to CDSS; the Home Care Services Branch is on (877) 424-5778.

In-home care services near you

To compare private caregivers in your area, start with the county pages, which list caregivers who have built a profile in that area. You can also post your needs free and let caregivers apply:

• San Diego County
• Imperial County
• Riverside County
• Orange County
• Kern County
• Tulare County
• Merced County
• All California areas

To post a care need, create a family account; how it works explains the steps, and the safety center covers screening advice and our verification policy.

Frequently asked questions

Sources

1. CDSS, Home Care Services Branch (Home Care Services Consumer Protection Act overview)
2. CDSS, Fact Sheet: The Home Care Services Consumer Protection Act (April 2022)
3. CDSS, Fact Sheet: Home Care Services (November 2023; services aides may and may not provide)
4. CDSS, Fact Sheet: Licensed Versus Unlicensed Home Care Services (April 2022)
5. CDSS, Home Care Aide Application Process ($35 registration, Live Scan)
6. CDSS, PIN 26-02-HCS, 2025 chaptered legislation affecting Home Care Organizations (March 27, 2026)
7. CDSS, Home Care Aide Registry search
8. Medicare.gov, Home health services
9. Medicare.gov, Long-term care
10. CDSS, In-Home Supportive Services (IHSS) program
11. California DIR, Domestic Worker Bill of Rights FAQ
12. EDD, Household employers (registration and tax thresholds)
13. IRS Topic 756, Employment taxes for household employees
14. CareScout, Cost of Care Survey 2025, Median Cost Data Tables (PDF; fielded July to November 2025)
15. Administration for Community Living, Eldercare Locator
16. VA, Homemaker and Home Health Aide Care