Side-by-Side Comparison: Home Care vs. Nursing Homes in PA

Understanding the difference between staying at home with assistance and moving to a facility helps you make the right choice for your loved one. Both options provide daily support, but they differ heavily in setting, medical capabilities, and cost.

Home care services cover a wide range of non-medical support. This includes personal care, such as assistance with bathing, dressing, toileting, and transfer activities. It also covers companionship services, which provide socialization and help with instrumental activities of daily living like meal preparation and laundry. A nursing home provides these same daily supports but adds a layer of clinical care. Nursing facilities have medical staff on-site to handle complex health conditions that require constant monitoring.

The table below compares non-medical home care with nursing home care using Pennsylvania statewide medians from the CareScout 2025 Cost of Care Survey.

In a home setting, your loved one receives one-on-one attention from a single caregiver. They decide when to eat, sleep, and watch television. In a nursing facility, residents share the time and attention of the staff. The facility dictates the schedule for meals, activities, and clinical rounds. Reviewing these differences is the first step when exploring senior care options for an aging parent.

Cost Math: Is Home Care Cheaper Than a Nursing Home in PA?

Families often assume that staying at home is always the cheaper option. This is true for many situations, but the math changes as care needs increase. The CareScout 2025 Cost of Care Survey provides statewide median costs for Pennsylvania. These figures help you estimate your budget, though actual rates vary by agency and location.

Using the Pennsylvania median of $34 per hour for an in-home caregiver, here is how different schedules compare to a nursing home’s semi-private room rate of $393 per day (which equals $143,445 per year) or a private room at $450 per day ($164,250 per year):

• Part-time care (20 hours a week): If your parent needs a caregiver for four hours a day, five days a week, you will pay for 20 hours. At $34 per hour, this costs $680 per week. Over a year, this totals roughly $35,360. This is significantly cheaper than a nursing home, which averages $2,751 per week.
• Full-time care (44 hours a week): A standard full-time schedule gives your loved one coverage during the workday. This totals $6,483 per month, or $77,792 per year. This remains about half the annual cost of a semi-private nursing home room.
• 24/7 hourly care: If you pay an agency by the hour for constant, awake coverage, the costs multiply quickly. 24 hours of care at $34 equals $816 per day. Over a 7-day week, this reaches $5,712. Over a year, 24/7 hourly in-home care costs nearly $300,000. This arithmetic shows that 24/7 hourly in-home care exceeds the daily rate of a nursing home.

Your actual expenses will depend on the exact hours scheduled. Read more about home care costs and how agencies price 24/7 home care costs to plan your budget.

Need help setting up non-medical care at home? Call New Century Home Care at 215-974-0000 or fill out our online form and choose “I am a client” then “I need services.” Our office staff speaks English, Russian, and Ukrainian.

When a Nursing Home May Be the Safer Choice

A nursing home is usually necessary when a person requires 24-hour skilled nursing oversight. Home care agencies provide non-skilled services. By Pennsylvania law, non-medical aides assist with activities of daily living, instrumental activities, and companionship.

Home care aides cannot perform skilled nursing tasks. They do not do wound care, injections, IVs, medication administration or nursing assessments.

If your loved one has complex medical needs that require a licensed nurse around the clock, a nursing facility provides the appropriate clinical environment. Some advanced chronic conditions need clinical care that an aide cannot provide. Three in four American adults have at least one chronic condition, and managing severe cases of heart disease or diabetes sometimes requires clinical monitoring.

Safety also plays a role in this decision. More than one out of four older people falls each year. If a person has advanced Parkinson’s disease, they may experience postural instability and freezing, which raise their fall risk. When a person cannot safely be left alone for even a few minutes and requires medical oversight to manage their symptoms, a facility might offer the most secure setting.

Medicaid: The Same Eligibility Test Applies to Both

If your family cannot afford private pay rates, Pennsylvania Medicaid can help. The Community HealthChoices (CHC) program is the state’s managed care system for adults 21 and older who need long-term services and supports. CHC covers nursing facility care for those who are eligible. The CHC waiver covers personal assistance services at home.

Participants in the Southeast zone, which includes Philadelphia, choose from three CHC plans: AmeriHealth Caritas CHC (known locally as Keystone First CHC), Pennsylvania Health & Wellness, and UPMC Community HealthChoices.

To qualify for either home care or a nursing home through Medicaid, the applicant must pass the exact same functional eligibility test. They must be found Nursing Facility Clinically Eligible (NFCE). The local Area Agency on Aging conducts a Functional Eligibility Determination (FED) assessment to decide this. In Philadelphia, the PCA assessor visits the applicant to complete the FED.

The FED looks at the last three days of the applicant’s routine. To be found NFCE, a person must meet specific criteria. Under Group 1, they must have at least one qualifying condition, such as needing hands-on help with three or more activities of daily living (bathing, dressing, toileting, walking, eating, personal hygiene), being bed bound, or being frequently incontinent of bowel.

Alternatively, under Group 2, they need at least three items from its list. For example, they might require hands-on help with two ADLs, exhibit mild to severe cognitive impairment, and use a wheelchair.

Because the clinical test is identical, a person approved for a nursing home level of care can choose waiver services in their own home instead, provided they meet the financial limits. Learn more about the income and asset limits in our guide to Medicaid eligibility rules.

Including a Paid Family Caregiver in the Plan

When you choose home care through the CHC waiver, you have options for who provides the daily assistance. You can use a licensed agency like New Century Home Care, or the participant can direct their own care through the Services My Way program.

In both models a family member can be the paid caregiver. With an agency, the agency hires them; with Services My Way, the participant is the employer and Tempus Unlimited handles payroll and taxes.

However, Pennsylvania enforces strict rules on who can take this role. The CHC waiver will not pay for services furnished by the participant’s spouse, legal guardian, representative payee, or Power of Attorney (POA). Services My Way also excludes the participant’s designated representative from being paid. Pandemic-era exceptions for these roles ended in May 2023, and the Office of Long-Term Living does not plan to make exceptions.

If you are an adult child or relative who does not hold POA, you may be eligible to become a paid family caregiver.

To start home care services in Philadelphia or the surrounding counties, contact us. Call 215-974-0000 or select “I am a client” and “I need services” on our contact form.