Honest numbers from inside a Houston home-care agency. The hourly and daily rates we charge, the four line-items most families miss in agency quotes, how long-term care insurance and VA benefits offset the bill in practice, and three sample weekly budgets you can stress-test against your own situation.
Our hourly rate sits in the upper end of the Houston range because we are a W-2-only, RN-supervised agency with annual background checks and a 5% caregiver-hire rate. Lower-priced agencies typically achieve their rate by using 1099 contractors, fewer-vetted caregivers, or no clinical oversight. The bands below reflect the Inner-Loop / Galleria / Memorial / River Oaks service area in 2026.
Rates as of April 2026 and refreshed quarterly. Insurance coverage, specialty pricing (advanced dementia, 24-hour rotating coverage, etc.), and discount programs are discussed during the free Care Manager consultation.
Families often see our hourly rate and wonder why it's higher than a private hire on Care.com. The difference shows up in everything that surrounds the caregiver, and in what happens when the caregiver is sick, when the family travels, or when something goes wrong at 2 a.m. The hourly rate covers all of the following:
Three real-world Houston scenarios with the math worked out. Your situation will land somewhere on or between these, the free Care Manager call gives you a number specific to your circumstance.
Typical use: a parent who still drives but needs meals, errands, and company twice a week. LTC insurance often covers all of it once the ADL trigger is met.
Typical use: discharge from Houston Methodist after a hip or knee replacement. Most LTC policies cover the full hourly rate once the ADL trigger is met (it usually is, post-op).
Typical use: late-stage dementia or end-of-life when staying home matters more than the bill. Memory-care facilities in Houston cost less per month, but the math changes when you factor in private companion hours at the facility and the loss of the family home.
We bill the carrier directly via Assignment of Benefits. No upfront cost. We handle benefit verification, the elimination-period paperwork, and the daily activity logs the carrier requires. Most families never write a check.
Veterans and surviving spouses may qualify for up to ~$2,727/month (2026), applied directly to home care. We help with the application, most denials are paperwork errors, not eligibility.
Most common. Weekly or biweekly ACH or credit card. No deposits, no contracts. Many families use a mix, LTCI as the primary funder, private pay supplementing extra hours.
A limited home care benefit through STAR+PLUS waivers for income- and asset-qualifying families. We accept Medicaid for select cases, call us to discuss whether your situation qualifies.
Most families plan home care one quarter at a time and get surprised when need extends. Below are three multi-year projections at today’s rates plus a 4% annual cost-of-care inflation factor (the 25-year average for non-medical home care in Texas). They are not predictions, they are stress tests. Run yours against the household balance sheet and the family conversation gets very different.
A common pattern for a parent in early-stage cognitive decline: two-hour daily visits for med reminders, a meal, and a shower escort. LTCI typically covers most of it once the trigger is met; private-pay families should plan on roughly $200k over five years.
The arc of progressive dementia. Care needs roughly double each year as supervision becomes the primary intervention. Families who plan only for year-one rates are often blindsided at year three.
Where families weigh dollars against legacy. Many will pay the premium for a year or two; few can pay it for five. This is where bridge planning (home-care to facility transition) becomes a real conversation.
Texas Medicaid is widely misunderstood. It does pay for in-home long-term services and supports, but through specific managed-care programs with income, asset, and clinical-need tests. The relevant programs for most home-care-seeking families in the Houston area are STAR+PLUS (waiver) and the Community-Based Alternatives program for adults under 65 with physical disabilities.
$2,829/month gross income for a single applicant for the STAR+PLUS waiver. Income above this limit can be redirected to a Qualified Income Trust (Miller Trust) and the applicant can still qualify, Texas is an income-cap state, not an income-spend state.
$2,000 in countable assets for a single applicant. $148,620 community spouse resource allowance (CSRA) for a married couple where one spouse remains at home in 2026 (federal max). The home itself, one vehicle, prepaid funeral, and household contents are excluded from the count.
Requires 'medical necessity' determined by a state nurse assessment. Generally, the applicant must need help with at least 3 of 6 ADLs or have a cognitive impairment requiring substantial supervision. Sound familiar? Same trigger as LTC insurance.
Up to ~84 hours/week of personal attendant services in the home for qualifying clients, plus adult day services, respite, home modifications (grab bars, ramps), emergency response systems, and case management. Not 24-hour care; Medicaid is not a 24-hour funding source in Texas.
STAR+PLUS uses a managed-care model with five contracted MCOs in the Harris service area: Amerigroup, Cigna-HealthSpring, Molina, Superior, and UnitedHealthcare. Each contracts with a panel of approved home-care agencies.
Income- and asset-qualifying applicants typically wait 4–12 weeks for an assessment plus another 2–4 weeks for service initiation. Applicants who need to spend down assets first should plan for 4–6 months total from decision to first shift.
Texas Medicaid reviews five years of bank, brokerage, and gift records when an application is filed. Asset transfers within that window, including reasonable-looking ones like helping a grandchild with college tuition, can trigger a penalty period of disqualification. A common scenario: a family transfers $100,000 to a child “to simplify estate planning,” then applies for Medicaid eighteen months later, and is penalized roughly 10 months of disqualification (based on Texas’s 2026 divisor of ~$8,400/month).
Legitimate spend-down strategies do exist and a Texas-credentialed elder-law attorney can structure them: paying off the home mortgage, pre-paying funeral costs, purchasing exempt assets (one vehicle, home modifications), funding a Miller Trust, and the spousal-protection rules. None of this is something to attempt without specialised counsel, the consequences of an error are losing both the gift and the Medicaid eligibility.
If Medicaid is realistically on the table within 5 years, talk to an elder-law attorney before any large transfer. We can refer to several Houston-area Texas Chapter NAELA members who do this work. There is no fee for the referral.
Most family meetings about care cost fall apart because the people in the room are working from different facts. Before the meeting, gather these seven numbers, written down, printed out, and the conversation gets more honest in minutes. We give every Care Manager assessment family a printable version of this worksheet.
Social Security + any pension + RMD or systematic withdrawal from retirement accounts + any continuing W-2 income. Net of taxes. The number the household lives on monthly today.
Checking, savings, brokerage, money market, CDs, and the cash value of any whole-life policies. Anything that can be converted to cash within 30 days without penalty.
IRA, 401(k), 403(b), TSP balances. Note: distributions are taxable and Required Minimum Distribution rules apply at 73+. Treat as available but not liquid.
Daily benefit, benefit period (years or pool of money), elimination period (the wait), and inflation rider type. If you don’t have a copy of the policy, request one from the carrier today, we’ll read it for free.
Estimated value minus any mortgage. Important: home equity is generally not liquid (unless sold or borrowed against) and is excluded from Medicaid asset counts up to ~$713,000 in Texas in 2026.
Veteran status, war-time service dates, and whether spouse is surviving. Determines Aid & Attendance eligibility. The benefit can run ~$2,795–$4,418/month depending on marital status.
The hardest line in the worksheet, who contributes what monthly, in writing, before the bills arrive. Equal shares, income-weighted shares, time-and-money shares, or one sibling covers in exchange for inheritance adjustment. Whatever you choose, document it.
Print this section. Fill in the right column. Bring it to the family meeting. The conversation that follows is the most important one most families have about a parent in the last decade of life.
Hourly home care in Houston runs $30–$40 per hour. 24-hour and live-in care are quoted per day ($450–$850). There is a four-hour visit minimum, no long-term contract, and a free in-home care consultation by a Care Manager. Long-term care insurance, VA Aid & Attendance, and other funding sources often reduce or eliminate out-of-pocket cost.
Two reasons. First, fewer than four hours of care is rarely enough to do anything meaningful for the client, by the time the caregiver arrives, gets oriented, completes a bath or meal, and updates the file, the visit is half over. Second, four hours respects the caregiver's W-2 employment and travel time. Agencies that advertise no minimums almost always rely on 1099 contractors, which creates other problems for families.
Yes, and we bill the carrier directly. We are a recognised Assignment of Benefits provider for MetLife, John Hancock, Genworth, Transamerica, Mutual of Omaha, and others. We handle benefit verification, daily activity logs, and claims paperwork. Most policies cover home care once the activities-of-daily-living trigger has been met (typically: needing help with two of six ADLs, or having a cognitive impairment requiring substantial supervision).
Veterans and surviving spouses may qualify for VA Aid & Attendance up to ~$2,727/month (2026 rate), which can be applied directly to home care. We help families navigate the application process and structure the care plan to maximise the benefit. See our VA benefits page for the full qualification rules.
Medicare pays for short-term skilled home health (RN visits, physical therapy) for 30–60 days after a hospitalisation. It does not pay for ongoing non-medical home care. The two often run in parallel, a Medicare home-health nurse visits twice a week, while our caregiver covers the other 168 hours.
No. Our hourly rate is the rate. No assessment fee. No setup fee. No re-engagement fee if you pause and restart. No mileage. No replacement fee if a caregiver isn't the right fit. The only thing that changes the rate is clinical complexity, which is discussed transparently up front.
Private-pay clients are billed weekly or bi-weekly via ACH, credit card, or check. Long-term-care-insured clients have the carrier billed directly via Assignment of Benefits, most never write a check. We send a daily activity log alongside every invoice so you know exactly what was provided.
A private caregiver at $20–$25/hr looks cheaper on paper. But the family is the legal employer, responsible for payroll tax, workers' compensation, liability if the caregiver is injured, and finding backup coverage when the caregiver is sick or on vacation. Our rate includes W-2 employment, benefits, training, supervision, insurance, and same-day replacement when needed. The all-in cost of a private hire is usually within a few dollars of our rate, with significantly more risk to the family.
There is none. No multi-month minimum, no setup fee, no early-cancellation penalty. You can adjust hours or stop care with 24 hours' notice. We earn the next week of care every week.
A Care Manager (usually one of our RNs) comes to the home for 60–90 minutes. They review the medication list and recent medical events, walk the routines and home for safety risks, talk to the client and family, and write a draft care plan. You receive an itemized written quote within 24 hours. No cost, no obligation, no follow-up sales pressure.
Every rate on this page, plus long-term care insurance coverage tables and current VA Aid & Attendance benefit amounts, in one PDF you can share with the family. We’ll email it over.
We bill the carrier directly via Assignment of Benefits.
VeteransUp to ~$2,727/month toward home care (2026).
Free toolSend your policy; we tell you what's actually covered.
The GuideForty chapters on Houston home care from the inside.
A 15-minute Care Manager call gives you an honest range. No pressure. No commitment.