Full-Time Home Care Costs More Than a Household Earns in 7 States

Imagine spending your entire annual salary on one thing. Not your mortgage, not your car, not your children’s education — just the cost of having someone help your elderly parent get dressed, prepare meals, and stay safe at home. In South Dakota, that is not a hypothetical. It is the arithmetic.

Private Duty Aides combined two authoritative datasets — the Genworth/CareScout Cost of Care Survey 2024, which captures median home care rates from over 15,000 provider surveys nationwide, and the U.S. Census Bureau’s 2024 American Community Survey — to calculate a single metric: what percentage of a state’s median household income does full-time home care consume?

The result is the Home Care Affordability Index, and the findings are striking.

At the national level, full-time home care consumes 95 cents of every dollar the median American household earns. In the most expensive states, that ratio tips well past 100%. In seven states, a family relying on median income would need to spend more than they earn to cover full-time care for one elderly relative.

The States Where Home Care Has Become Unaffordable

South Dakota tops the unaffordability ranking — not because its wages are low, but because its home care market has outpaced income growth dramatically. The median annual cost of home care in South Dakota reached $100,672 in 2024, according to Genworth/CareScout data. The state’s median household income sits at approximately $67,034, per the Census Bureau. That means home care costs 150% of what the typical household earns.

Vermont ($99,528 care / $78,358 income = 127%) and Maine ($98,384 / $72,000 = 137%) follow closely. These states share a common profile: strong demand for care workers in rural areas, higher wages required to attract qualified staff, and thin supply of licensed home care agencies.

Minnesota ($98,384 / $87,060 = 113%) and Rhode Island ($96,096 / $83,098 = 116%) round out the top five, while Hawaii (110%), Colorado (109%), and Washington (104%) complete the seven states where home care exceeds median income.

Why This Matters: The $1 Trillion Hidden Economy

The gap between what home care costs and what families can actually pay is not absorbed by government programs or insurance. It is absorbed by family members — predominantly women, predominantly in the 45–64 age bracket — who quit jobs, reduce hours, and burn through savings to provide care themselves.

AARP’s 2026 “Valuing the Invaluable” report put a number on that labor for the first time at scale: 59 million family caregivers provided 49.5 billion hours of unpaid care in 2024, valued at $1 trillion — equivalent to the work of 23.8 million full-time employees. The average caregiver provides 27 hours of care per week, often on top of paid employment.

This is the economic reality the Home Care Affordability Index makes visible. When families cannot afford professional care, they become the care system. And when the care system is individual people burning out in private, it doesn’t show up in any state budget — until it collapses.

What Families Can Do

The affordability gap is real, but families are not without options. Several funding mechanisms can dramatically reduce out-of-pocket costs:

Medicaid home care programs exist in every state and can cover personal care services for qualifying low-income individuals. Eligibility and covered services vary significantly by state; contact your state’s Medicaid office or local Area Agency on Aging for specifics.

Veterans’ benefits — specifically the VA Aid and Attendance benefit — can pay up to $2,727 per month toward home care for qualifying veterans and surviving spouses. This benefit is dramatically underutilized: many eligible families are unaware it exists.

Consumer-directed care programmes (also called self-directed Medicaid) allow family members to be paid as caregivers in many states. If you are already providing care for an elderly relative, you may qualify to receive compensation for work you are already doing.

Long-term care insurance, where policies exist, often covers in-home care — but benefits are typically capped. Review the policy carefully to understand what triggers payment and for how long.

Even partial outside help — a professional caregiver for a few hours per day — can prevent the burnout that leads families to crisis decisions. A home care assessment from a reputable agency is typically free and can map available funding sources to your specific situation.

The Bottom Line

Home care has quietly become one of the most significant financial burdens facing American families — and unlike housing, education, or healthcare, it rarely enters the policy conversation until a family is already in crisis. The Home Care Affordability Index is designed to change that: to put numbers on a problem that has long been carried in private.

These findings will be updated annually as new Genworth/CareScout and Census Bureau data is released. Journalists, researchers, and policymakers are welcome to use and cite this data with attribution to Private Duty Aides.