In-Home Care in Texas

Approximately 12.6% of Texans are aged 65 and older, and the state’s Department of Health and Human Services takes its job of regulating in-home care providers seriously, which offers peace of mind to seniors who want to age in place. The HHS is also the government agency that oversees a wide range of state and local programs aimed at enhancing the quality of life for independent Texans. Seniors in the Lone Star state can expect to pay $3,956 per month for in-home care, which is less than the national average.

This guide offers additional insight into in-home care costs in Texas, financial assistance options to help pay for that care and free and low-cost resources for seniors who wish to remain living at home.

The Cost of In-Home Care in Texas

In-Home Care Costs in Nearby States

Genworth’s 2019 Cost of Care Survey shows that in-home care in Texas costs an average of $3,956 per month, which is $334 below the $4,290 national and New Mexico averages. It’s also about $240 less than the average cost in Oklahoma. However, seniors in Arkansas and Louisiana pay even less for in-home care services, with average costs of $3,623 and $3,218, respectively.

$3956

Texas

$4290

United States average

$4290

New Mexico

$4195

Oklahoma

$3623

Arkansas

$3218

Louisiana

Cost of Other Types of Care in Texas

The cost of senior care in Texas differs depending on the setting and type of care required. In-home care averages $3,956 per month and falls in between the rates for residential assisted living and home health care services, which average $3,750 and $4,004, respectively. Adult day health care services are the least costly option at an average of only $704 per month, whereas care in a nursing home costs the most at $4,867.

$3956

In-home care

$4004

Home health care

$704

Adult day care

$3750

Assisted living facility

$4867

Nursing home care

The Cost of In-Home Care in Texas’ Top Cities

Comparing Costs Across Texas

The cost of in-home care varies considerably between Texas’ most populous cities. At $4,576 per month, the highest price is paid in the state capital of Austin, while home care services average just $2,837 in the western city of El Paso. In the state’s biggest city, Houston, seniors pay an average of $4,099 per month, while the average rate in San Antonio is $4,185. Costs in the Dallas area are just $10 more per month at $4,195. It’s notable that in all but one of these major Texas cities, in-home care costs are well above the statewide median of $3,956.

$4099

Houston

$4185

San Antonio

$4195

Dallas

$4576

Austin

$2837

El Paso

Financial Assistance for In-Home Care in Texas

Community First Choice

Community First Choice is an entitlement program of Texas Medicaid, so participation is not capped, and there is no waiting list to receive services. The program is designed to provide supportive services to seniors at home to prevent premature nursing facility admission. Services available through the CFC may include assistance performing activities of daily living, meal preparation, housekeeping, health maintenance and help managing personal finances and medications.

Who Is Eligible?
To be eligible for services through the CFC program, applicants must meet the qualification guidelines for Texas Medicaid and be assessed as at risk of nursing home admission if assistance is not provided.

How to Apply
Interested seniors who are not already enrolled should apply for Medicaid coverage. To learn more about the CFC, they may contact the Area Agency on Aging serving their community.

STAR+PLUS Waiver

STAR+PLUS is a Medicaid waiver that lets elderly or disabled Texans receive essential care at home or in another community setting. The waiver covers medical and nonmedical long-term care services such as assistance with activities of daily living, assistive technologies and home modifications. Most waiver services are provided by managed care organizations in each county, and participants may choose their preferred provider. Some services are categorized as consumer directed, which allows a senior to choose their own caregiver, who may be a friend or family member.

Who Is Eligible?
Texas residents aged 65 and over may qualify for assistance through the STAR+Plus waiver if they meet the financial criteria for Medicaid coverage and require a nursing home level of care.

How to Apply
Seniors may contact their local Area Agency on Aging to learn more about the STAR+Plus program and how to apply. Those not already enrolled should apply for Medicaid benefits first.

Community Attendant Services Program

CAS is a Medicaid-funded program designed to provide disabled adults and seniors with the services of a care attendant in their own home. The program covers up to 50 hours per week of basic assistance with ADLs such as mobility, bathing and dressing, household management and accompaniment to medical appointments. Participants may have services delivered through a state-approved care agency or choose their own caregiver.

Who Is Eligible
Applicants must have a medically demonstrated need for daily assistance and meet the income and asset criteria to qualify for Texas Medicaid coverage.

How to Apply
Applications for the CAS program are handled by HHS offices throughout the state. Interested seniors may contact their local office to learn more or apply.

Community Care for the Aged and Disabled

Community Care for the Aged and Disabled is a non-Medicaid suite of programs that help elderly and disabled Texans avoid nursing home placement and continue living at home. Eligible seniors receive case management services and benefits through specific CCAD programs such as consumer-managed personal attendant services, day activity and health services, home-delivered meals and personal emergency response services.

Who Is Eligible?
Adult residents of Texas who require assistance due to a disability or functional impairment may be eligible for assistance through a particular CCAD program if they meet the applicable financial guidelines.

How to Apply
Seniors who wish to apply for CCAD services should contact their nearest Aging and Disability Resource Center.

Program of All-Inclusive Care for the Elderly

The goal of the Program of All-Inclusive Care for the Elderly is to help seniors stay living independently and avoid nursing home admission. The program provides eligible Texas seniors with a comprehensive plan that covers medical care, day services at a PACE center and a range of in-home support services. Those who qualify for Medicare and/or Medicaid coverage may pay no out-of-pocket costs for provided services.

Who Is Eligible?
To be eligible for PACE services, individuals must be at least 55 years of age, live within the defined service area of a PACE provider and meet the program’s income and asset limits. Applicants also must be assessed as requiring a nursing facility level of care but deemed able to live safely at home.

How to Apply
Interested individuals may contact their local Texas HHS office to learn if a PACE program is available in their area and begin the application process.

More Ways to Pay for In-Home Care

While the above programs help many people finance in-home care, they will not cover all costs for everyone. There are other ways to pay for in-home care, including out-of-pocket arrangements with siblings, annuities, reverse mortgages, private insurance and more. Read Caring.com’s Guide to In-Home Care Costs to learn more about these alternative payment options.

Free and Low-Cost In-Home Care Resources in Texas

There are a variety of free and low-cost resources that Texas seniors can take advantage of to help them remain independent in their own homes. These include home-delivered meals, respite care, transportation and aging-related home modifications. Depending on the resource, seniors may need to meet financial and/or functional criteria to qualify for assistance.

	Contact	Services Provided
Home Delivered Meals	Call 800-252-9240 to connect with your local AAA	Eligible Texas seniors may receive nutritious meals delivered to their home at no cost through programs organized by the 28 Area Agencies on Aging throughout the state.
Take Time Texas	Contact your local ADRC by calling 855-937-2372	Take Time Texas offers resources for those caring for aging family members, as well as short-term in- and out-of-home respite services.
Medical Transportation Program	Call the number for your area:855-687-4786 Houston855-687-3255 DFW877-633-8747 all other areas	The Medical Transportation program provides free rides to nonemergency health care-related appointments for eligible individuals who have no other means of transportation.
Legal Assistance	Call 800-252-9240 to get in touch with your local AAA	Access to free or low-cost legal assistance is coordinated by local Area Agencies on Aging throughout the state. Assistance may be provided concerning issues such as consumer fraud, housing, elder abuse and health care.
Texas Associations for Homecare & Hospice	512-338-9293	This membership organization of Texas homecare and hospice providers advocates for quality, affordable home care services on the state and national levels.
Care Coordination Program	Contact your local AAA or call 800-252-9240	The CCP offers broad-based in-home supportive services to Texas residents aged 60 and over. These may include minor home repairs/modifications, homemaker, personal assistance and health maintenance services.

In-Home Care Laws and Regulations in Texas

Home and Community Support Services providers that offer personal assistance services to seniors in their own homes are licensed and regulated by the Texas Department of Health and Human Services. Department staff perform an initial survey of each provider 18 months after licensing, as well as follow-up surveys every 36 months to ensure compliance with state regulations. The following table offers an overview of the rules and regulations governing PAS providers in Texas:

Scope of Care	PAS staff may complete general household tasks, prepare meals and accompany a patient on appointments. They may also provide assistance with daily living activities, personal care services and complete health-related tasks not normally performed by a professional nurse.
Care Plan Requirements	A provider supervisor must visit the patient’s home to discuss their care needs and develop a personalized service plan. This plan must detail the types, frequency and duration of the services a patient receives, and the charges for these services.
Medication Management Requirements	PAS staff may assist clients with self-administration of doctor-ordered medications.
Staff Screening Requirements	Staff must pass a criminal background check as part of the hiring process. The provider must also verify that new hires are not listed on the state Employee Misconduct and Nurse Aide registries.
Staff Training Requirements	Staff must receive training that covers the scope of their assigned duties, and their employer must verify their competency in performing these duties.
Medicaid Coverage	Texas Medicaid’s Community First Choice, Community Attendant Services and STAR+PLUS waiver programs cover some or all of the cost of in-home care services for eligible individuals.
Reporting Abuse	Those with concerns about the abuse, exploitation or neglect of a senior should contact the Texas Department of Family and Protective Services’ abuse hotline at 800-252-5400. Alternatively, they may file a report online.

Frequently Asked Questions

How Much Does In-Home Care Cost in Texas?

According to Genworth Financial’s 2019 Cost of Care Survey, in-home care services cost an average of $3,956 per month in Texas. Home health care services that provide skilled nursing care cost slightly more at an average of $4,004 per month.

Does Texas Medicaid Pay for In-Home Care?

Texas Medicaid currently has three programs available that can cover some or all of the cost of in-home care for eligible seniors. Community First Choice and Community Attendant Services are Medicaid entitlement programs, while STAR+PLUS is a waiver program with a statewide participation cap.

Are There Transportation Assistance Programs in Texas?

The statewide Medical Transportation Program offers free rides so Texas seniors without any other means of transportation can get to nonemergency, health care-related appointments. Area Agencies on Aging also offer transportation programs throughout the state. Seniors may need to meet eligibility guidelines to qualify for these programs.

Does Medicare Pay for In-Home Care?

Medicare pays for specific types of in-home care while an eligible beneficiary is recovering from an illness, injury, hospital stay or surgery and under a doctor’s care. It pays for intermittent skilled nursing care, occupational/physical therapy and home health aide visits. Round-the-clock at-home care, home-delivered meals and homemaker services are not covered.

What Are Activities of Daily Living (ADLs)?

Activities of daily living, or ADLs, are the routine tasks of self-care a person completes each day. They include personal hygiene and grooming, dressing and undressing, continence-related tasks, mobility and eating. ADLs should not be confused with more complex instrumental activities of daily living.