When an aging parent or family member needs assistance, families face a high-stakes question: how much does home care actually cost, and how can they afford it? There are two paths — hiring a self-employed independent caregiver, or partnering with a licensed home care agency. This guide breaks down real 2026 rates, the legal risks of hiring independently, and how to build a tax-ready record either way.

This is general information, not a quote for your household — rates vary widely by region, so always get local estimates before committing.

1. 2026 hourly rates — the verified figures

Home care pricing depends on the level of care (companion vs. personal care vs. nursing), whether you go through an agency, and where you live. The United States and Canada are shown separately because the data sources and currencies are different. Do not blend the two.

United States

US figures come from the CareScout 2025 Cost of Care Survey, released March 2026 — the successor to the Genworth survey, based on more than 25,000 collected rates nationwide. These are national medians; your local rate may be meaningfully higher or lower.

Non-medical caregiver (companion and personal care, now a single merged category): national median $35/hour, up 3% from 2024's $34/hour.
Private duty nursing (LPN/RN-level in-home medical care): national median $90/hour, with a median per-visit rate of $160.
24/7 round-the-clock agency care: approximately $24,700–$25,500/month nationally.
Regional variance is large. CareScout found Wyoming highest at $46/hour and Mississippi lowest at $24/hour for non-medical care — nearly double. A national median is only a starting point; get local quotes.

Canada

Canada has no equivalent national cost-of-care survey. The ranges below come from major provider price lists — Bayshore HealthCare, ComForCare Canada, and Closing the Gap — not a single authoritative survey, so treat them as ranges, not medians.

Companion/homemaker care: approximately C$24–33/hour.
Personal care (PSW/health care aide): approximately C$28–45/hour, higher in Alberta and British Columbia (C$40–55/hour) and Quebec (C$40–55/hour).
Private duty nursing (RPN/RN): approximately C$45–85/hour, higher in Quebec (C$80–100/hour).
24/7 round-the-clock agency care: approximately C$12,000–24,000/month, varying significantly by region.

US figures are in USD; Canadian figures are in CAD. The two markets are not directly comparable.

2. Independent vs. agency: what you actually save

Hiring a caregiver directly, without an agency, looks cheaper on paper — and usually is, but by less than the headline rate suggests.

United States: hiring independently typically saves 20–30% on the hourly rate. Some sources cite up to 50%, but after payroll taxes and insurance the realistic net saving is closer to 20%.
Canada: hiring independently typically saves 20–40%.

The important caveat: these are wage-vs-billed-rate distinctions. An agency's rate includes the caregiver's wage plus overhead — background checks, liability insurance, training, scheduling, and backup staffing — which is roughly 40–60% of the bill rate. When you hire independently, some of that overhead becomes your responsibility in cash, time, or risk.

3. The hidden legal risk: becoming an accidental employer

When you hire a private caregiver independently, your family typically becomes their legal employer — whether you intended to or not. That carries real obligations:

Payroll and employment taxes. You are responsible for withholding income tax and contributing to worker insurance (WSIB/WorkSafe in Canada; FICA/FUTA in the US) and employer contributions (EI/CPP in Canada). Many families discover this only after the fact.
The liability gap. If an independent caregiver is injured on the job, your homeowner's insurance typically won't cover their medical bills or lost wages. Agencies carry liability and workers' compensation coverage for exactly this.
The backup gap. If an agency caregiver calls in sick, the agency is contractually obligated to send a replacement. If an independent caregiver calls in sick, coverage falls back on you — often at short notice and at the worst possible moment.

None of this means independent hiring is wrong. It means the hourly saving should be weighed against employer obligations, liability exposure, and continuity risk — not just compared line-for-line against the agency rate.

4. Building a tax-ready evidence file

Whether you choose an agency or a private arrangement, don't leave money on the table. Both the IRS (US) and the CRA (Canada) allow significant deductions or credits for home care documented as a medical necessity.

A tax-ready file — not "audit-proof", because no organizing tool or record can guarantee an audit outcome, only organized and complete records — should include:

A doctor's note establishing medical necessity.
A complete evidence chain: every care hour, medical mileage log, pharmacy receipt, and caregiver payment kept together, recorded as they happen rather than reconstructed at tax time.

In the United States, eligible costs may be deductible under the IRS Medical and Dental Expenses framework, to the extent the care is medically necessary and your total qualifying expenses clear the deduction threshold.

In Canada, home care expenses may be claimed under the Disability Tax Credit (DTC) or the Medical Expense Tax Credit (METC) — see our DTC guide with verified province-by-province figures, or run the benefits checker to see which programs your household may qualify for.

You don't have to hold all of this yourself anymore

Choosing between a private caregiver and an agency is a major decision. But the real breakdown in caregiving often comes from fragmented information, not the choice itself — appointments, medications, receipts, mileage, and family contributions scattered across notebooks and email threads.

FeatherKeep brings this into one place: log expenses and mileage as they happen, keep medical documentation together, and see what tax credits or benefits your records suggest you may qualify for.

You don't have to hold all of this yourself anymore.

Check which benefits you may qualify for — or read the DTC guide for verified province-by-province figures.