In-Home Care or Assisted Living? How Placer and Sacramento Families Decide

Quick answer: If your parent needs help a few hours a day and is safe alone at night, in-home care often fits better and can cost less. If they need help around the clock or the family caregiver is worn out, a licensed care home is usually safer and often costs less than 24-hour care at home.

Maybe Mom says she’ll never leave her house. Maybe Dad fell last month, and you’ve been driving over every night after work. You’re tired and not sure what’s right. This guide walks through both choices honestly. Sometimes staying home really is the right answer, and we’ll tell you when.

The short version

• In-home care brings a caregiver to your parent’s house for set hours. Assisted living and board and care homes have staff on site day and night.
• A few hours of help a day at home often costs less than a care home. Help around the clock at home usually costs more.
• Medicare does not pay for a caregiver to help with daily tasks at home or for assisted living.
• Medi-Cal’s IHSS program can help some people stay home. It does not pay for care in a licensed care home.

What’s the difference between in-home care and assisted living?

In-home care means a caregiver comes to your parent’s home. They can help with bathing, dressing, meals, light housework, rides and reminders. You choose the hours, from a few a week to around the clock. When the caregiver leaves, your parent is on their own again.

Home health is different. It’s short-term medical care at home, like a nurse or a physical therapist, ordered by a doctor. People mix these two up all the time.

Assisted living and board and care homes are licensed homes where your parent lives. Staff are there 24 hours a day. Meals, help with daily tasks and medication help are part of the package. A board and care home is a regular house with a small number of residents. Assisted living is usually a larger building. Our guide to board and care vs assisted living explains the difference.

When is staying home the right answer?

Staying home can be a good choice. It often is when:

• Your parent needs help with a few things, like bathing, meals or errands, but not all day.
• They’re safe alone at night and can call for help if they need it.
• They aren’t wandering, getting lost, or forgetting the stove.
• Family or friends live close by and can fill in the gaps without burning out.
• The house is safe, or can be made safe, for how they move around today.
• They have people to see and things to do, so they aren’t lonely.
• They strongly want to stay, and their doctor agrees it’s safe.

If this sounds like your parent, in-home care may give them good time at home. At Nonna Placements we place people in care homes, but we’ll still tell you if staying home makes more sense. If it does, call or text us and we can help you find in-home care options.

When does a care home make more sense?

The signs usually show up at night, or in the caregiver. A care home may be the better fit when:

• Your parent needs help at night, or isn’t safe alone for long.
• They’ve fallen more than once, or can’t get up on their own.
• Memory changes mean they wander, get confused, or miss medications.
• Their needs keep growing, and the hours of help keep adding up.
• They’re alone most of the day and seem lonely or down.
• You or another family caregiver are exhausted, sick, or missing work.

A care home isn’t giving up. It can mean more company, steady meals and someone there at 2 a.m.

How do they compare?

• Where your parent lives. In-home care: Their own home. Assisted living or board and care: A licensed care home.
• Help available. In-home care: Only during the hours you book. Assisted living or board and care: Staff on site 24 hours a day.
• Nights. In-home care: Covered only if you pay for overnight hours. Assisted living or board and care: Covered.
• Meals and housekeeping. In-home care: Only if the caregiver does them or you arrange them. Assisted living or board and care: Included.
• Company. In-home care: Mostly the caregiver and family. Assisted living or board and care: Other residents, staff and activities.
• How it's paid. In-home care: Usually by the hour. Assisted living or board and care: Usually a monthly rate.
• Home costs. In-home care: Mortgage or rent, utilities, upkeep and repairs continue. Assisted living or board and care: Room and meals are part of the monthly rate.
• Good fit for. In-home care: Lighter needs, safe alone at night. Assisted living or board and care: Needs around the clock, safety worries, tired caregivers.

The surprise: Medicare’s home health benefit is not a caregiver. Medicare can cover part-time skilled care at home, like a nurse or therapy, for people who qualify. It does not pay for 24-hour care at home, or for help with bathing and dressing when that’s the only care someone needs (Medicare.gov). Medicare also doesn’t pay for long-term care in assisted living (Medicare.gov).

How do the costs compare?

In-home care is usually billed by the hour. Rates vary by agency, the level of help and the time of day, and some agencies have a minimum number of hours per visit. Ask for rates and minimums in writing. Want help figuring out what in-home care might cost for your parent? Call or text us and we’ll talk it through with you.

Here’s the honest pattern:

• A few hours a day: in-home care often costs less than a care home.
• Around the clock: paying for caregivers 24 hours a day, every day, usually costs more than many care homes. And the house still has its own bills.

In the Sacramento area, assisted living and board and care homes typically run about $4,000 to $15,000 a month, depending on the home and the level of care. That monthly rate covers the room, meals and staff day and night. Our assisted living cost guide for Sacramento goes deeper.

A good way to compare is to add up what your parent really needs per week, including nights, and price both options for that same amount of care.

Can Medi-Cal or IHSS help pay for care at home?

For some people, yes. California’s In-Home Supportive Services (IHSS) program helps people stay safely in their own homes. It’s for people who are 65 or older, blind, or disabled, and it requires a Medi-Cal eligibility determination. A doctor or other licensed health professional fills out a health form. Then a county social worker visits the home and decides how many hours to approve (CDSS).

IHSS can cover help like housecleaning, meals, laundry, grocery shopping, personal care, rides to medical visits and, for some people with memory problems, supervision. If approved, your parent hires the caregiver, and that can be a family member or friend.

One key point: IHSS only works at home. A licensed care home does not count as “own home” for IHSS. This is general information, so ask the county about your parent’s situation.

For care homes, Medi-Cal’s Assisted Living Waiver can help with care costs in some homes, but only in 15 counties. Sacramento County is one of them. Placer County is not, and there’s a waitlist (DHCS). Our guide to Medi-Cal and assisted living has more.

How do you decide? An if-then guide

• If your parent needs a few hours of help a day and is safe at night, then start with in-home care.
• If they need help at night, or can’t be left alone, then a care home is usually safer, and often costs less than 24-hour care at home.
• If they’re on Medi-Cal and want to stay home, then ask the county about IHSS.
• If they’re on Medi-Cal and need a care home in Sacramento County, then ask about the Assisted Living Waiver.
• If they’re leaving the hospital and can’t go home safely, then call the hospital’s discharge team and a placement service today.
• If you’re not sure yet, then try a short stay first. Our respite care guide explains how that works.
• If the family caregiver is running on empty, then that counts as a reason to get help. Your health is part of the plan.

Questions to talk through as a family

These are about your parent and your family. Talk them over before you decide:

• What does Mom or Dad need help with each day, morning to night?
• Are they safe alone at night? Who would they call?
• How many falls or close calls have there been this year?
• What does their doctor think is safe?
• Who in the family is helping now, and for how long can they keep it up?
• What happens if the caregiver calls in sick?
• How many hours of help would they really need each week?
• What do they want most: their own house, company, or feeling safe?

Bring these answers to the doctor’s next visit. The doctor can help you understand what level of care your parent needs.

Local help in Sacramento and Placer counties

• Sacramento County IHSS: call (916) 874-9471, Monday to Friday, 9 a.m. to 4 p.m. (Sacramento County).
• Placer County IHSS: call Adult Intake at (916) 787-8860 or toll free at (888) 886-5401 (Placer County).
• Agency on Aging Area 4 offers free information on senior programs in Sacramento and Placer counties, including help for people living at home.

We serve families across California, with a focus on Sacramento and Placer counties.

How Nonna Placements works: Nonna Placements is free to families. Licensed homes pay us a placement fee when someone moves in. You can choose any home. If the first home doesn’t work out, we find another one for free. This article is general information, not medical, legal, or financial advice. Talk with your parent’s doctor about what care is safe for them.

Talk it through with us

Not sure which way to go? Call or text us. We’ll listen to what your parent needs and talk through both choices honestly. If a care home is the right fit, we’ll help you find licensed homes, and we can come on tours with you or set up video tours if you live out of state. If staying home makes more sense, we can help you find in-home care options. It’s free to your family, and we reply within 1 hour, 24/7.

Call or text (916) 261-2644 or email roberto@nonnaplacements.com. If a hospital discharge is coming up fast, tell us right away.

Related reading: Board and Care or Assisted Living? · How Much Does Assisted Living Cost in Sacramento? · How Will We Pay for Mom’s Care? · Respite Care in Sacramento and Placer · Memory Care in Roseville and Placer County · Senior living in Roseville

Sources

• Medicare.gov, Home health services (checked October 22, 2026): https://www.medicare.gov/coverage/home-health-services
• Medicare.gov, Long-term care (checked October 22, 2026): https://www.medicare.gov/coverage/long-term-care
• California Department of Social Services, In-Home Supportive Services (IHSS) Program (checked October 22, 2026): https://www.cdss.ca.gov/in-home-supportive-services
• Sacramento County, Applying for IHSS (checked October 22, 2026): https://dcfas.saccounty.gov/content/dcfas/us/en/senior-and-adult-services/in-home-supportive-services/applying-for-ihss.html
• Placer County, In-Home Supportive Services (checked October 22, 2026): https://www.placer.ca.gov/ihss
• California DHCS, Assisted Living Waiver (checked October 22, 2026): https://www.dhcs.ca.gov/services/long-term-care-alternatives-home-and-community-based-service-options/assisted-living-waiver/
• Agency on Aging Area 4: https://agencyonaging4.org/

About the author

Roberto Hategan is the CEO & Founder of Nonna Placements, a senior placement service in Granite Bay serving families across California, with a focus on Placer and Sacramento counties. Contact: roberto@nonnaplacements.com

Photo credits: Brett Sayles, Tima Miroshnichenko, and cottonbro studio, via Pexels, Pexels License.