Assisted Living vs Home Care in New Hampshire: Costs, Medicaid, and How to Decide

The Cost Comparison

Families often assume assisted living is the more expensive option. In New Hampshire, the math is more nuanced than that — and depends heavily on how many hours of care your parent actually needs.

Assisted living: A private room in a New Hampshire assisted living facility costs approximately $5,000 to $7,000 per month. That rate is all-inclusive: room, board, meals, housekeeping, medication management, and basic personal care assistance. Memory care units run higher — roughly $1,800 per month above the base rate. Facilities are licensed under He-P 804 (Assisted Living Residence-Housing) or He-P 805 (Supported Residential Health Care Facility).

Home care (private duty): Private-pay home care in New Hampshire runs $35 to $50 per hour depending on the region and level of care. A parent needing 4 hours of daily personal care averages $4,200 to $6,000 per month — comparable to assisted living. At 8 hours per day, costs jump to $8,400 to $12,000 per month, exceeding most assisted living facilities. And unlike assisted living, your parent still pays for their own housing, food, utilities, and home maintenance.

The crossover point: At roughly 4 to 5 hours of daily paid care, home care costs match or exceed assisted living. Below that threshold, staying home is usually cheaper. Above it, the economics favor a facility — unless Medicaid is covering the home care hours.

How Medicaid Changes the Equation

The Choices for Independence (CFI) waiver is what makes aging in place financially viable for families who qualify. It covers comprehensive home care services — personal care, homemaker services, adult day health, PERS devices, home modifications, respite, and non-medical transportation — at no cost to the family.

CFI waiver for home care: Full coverage of authorized services. The parent continues living at home, and Medicaid pays the providers. Financial eligibility: gross monthly income under $2,982, countable assets under the $8,500 effective categorical ceiling (with New Hampshire's He-W 856.07 resource disregard). Medical eligibility: nursing facility level of care (hands-on help needed with 2+ ADLs).

CFI waiver in assisted living: Medicaid will pay for personal care services delivered inside an assisted living facility, but it does not cover room and board. The resident or their family must pay the residential costs out of pocket. This means even with Medicaid coverage for the care component, the family is still on the hook for several thousand dollars per month in facility fees.

Nursing home Medicaid: By contrast, Medicaid covers the full cost of a nursing home stay (room, board, and care) with no out-of-pocket facility charges. The resident contributes their monthly income minus a $93 Personal Needs Allowance, and Medicaid covers the rest. This is why nursing facility placement remains the default for families who cannot sustain the gap between authorized home care hours and actual need.

What Each Setting Provides

Home Care Advantages

• Familiarity and autonomy. Your parent stays in their own environment, surrounded by their belongings, maintaining their routines, and preserving whatever independence remains.
• Flexibility. Care can be scheduled around the parent's preferences and the family's availability. Self-directed care under the CFI waiver allows hiring a family member as a paid caregiver.
• Lower infection risk. Congregate living facilities have inherently higher exposure to respiratory infections and gastrointestinal outbreaks.
• One-on-one attention. During care visits, the caregiver is focused entirely on your parent — not splitting attention across a resident census.

Home Care Drawbacks

• Gaps between visits. Home care is scheduled, not continuous. The hours between caregiver visits are when falls, medication errors, and wandering happen. A PERS device provides emergency response but not prevention.
• Staffing uncertainty. New Hampshire's home care workforce shortage means authorized hours may go unfilled. Agencies struggle to recruit workers for rural areas where drive time between clients makes shifts uneconomical.
• Family burden. The home care model depends on family members covering the hours that formal care doesn't fill. For parents who need supervision 12 or more hours per day, the unpaid family labor can be unsustainable.

Assisted Living Advantages

• 24-hour staffed environment. Staff are on-site around the clock. There are no gaps in supervision, no periods where your parent is alone and unmonitored.
• Built-in social engagement. Shared meals, group activities, and daily interaction with other residents and staff reduce the isolation that accelerates cognitive decline.
• Predictable costs. One monthly rate covers everything. No surprises from variable care hours, home repair emergencies, or utility bills.
• Medication management. Licensed staff handle medication administration, reducing the risk of missed doses or dangerous interactions.

Assisted Living Drawbacks

• Loss of autonomy. Your parent lives by the facility's schedule, eats the facility's food, and adapts to shared living. For fiercely independent seniors, this transition can trigger depression and accelerated decline.
• Cost without Medicaid room and board coverage. Even with CFI waiver coverage for personal care services, the family pays the facility's residential charges. This limits the option to families with sufficient private resources or long-term care insurance.
• Quality variation. New Hampshire licenses facilities, but staffing levels, staff training, and care quality vary significantly between providers. Investigating a facility's inspection history, complaint record, and dementia care capabilities is essential.

The Decision Framework

Stay home if: Your parent needs fewer than 5 hours of daily paid care, the home can be adapted for safety (grab bars, ramps, accessible bathroom), the CFI waiver is covering the care hours, and family members can reliably cover the supervision gaps. The arrangement is sustainable when the caregiver has respite support and the parent is not at risk of harm during unsupervised periods.

Consider assisted living if: Your parent needs continuous supervision that scheduled home care visits cannot provide, social isolation at home is contributing to cognitive or emotional decline, the home environment is not safely adaptable, or the primary family caregiver is burning out. The transition works best as a planned move rather than an emergency placement after a hospitalization.

Consider a nursing home if: Your parent's medical complexity exceeds what either home care or assisted living can manage — advanced dementia with significant behavioral symptoms, skilled nursing needs around the clock, or ventilator/wound care requirements. Nursing home Medicaid covers the full cost with no waitlist, making it the most financially accessible option for the highest level of need.

If you are weighing these options for a parent in New Hampshire, the Aging in Place in New Hampshire guide covers the CFI waiver application process, the financial eligibility thresholds, and the home modification programs available through the waiver and independent state programs — giving you the full picture before you decide.

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