Nursing Home vs Home Care Costs in Delaware: A Side-by-Side Comparison

The Numbers Side by Side

Before choosing a care setting for a parent in Delaware, start with what each one actually costs:

On the surface, home care appears to cost less than half of nursing home care. But those numbers describe different amounts of coverage. A home health aide at $6,673 per month typically covers 30 to 44 hours per week — roughly six to eight hours a day, five or six days a week. A nursing home provides care 24 hours a day, 7 days a week.

When Home Care Is Actually Cheaper

Home care makes financial sense when your parent needs help with specific daily tasks but does not require round-the-clock supervision. If a parent needs assistance with bathing, dressing, meal preparation, and medication reminders — say 4 to 6 hours per day — home care will cost significantly less than a nursing home.

The math changes fast when needs increase. If your parent has moderate-to-advanced dementia with nighttime wandering, or a fall risk that requires 24-hour monitoring, you are looking at two or three shifts of home aides per day. At Delaware's average home health aide rate of roughly $30 per hour, 24-hour coverage runs approximately $21,600 per month — substantially more than the nursing home.

The crossover point is typically around 12 to 14 hours of daily care. Below that, home care is cheaper. Above it, the nursing home is cheaper per hour of care delivered.

What Medicaid Covers in Each Setting

Under Delaware's DSHP-Plus managed care program, Medicaid covers both options — but differently:

Nursing home: Medicaid pays the full cost of a certified nursing home bed. The resident contributes nearly all of their monthly income minus a $75 personal needs allowance and any spousal maintenance allowance. Room, board, nursing care, and therapy are all included.

Home care (LTCCS program): Medicaid covers personal care aides, home-delivered meals, home modifications (up to $6,000 per project / $10,000 per year), adult day care, personal emergency response systems, and respite care. The beneficiary pays $0 for authorized services. However, Medicaid does not pay for the family's standard housing costs — mortgage, rent, utilities, and groceries remain the family's responsibility.

The key advantage of Medicaid-funded home care: there is no waiting list. Delaware's DSHP-Plus program operates as an entitlement under a federal Section 1115 waiver, so anyone who qualifies clinically and financially is enrolled. No cap, no queue.

The key disadvantage: the clinical threshold is the same for both settings. Your parent must meet the nursing-home level of care (assessed through the PAE Tool-001) even to qualify for home care through LTCCS. Someone who needs help with housework and meals but does not meet the skilled or intermediate nursing care standard will not qualify for either Medicaid option.

Hidden Costs of Each Setting

Home care hidden costs:

• Family members often fill gaps between aide shifts — unpaid, but real in terms of lost wages and caregiver burnout
• Home modifications (ramps, grab bars, bathroom renovations) may exceed Medicaid's annual cap
• Transportation to medical appointments is the family's responsibility unless the MCO authorizes Medicaid transportation
• If the parent owns the home, property taxes, insurance, and maintenance continue

Nursing home hidden costs:

• The $75 personal needs allowance barely covers toiletries and personal items — families often supplement
• Laundry services for personal items may carry an extra charge at some facilities
• Private-pay rates during the Medicaid eligibility review can deplete savings fast

Making the Decision

The care decision is clinical first, financial second. If your parent needs skilled nursing interventions (IV medications, wound care, complex therapy) that cannot be safely delivered at home, a nursing home is the medically appropriate choice regardless of cost.

If your parent's needs are personal care and supervision, the choice comes down to how many hours of care they need per day and whether the home environment can be made safe. A geriatric care manager or the MCO care coordinator can assess both factors.

For families working through the Medicaid eligibility process for either setting, the Delaware Medicaid Long-Term Care & Asset Protection Guide covers the financial qualification steps, Miller Trust setup, and MCO enrollment for both nursing home and LTCCS home care under DSHP-Plus.

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