Home care, assisted living, a nursing home, or managing it yourself. Real Austin numbers, and the honest answer about where each one stops making sense.
Almost nobody starts out shopping for home care. Families start out worried. Something happened, a fall, a hospital stay, a phone call that did not sound right, and suddenly there is a decision to make that nobody prepared for.
The hard part is that the options do not compare cleanly. A facility quotes you a monthly rate. An agency quotes you an hourly rate. A neighbor tells you her mother did fine with family help for two more years. None of those are the same unit of measurement, and none of the brochures are going to tell you when their own option is the wrong one.
So here is the comparison written the way we would explain it to a friend, including the parts that do not favor us.
| Option | Roughly what it costs | Best when |
|---|---|---|
| In-home care | $32 to $39 an hour | Help is needed for part of the day and staying home matters |
| Assisted living | $5,700 to $7,700 a month in Austin, plus care-level fees | Overnights are the problem, or isolation is |
| Nursing home | About $5,800 a month, semi-private, in Texas | The need is medical and requires licensed nursing |
| Family alone | Nothing on paper, a great deal in practice | The need is light and more than one person is sharing it |
What it is. A caregiver comes to the house on a schedule you set. Bathing and dressing, meals, medication reminders, light housekeeping, errands and appointments, and company. The house does not change. The routine does not change. Nobody packs a lifetime of belongings into one room.
What it costs. In Austin, non-medical home care generally runs $30 to $40 an hour. Our rates are $32 to $39, and they come down as weekly hours go up, because a caregiver who spends twenty hours a week with one client costs us less to schedule than one who drives across town for a two-hour visit. Some real examples at our rates:
| What it looks like | Hours a week | About what you'd pay a month |
|---|---|---|
| A few check-ins, errands, a little company | 3 | $507 |
| Three mornings a week, bathing and breakfast | 12 | $1,716 |
| Weekday mornings and afternoons | 20 | $2,773 |
| Four hours every day, seven days a week | 28 | $3,883 |
| Six hours every day, seven days a week | 42 | $5,824 |
Who it fits. Someone who is safe at home with help, who wants to stay there, and who needs a defined amount of assistance rather than around-the-clock supervision.
Where it stops making sense. Right around six hours a day. Past that the arithmetic turns against us, and we would rather you hear it from us than work it out yourself three months in. The cost section below has the math.
What it is. An apartment in a community, with meals, housekeeping, activities, and staff on site who help with daily tasks. Care is shared across residents rather than assigned to one person for a block of hours.
What it costs. Austin is the most expensive assisted living market in Texas by a real margin. Communities here commonly run $5,700 to $7,700 a month, against a Texas median closer to $5,666. The number families get surprised by is not the base rate, it is everything stacked on top of it: a one-time community or move-in fee, a levels-of-care charge that rises as needs increase, medication administration billed separately, and a memory care surcharge if that becomes necessary. Ask for the full fee schedule in writing rather than the starting-at number, and ask specifically how often the level-of-care assessment gets redone.
Where it genuinely beats home care. Three places, and we will not pretend otherwise.
Around-the-clock availability. Somebody is on the property at three in the morning, and you are not paying by the hour for that. If your parent's real problem is nighttime, this is a serious advantage.
Isolation. A dining room and a calendar of activities solves loneliness in a way a caregiver visiting three mornings a week does not. Loneliness is not a soft concern for older adults. It tracks with real decline.
Heavy daily need. Past roughly six hours a day of hands-on help, a facility's shared-staffing model is simply cheaper than paying one person's wage by the hour.
What you give up. The house, the neighborhood, the dog in some cases, and the specific comfort of familiar walls, which matters enormously for anyone with memory loss. You also give up one-to-one attention. Staffing ratios in assisted living are commonly one aide to a dozen or more residents, which is not a criticism of the aides. It is arithmetic.
We have a longer piece on this one specifically: home care vs. assisted living in Austin, with 2026 costs compared.
What it is. Twenty-four-hour licensed nursing care. This is a medical setting, not a housing arrangement with help attached.
What it costs. Texas is among the least expensive states in the country for this. A semi-private room runs around $5,800 a month and a private room around $7,500, against national medians closer to $9,800 and $11,300.
When it is the right call. When the need is medical rather than personal. Wound care, IV therapy, feeding tubes, unstable conditions that need a nurse's judgment on hand at all hours, or a rehabilitation stay after surgery or a stroke. No non-medical home care agency in Texas can lawfully substitute for this, ours included. We hold a Home and Community Support Services Agency license for personal assistance services, which is a different license and a different scope, and we will say so plainly if that is what your situation calls for.
One thing worth knowing. A short skilled-nursing stay and long-term home care are not really competitors, they are usually sequential. A great many of our conversations start the week someone is being discharged from rehab and the family realizes the house is not ready for them yet. If that is where you are, the hospital discharge checklist is the more useful page.
This is the most common option in Austin and the one nobody puts on a comparison chart, so we will.
What it costs. On paper, nothing. In practice it is usually the most expensive option in the house. It gets paid for in reduced hours at work, in missed promotions, in a marriage that gets thinner, in the health of the adult child doing the caregiving, and often enough in a crisis that arrives because one exhausted person was doing a job built for three.
When it works. When the need is genuinely light, when more than one family member is actually sharing the load rather than one person doing it and everyone else approving of it, and when the caregiver has real time off. Those three conditions together are rarer than people expect.
What usually helps. Not replacement, relief. A great many of our clients started with eight or twelve hours a week specifically so a daughter could keep her job or a spouse could sleep through the night. Respite care exists precisely for this, and using it early is what keeps families from hitting the wall that forces a facility decision on somebody else's timeline.
Once a family decides on home care, every agency's website starts to look the same. Compassionate, trusted, family-owned. Here is what actually differs, and how to check it in a five-minute phone call.
Licensing. In Texas, a non-medical home care agency must hold a Home and Community Support Services Agency license from Texas Health and Human Services. Ask for the license number. An agency that hesitates has told you something.
Employee or contractor. This is the biggest hidden difference in the industry. If caregivers are independent contractors, the liability, the payroll taxes, and the workers' compensation exposure can land on you as the client. Ask directly: are your caregivers W-2 employees, and do you carry workers' compensation and liability insurance? Willow's caregivers are employees, and we are licensed, insured, and bonded. We wrote this one up in detail as well: private caregiver vs. agency in Texas.
Who shows up, and how many of them. Continuity is the single strongest predictor of whether a family stays happy. Ask how many different caregivers a typical client sees in a month, and what happens when the regular one is sick. Ask whether you get to meet the caregiver before the first shift.
The minimum. Most agencies have a shift minimum. Ask what it is before you fall in love with a schedule.
How rates change. Ask whether the rate goes up on nights, weekends, or holidays, whether there is a separate rate for dementia care, and what triggers a rate increase mid-arrangement. Ask for it in writing. Texas requires a written service agreement disclosing an agency's charges when a client or family is paying privately, so an agency that will not put its rates on paper is not merely being cagey.
Supervision. Who checks the care plan, how often, and what happens when something goes wrong at 9pm on a Saturday. Ask for the after-hours number and, if you want to be thorough, call it.
Scope. Non-medical home care in Texas cannot administer medications, perform wound care, or do anything requiring a nurse. Any agency implying otherwise is either confused about its own license or willing to mislead you, and neither is what you want in the house. The difference is spelled out in home health vs. home care in Texas.
If you want the full list to bring to any agency, including us, we keep one here: questions to ask a home care agency.
Here is the number most comparison pages leave out.
Take the Austin assisted living median of roughly $6,700 a month. At our 20-plus-hour rate of $32 an hour, that same money buys about 48 hours of one-to-one care a week. Call it a bit under seven hours a day, every day. Against the Texas median of about $5,666, it is closer to 41 hours a week, or just under six hours a day.
Two things bend that line, both in favor of staying home. Assisted living's real bill is usually above its quoted base rate once level-of-care and medication fees land, so the true comparison point is often higher than $6,700. And most families do not need six hours a day. They need two or three, in the right part of the day.
We would rather lose the inquiry than take a case we cannot serve well. We will say so directly if the need is medical and requires a nurse, in which case we will point you toward home health or skilled nursing. Or if someone is unsafe alone overnight and cannot afford overnight coverage, where a facility is usually the safer answer. Or if the address is outside our service area and we cannot staff it reliably, because a caregiver who cannot get there consistently is worse than no caregiver. Or if the family needs supervision to prevent wandering around the clock, which is a memory care setting's job.