Home Care vs Nursing Facility in Texas: Costs, Medicaid, and Quality of Life

The conversation usually starts the same way: a parent’s health has declined, daily life
has become difficult, and the family is weighing options. Nursing home or home care? In
Texas, the financial and quality-of-life case for home care — especially when a family
member can be hired as the paid caregiver — is compelling.

The Cost Picture

Nursing facility care in Texas is expensive. The median cost for a semi-private room runs
approximately $5,500 to $7,500 per month in the Dallas-Fort Worth area — and
private rooms cost more. That’s $66,000 to $90,000 annually. For Medicaid-funded
stays, the state bears the cost, which is why Texas aggressively funds home and
community-based alternatives.

A family caregiver through CDS providing 30 hours per week at $13.00 per hour costs
approximately $1,690 per month — roughly one-quarter to one-fifth the cost of a
nursing facility. Even with additional services through STAR+PLUS HCBS (adaptive aids,
emergency response, respite), the total home care cost is dramatically lower.

This cost differential is the economic engine behind Texas’s waiver programs. The state
saves money every time a Medicaid recipient stays home instead of entering a facility —
and it’s willing to pay your family member to make that possible.

What Medicaid Covers in Each Setting

In a nursing facility, Medicaid covers room, board, medical care, personal care, meals,
and 24-hour supervision. The individual’s income goes toward the cost; Medicaid covers
the rest. The individual retains a small personal needs allowance.

At home through STAR+PLUS HCBS, Medicaid funds the care services — attendant
hours, homemaker support, adaptive aids, emergency response — while the individual
lives in their own home. The family provides housing. The individual keeps more of their
income.

When a family member becomes the paid caregiver through CDS, the financial dynamic
is especially favorable: Medicaid dollars flow into the household as caregiver wages
rather than to a nursing facility. The care recipient stays home, and the family’s financial
position improves.

Quality of Life

In our experience working with Dallas families, the quality-of-life argument almost
always tips toward home care. At home, your loved one eats familiar food prepared by
someone who knows their preferences. They maintain routines that give their day
structure and meaning. They receive personal care from a family member, not a rotating
staff of strangers. They stay connected to their neighborhood, their faith community,
their friends.

Nursing facilities provide 24-hour clinical monitoring, which is genuinely necessary for
individuals with complex medical needs — active medical instability, ventilator
dependence, or continuous skilled nursing requirements. For the much larger population
whose needs are personal care, daily living support, and safety supervision, home care
with a family caregiver is equal or superior.

When Home Care Is the Clear Choice

Home care through CDS is the stronger option when the care needs are primarily
personal care and daily living assistance, a family member is willing and able to provide
the care, the home can be made safe with appropriate modifications, and the care
recipient wants to stay home. In our experience, that last condition is almost universally
true.

Explore your family’s options → Contact CareChoice in Dallas

Written by Shamere Dunswell, Community Relations Manager | CareChoice

Related: Get Paid to Care for Family in TX → | STAR+PLUS in Dallas →