State of Senior Homecare & Aging in Place 2027

Publishing details

This is a flagship research report for the Vitalis blog, written as a linkable reference asset. Figures were checked against primary sources as of October 2026.

Key findings at a glance

Most older Americans want to grow old at home, but the cost, staffing and safety systems that make that possible are under strain in nearly every state. Here is what the 2027 data shows.

1. 64.6 million Americans are now 65 or older. That is 18.9% of the U.S. population, based on July 2025 Census estimates reported by the Social Security Administration. In Maine, nearly 1 in 4 residents is 65+.
2. 75% of adults 50+ want to stay in their current home. Yet 44% expect they will have to move at some point (AARP, 2024).
3. Full-time home care now costs a median $80,080 a year. The national median rate for a non-medical caregiver is $35 an hour (CareScout Cost of Care Survey 2025).
4. Hourly rates vary almost 2-to-1 by state. They run from $24 in Mississippi to $46 in Wyoming.
5. Part-time care is the real “aging in place” budget. Twenty hours a week at the national median costs about $36,400 a year. That is roughly one-third of the median cost of a semi-private nursing home room ($114,975).
6. The workforce is the bottleneck. Home health and personal care aides held about 4.3 million jobs in 2024. The field needs about 765,800 openings filled every year through 2034 (BLS).
7. Over 205,000 seniors and adults with physical disabilities are waiting for Medicaid home care. Total HCBS waiting lists reached 649,905 people in KFF’s 2026 data (KFF).
8. Families carry most of the load. 63 million Americans are family caregivers, up about 45% since 2015 (AARP and NAC, 2025).
9. Falls remain the top safety threat. The age-adjusted fall death rate for adults 65+ rose 21% between 2018 and 2024, to 78.4 per 100,000 (CDC).
10. Home monitoring is going mainstream. Nearly 1 million Medicare enrollees used remote patient monitoring in 2024, with Medicare payments above $500 million (summary of HHS-OIG report).

How we built this report

This report combines public data from government and research sources with original analysis by the Vitalis team. We did not rely on secondary blogs for any figure. Each table names its source, and every number links back to it.

Data sources used

Original Vitalis calculations

We calculated four new measures from the source data:

• Share of residents 65+ in each state (65+ population divided by total population).
• Part-time home care cost, which is the state hourly rate × 20 hours × 52 weeks. Most people aging in place need help with some tasks, not round-the-clock care, so this is a more realistic household budget.
• Home care vs. nursing home ratio, which is full-time home care (44 hours a week) as a percentage of a semi-private nursing home room.
• Home Care Pressure Index, a 0–100 score combining age share, cost and Medicaid waiting lists (method explained in its section).

Limitations

• Cost figures are medians. Actual prices vary by city, agency and care needs.
• KFF notes that waiting lists are an incomplete measure of unmet need. States run their lists differently, so state comparisons should be read with care.
• Washington, D.C. is shown in population totals but is not in the state rankings, because some cost data is not reported for it..

1. Who is aging in place: the 2027 landscape

America has never had this many older adults, and most of them want to stay where they are. That simple fact drives every other trend in this report.

An older country, state by state

As of July 2025, 64.6 million Americans were 65 or older. That is 18.9% of a total population of 341.8 million (SSA, from Census estimates). The ACL had counted 57.8 million in 2022, so the group grew by nearly 7 million in three years (ACL).

The age mix is very uneven across states:

• Oldest states (share 65+): Maine 24.6%, Vermont 24.1%, New Hampshire 23.0%, Florida 22.8%, Delaware 22.8% and Hawaii 22.6%.
• Youngest states: Utah 13.0%, Texas 14.9%, Alaska 15.8%, Georgia 16.7% and Colorado 17.1%.
• Largest senior populations: California (6.9 million), Florida (5.3 million), Texas (4.7 million), New York (3.9 million) and Pennsylvania (2.8 million).

The full 50-state table is in the next section.

What older adults say they want

AARP’s 2024 national survey found that 75% of adults 50+ want to stay in their current home as they age, and 73% want to stay in their community (AARP). But the same survey shows a gap between hope and reality:

• 44% of adults 50+ expect they will have to move at some point.
• 51% say they need a home that supports independent aging.
• 43% say they will need to make their home more accessible. Of those, 72% plan bathroom changes such as grab bars and non-slip tile (AARP).

Many are aging in place alone

In 2023, about 28% of older adults living in the community lived alone. That is 16.2 million people: 10.5 million women and 5.7 million men (ACL). Among women 75 and older, about 42% live alone.

Living alone is not a problem in itself. Many people value it. But it changes the risk picture. If a fall or health change happens, nobody may notice for hours. This is where home care, check-ins and monitoring matter most.

What this means for families: Planning to age in place is no longer a single decision. It is a plan with three parts: the home itself, the people who help, and a way to get help fast when something goes wrong.

2. What senior homecare costs in 2027: national and state-by-state

The median cost of full-time, non-medical home care is now $80,080 a year, or $35 an hour. After several years of sharp increases, cost growth slowed in 2025 (CareScout, March 2026).

Why the categories changed

Until 2024, the survey split home care into “homemaker” help (cooking, cleaning, errands) and “home health aide” help (bathing, dressing, eating). In 2024 the gap between the two shrank fast. Homemaker rates rose 10% while aide rates rose 3% (Genworth and CareScout, 2024 survey). By 2025, prices had converged so closely that both are now reported as one category, “non-medical caregiver.” Labor costs were the main driver.

Three ways to read the cost of care

• Full-time home care (44 hours a week) costs more than assisted living in many states. Nationally, it is $80,080 vs. $74,400.
• Part-time home care (20 hours a week) is closer to what most aging-in-place households buy. It costs about $36,400 a year at the national median.
• Nursing home care is still the most expensive setting: $114,975 a year for a semi-private room.

Full-time home care costs about 70% of a semi-private nursing home room nationally. Part-time home care costs about 32%.

State-by-state cost table

All costs are 2025 medians from the CareScout Cost of Care Survey 2025. Population figures are July 2025 Census estimates via the SSA. Part-time cost and the final column are Vitalis calculations.

Note: CareScout reports annual and hourly figures separately, and hourly rates are rounded. That is why hourly × hours may differ slightly from the annual column in a few states.

What stands out

• The most expensive states for home care are Wyoming ($46/hr), Maine, Vermont and Washington ($45/hr), and Minnesota and South Dakota ($44/hr).
• The least expensive are Mississippi ($24/hr), Arkansas ($25/hr), Louisiana ($26/hr) and Alabama ($27/hr).
• In Texas, full-time home care costs slightly more than a semi-private nursing home room (102%). Missouri (93%) and Oklahoma (90%) are close behind. In these states, families who need 24/7 support often face a hard trade-off.
• In New York, Connecticut, West Virginia and Oregon, full-time home care costs less than half of nursing home care. Aging in place has the clearest financial advantage there.
• Older states are often expensive states. Maine and Vermont have the highest share of residents 65+ and some of the highest hourly rates. That combination puts the most pressure on families.

Planning tip: Most families do not need 44 hours a week from day one. A realistic plan often starts with a few hours of help, plus home safety changes and monitoring, and adds hours as needs grow.

3. The caregiver workforce: the real limit on aging in place

The biggest barrier to aging in place in 2027 is not demand or money alone. It is finding enough trained people to provide care.

The numbers

Why it matters for families

The annual openings figure is larger than the number of new jobs. That gap reflects workers leaving the field or changing jobs each year. Turnover means families often see new faces, missed shifts, or waits before care can start.

There is also a pay paradox. Families pay about $35 an hour for care, while the median aide earns roughly $17 an hour ($34,900 ÷ 2,080 hours). The difference covers agency costs such as training, insurance, scheduling, supervision and payroll taxes. Even so, low wages make it hard to recruit and keep caregivers. That is why rates keep rising even as families struggle to pay them.

What this means in 2027

• Expect waits in high-demand areas, especially rural counties and for weekend or overnight shifts.
• Hours are precious. Families get more from each paid hour when caregivers spend it on hands-on help, not just being present “in case” something happens.
• Technology fills the gaps between visits. Monitoring and alert tools cannot replace a caregiver. But they can cover the many hours when no one is in the home.

4. Medicaid home care and the waiting-list problem

For many lower-income older adults, Medicaid is the main way to pay for long-term home care. But in most states, the home care programs have limited slots, and people can wait months or years.

How it works, in plain terms

Medicaid Home and Community-Based Services (HCBS) pay for help at home, such as personal care, adult day programs and home changes. Many of these services run through “waivers.” States can cap the number of people in each waiver. When the slots fill up, a waiting list forms. Nursing home Medicaid, by contrast, is an entitlement and has no waiting list.

KFF estimates that 4.5 million Medicaid enrollees use HCBS (KFF).

The 2026 picture

• 649,905 people were on HCBS waiting lists nationally in KFF’s 2026 data. Most are people with intellectual and developmental disabilities.
• 205,137 were seniors or adults with physical disabilities. That group grew from 167,082 in 2024 and 182,162 in 2025, a rise of about 23% in two years (KFF).
• Many states report no senior waiting list at all, including Arizona, Massachusetts, Minnesota, New York, Pennsylvania and Washington.

States with the longest senior waiting lists

Seniors and adults with physical disabilities on HCBS waiting lists, 2026. The “per 1,000 adults 65+” column is a Vitalis calculation to allow fairer comparison between large and small states.

Source: KFF State Health Facts, 2026. The population denominator includes all adults 65+, not only Medicaid enrollees.

Read these numbers with care

KFF warns that waiting lists are an incomplete measure of unmet need. States use different rules. Some screen everyone on the list for eligibility, and others do not. A short list can mean a well-funded program, or it can mean a state does not keep a list. Florida’s figures, for example, have been reported unchanged for several years.

Policy to watch

Under the federal Medicaid Access Rule, states must begin reporting HCBS waiting list information in 2027 (Shirley Ryan AbilityLab, summarizing KFF). This should make state comparisons more reliable starting with the 2028 edition of this report.

What this means for families: If you think a loved one may need Medicaid home care, apply early. Being on a list sooner can shorten the wait. Your local Area Agency on Aging can explain your state’s programs.

5. Family caregivers: the backbone of aging in place

Paid home care fills only part of the need. Family members, friends and neighbors provide most of the day-to-day help that keeps older adults at home.

The scale of family caregiving in 2025

The 2025 Caregiving in the U.S. study by AARP and the National Alliance for Caregiving found:

• 63 million Americans are family caregivers. That is nearly 1 in 4 adults, and about 20 million more than in 2015 (AARP press release).
• 59 million of them care for someone over 18.
• Half report a negative financial impact from caregiving. About a quarter have taken on debt (AARP research summary).
• One in five report poor health of their own.
• Seven in ten working-age caregivers also hold paid jobs.
• 11.2 million receive some payment, for example through Medicaid or VA programs. Most are still unpaid.
• 28% had trouble finding affordable services such as home health aides, transportation and meal delivery (Medicare Rights Center summary).

AARP estimates that family caregivers provide about $600 billion in unpaid care each year (AARP).

Why this matters

When a family caregiver burns out, the care plan often falls apart. A move to assisted living or a nursing home frequently follows a caregiver crisis, not only a health crisis. Supporting the caregiver is part of supporting the older adult.

6. Safety at home: falls, living alone and the “long lie”

Falls are the leading cause of injury and injury death for adults 65 and older (CDC). For people aging in place, a fall is often the event that decides whether they can stay home.

The fall data

When getting help takes too long

A “long lie” means being unable to get up after a fall and staying on the floor for an hour or more. A UK cohort study of people over 90, published in the BMJ, found that among those who fell, 80% could not get up without help after at least one fall. 30% lay on the floor for an hour or more (Fleming & Brayne, BMJ 2008).

Long lies were strongly linked to serious injury, hospital admission and later moves into long-term care. One more finding is important: call alarms were widely available, but most people who had a long lie did not use them.

This matters for the 16.2 million older adults who live alone. It also suggests that the design of an alert system matters as much as owning one.

Practical prevention steps

• Ask a doctor about a fall-risk check. CDC’s STEADI program gives clinicians a simple screening process.
• Review medicines that can cause dizziness or drowsiness.
• Do strength and balance exercise most days, such as tai chi or guided programs.
• Add grab bars, bright lighting and non-slip surfaces, especially in bathrooms and on stairs.
• Get an eye exam every year.
• Have a plan for getting help fast, and make sure it works even if the person cannot reach a phone.

7. Technology in home care: what is changing

Technology is moving from “nice to have” to a standard part of aging in place. The goal is simple: notice problems early and get help fast, during the many hours when no caregiver is in the home.

Remote patient monitoring (RPM)

RPM means using connected devices at home, such as a blood pressure cuff, scale or glucose meter. The readings go to a care team, who can spot changes and act before a problem becomes an emergency.

Medicare started paying separately for RPM in 2018–2019. Since then, use has grown fast:

The government is also watching quality. HHS-OIG found that in 2022, about 43% of enrollees who received RPM did not receive all key parts of the service. It has urged closer oversight of billing (Manatt). For families, the lesson is clear: good monitoring means someone is actually reviewing the data and following up, not just a device in a drawer.

Medical alert and fall detection

Personal emergency response systems, often called medical alert systems, let an older adult call for help with a button or wearable. Newer devices add automatic fall detection, GPS for use outside the home, and two-way voice.

The BMJ “long lie” research shows why design matters. Alarms only help if they are worn and used. Wearables that people actually like to wear, and that can detect a fall without a button press, address a key weakness of older systems.

AI-based tracking and early warning

AI tools can look for patterns across days and weeks, such as a slow rise in blood pressure, less activity, or changes in sleep. These patterns can flag a possible problem before the person or family notices it. The value depends on clinicians reviewing the alerts and acting on them.

Telehealth

Video and phone visits reduce travel for older adults with mobility limits. They work best alongside home monitoring, so the clinician can see recent readings during the visit.

What to look for in home care technology

• Is a human watching? Ask who reviews alerts and readings, and how fast they respond.
• Does it work without a button? Automatic fall detection helps if the person cannot press a button.
• Will the person wear it? Comfort and style affect daily use.
• Does it connect to care? The best tools share data with doctors and family, with permission.
• What are the costs? Check device, monthly and annual fees, and whether Medicare or other insurance covers any part.

8. The Vitalis Home Care Pressure Index 2027

New Mexico, Iowa, Maine and Vermont face the most pressure on home care in 2027, according to our new state index. Texas, Utah and Arkansas face the least. This is an original Vitalis analysis built from public data.

What the index measures

The index asks one question: where is it hardest for older adults to get and pay for care at home? It combines three factors, each weighted equally:

1. Demand: share of the state’s population aged 65+ (Census, July 2025).
2. Cost: median hourly rate for a non-medical caregiver (CareScout, 2025).
3. Public program access: seniors and adults with physical disabilities on Medicaid HCBS waiting lists, per 1,000 adults 65+ (KFF, 2026).

For each factor, we turned the state’s value into a standard score (how far it sits above or below the 50-state average). We added the three scores and scaled the total from 0 (least pressure) to 100 (most pressure).

50-state ranking

How to read the index

• Two kinds of pressure show up at the top. New Mexico and Iowa rank high mainly because of long Medicaid waiting lists. Maine, Vermont, Wyoming and New Hampshire rank high because they combine an older population with high hourly rates.
• A low score does not mean care is easy to find. Texas scores lowest because it has a younger population and moderate prices. But it still has one of the largest Medicaid HCBS waiting lists in the country across all groups.
• Waiting list data has known limits. As KFF notes, states report lists differently. A state with “0” may not keep a list. Treat this factor as a signal, not a precise measure.

9. Expert perspectives and Vitalis insights

Data tells us what is happening. People who work in senior care every day help explain why it matters.

From the research community

AARP’s Rodney Harrell, PhD, Vice President of Family, Home, and Community, summed up the survey findings this way:

“Affordable and independent living isn’t just a preference—it’s essential for their wellbeing.” — Rodney Harrell, PhD, AARP (source)

The BMJ authors who studied falls among people over 90 concluded that long periods on the floor after a fall are more common in the oldest adults than once believed, and carry serious consequences (Fleming & Brayne, 2008).

Vitalis member data will be added in a future update.

10. The 2027 outlook: six trends to watch

Based on the data in this report, these are the trends most likely to shape senior homecare over the next 12 to 24 months.

1. Price growth slows, but prices stay high. Cost growth eased in 2025 after several high years. With wages still low and demand rising, we do not expect prices to fall. Families should budget for continued increases.
2. “Hybrid care” becomes the default. More households will combine a few hours of paid help, family support and technology, rather than relying on one source. Part-time care at about $36,400 a year is far more reachable than full-time care at $80,080.
3. Workforce shortages hit rural areas hardest. With about 765,800 openings needed each year, rural and frontier states such as Wyoming, Montana and the Dakotas are likely to see the longest waits for in-person help.
4. Medicaid waiting lists get more visible. New federal reporting rules begin in 2027. Better data may show that unmet need is larger than today’s lists suggest.
5. Remote monitoring grows, with tighter oversight. RPM use roughly doubled between 2022 and 2024. Expect more scrutiny of quality, which should favor programs with real clinical follow-up.
6. Fall prevention becomes a central part of aging in place. With fall death rates up 21% since 2018, more health systems, insurers and families will treat fall risk screening, home changes and fast-response alerts as basic care, not extras.

These are forecasts based on current data, not guarantees. We will review them in the 2028 edition.

11. A practical aging-in-place plan for families

You do not need to solve everything at once. Use these steps to build a plan that can grow as needs change.

1. Start the conversation early. Talk with your loved one about what matters most to them, before a crisis forces quick decisions.
2. Check the home. Look at stairs, bathrooms, lighting and entryways. An occupational therapist can do a home safety assessment.
3. Talk to the doctor about fall risk. Ask for a fall-risk screening and a medicine review.
4. Estimate costs for your state. Use the state table above. Start with part-time care (20 hours a week) and adjust.
5. Learn your coverage options. Medicare covers some short-term home health care after an illness or injury, but not ongoing non-medical help. Medicaid, VA benefits and long-term care insurance may help. Apply early for Medicaid programs with waiting lists.
6. Plan for the hours no one is there. Decide how your loved one will get help fast if they fall or feel unwell when alone. Consider a medical alert device with fall detection and health monitoring.
7. Support the family caregiver. Share tasks, schedule breaks and look for respite care. A caregiver’s health is part of the care plan.
8. Review the plan every few months. Needs change. Adjust hours, tools and support as you go.

Frequently asked questions

How much does in-home senior care cost per hour in 2027? The national median is $35 an hour for a non-medical caregiver, based on 2025 survey data. State rates range from $24 in Mississippi to $46 in Wyoming.

Is home care cheaper than a nursing home? Usually, yes. Full-time home care (44 hours a week) costs about 70% of a semi-private nursing home room nationally. Part-time care costs much less. In a few states, like Texas, full-time home care can cost about the same as a nursing home.

Does Medicare pay for home care? Medicare covers some part-time skilled home health care when a doctor orders it and certain conditions are met. It does not cover ongoing help with daily tasks like bathing or cooking. Medicaid may cover these services, depending on your state and income.

Why is it hard to find a home caregiver right now? Demand is growing faster than the workforce. The U.S. needs to fill about 765,800 aide openings each year through 2034, and aide pay remains low.

Can technology replace a home caregiver? No. But it can help between visits. Medical alerts, fall detection and remote monitoring can get help faster and spot health changes early, especially for people who live alone.

Conclusion: aging in place works best with a plan

The 2027 data points to one clear lesson. Staying at home is what most older adults want, and it is often the more affordable choice. But it works best when families plan ahead. That means a safer home, the right amount of hands-on help, support for family caregivers, and a reliable way to get help fast when no one else is there.

How Vitalis supports aging in place

Vitalis PHA is a proactive healthcare partner focused on prevention. Our work centers on two services that fill the gaps this report describes:

• Medical alert monitoring with a wearable watch, including fall detection, so help can be reached quickly even when a loved one is alone.
• Remote patient monitoring, which tracks readings such as blood pressure and glucose at home and uses AI-based tracking to flag changes early.

Together with Vitalis Homecare Services, these tools are designed to support continuous monitoring, faster response times and earlier detection of health changes. Plans are available on monthly and annual subscriptions.

Technology does not replace caregivers or doctors. It helps them by covering the hours between visits and turning daily readings into useful information.

Take the next step. If you are planning care for yourself or a loved one, schedule a consultation with Vitalis to talk through your situation and get personalized monitoring support.

Medical disclaimer

This content is for informational purposes only and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for personalized medical guidance.

References

1. Administration for Community Living. 2023 Profile of Older Americans. May 2024.
2. AARP. 2024 Home and Community Preferences Survey. December 2024.
3. AARP. Press release: Majority of adults 50-plus want to age in place. December 10, 2024.
4. AARP and National Alliance for Caregiving. Caregiving in the U.S. 2025. July 2025.
5. AARP. Press release: Crisis point for America’s 63 million family caregivers. July 24, 2025.
6. CareScout. Cost of Care Survey 2025: Median cost data tables. March 2026.
7. CareScout. 2025 Cost of Care Survey results (press release). March 2, 2026.
8. Genworth and CareScout. 2024 Cost of Care Survey results. 2025.
9. Centers for Disease Control and Prevention. Older Adult Falls Data. Updated September 4, 2026.
10. National Safety Council. Older Adult Falls, Injury Facts.
11. Fleming J, Brayne C. Inability to get up after falling, subsequent time on floor, and summoning help. BMJ. 2008;337:a2227.
12. KFF. Number of People Waiting for Medicaid Home Care (HCBS), by Target Population. Accessed October 2026.
13. KFF. A Look at Waiting Lists for Medicaid HCBS from 2016 to 2024.
14. Social Security Administration. OASDI Beneficiaries by State and County, 2025, Table 1 (Census Bureau population estimates, July 1, 2025).
15. U.S. Bureau of Labor Statistics. Occupational Outlook Handbook: Home Health and Personal Care Aides.
16. U.S. Bureau of Labor Statistics. Most New Jobs, 2024–34.
17. HHS Office of Inspector General. Additional Oversight of Remote Patient Monitoring in Medicare Is Needed (OEI-02-23-00260), September 2024; summarized by Manatt Health.
18. HHS Office of Inspector General. RPM billing trends report, August 2025; summarized by Morgan Lewis and LexBlog.
19. Shirley Ryan AbilityLab. Moving the needle on HCBS waiver waiting lists.