Des Moines Senior AdvisorIs home care or assisted living cheaper in Des Moines?
Up to about 28 hours a week, home care usually costs less; beyond that, Iowa's 2025 medians make assisted living the cheaper option, because non-medical home care runs about $41 an hour while assisted living's median is about $5,100 a month.
| Hours of paid help a week | Monthly cost at $41 an hour | Compared with the $5,100 assisted living median |
|---|---|---|
| 8 | $1,421 | below it |
| 12 | $2,132 | below it |
| 20 | $3,553 | below it |
| 24 | $4,264 | below it |
| 28 | $4,975 | below it |
| 36 | $6,396 | above it |
| 44 | $7,817 | above it |
| 84 | $14,924 | above it |
| 168 | $29,848 | above it |
The arithmetic ignores what home care leaves out: the house, its taxes, food and utilities, and the hours no one is there. It also ignores what assisted living adds: meals, activities, and staff on site at night.
When is staying home with help the better choice?
When the person is safe alone for long stretches, needs help mainly with bathing, meals or errands, has family nearby, and lives in a home that is easy to adapt, such as a ranch house without stairs to the bedroom.
A few hours a day of home care combined with adult day services or a family schedule can work for years. The Elderly Waiver can pay for homemaker, aide and attendant care, home-delivered meals and home modifications for eligible Iowans 65 and older, and PACE covers similar help in five of our six counties.
When does a move to assisted living make more sense?
When help is needed at unpredictable times or at night, when isolation is wearing a parent down, when medication mistakes are happening, or when the family caregiver cannot keep going.
Iowa assisted living provides a 24-hour emergency call system and staff on site around the clock, which home care cannot match at a similar price. Winter matters in central Iowa too: icy steps, cancelled appointments and long dark evenings push many families toward a move in the fall rather than in a crisis in January.
How do we find reliable home care in the Des Moines metro?
For skilled care after an illness, use a DIAL-licensed, Medicare-certified home health agency; for hourly non-medical help, interview private-duty agencies about screening, supervision, backup when an aide is out and minimum shift lengths.
DIAL lists 20 home health agencies, 11 hospices and 3 inpatient hospice houses with offices in the six metro counties. Ask whether aides are employees or contractors, whether the agency carries liability insurance and does background checks, and how it handles a no-show. Our home health roster lists every licensed agency with an office in the six counties.
Side by side
| Home care in Des Moines | Assisted living in Des Moines | |
|---|---|---|
| Price (2025 Iowa median) | About $41 an hour | About $5,100 a month |
| Night coverage | Only if paid for, by the hour | Staff on site 24 hours |
| Oversight | Home health is DIAL-licensed; private aides vary | DIAL certification and monitoring |
| Public help | Elderly Waiver services, PACE | Elderly Waiver services in participating programs |
Drawn from Iowa Code chapter 231C, 481 IAC chapters 67 and 69, Iowa HHS and DIAL publications, CareScout, CMS, the VA and the aging agencies cited in the text; our editorial standards explain how we check them.
