24-Hour Home Care in Allentown: How It Works and What It Costs

Families who search for “24 hour home care Allentown” usually mean one of two things: rotating shifts of caregivers, or one live-in caregiver who sleeps in the home. Both put a trained caregiver in the house at every hour so an older adult who cannot be left alone can stay home, but they cover different needs and cost different amounts. This guide explains both, with 2025 Pennsylvania costs and a plain answer to the first question every family asks: who pays.

What “24-hour home care” actually means

Pennsylvania has no legal definition of 24-hour home care. Lehigh Valley agencies use the phrase for two arrangements.

Hourly shift care. Two or three caregivers rotate so that someone awake is always present. A common pattern is two 12-hour shifts, 7 am to 7 pm and 7 pm to 7 am. The overnight caregiver stays awake and helps with toileting, repositioning or confusion. Every hour is a paid working hour.

Live-in care. One caregiver moves into the home for several days at a time, usually rotating with a second live-in. The caregiver has a private room, works during the day and sleeps at night. Federal rules let the agency and worker agree to exclude bona fide sleep and meal periods from paid time, but interrupted sleep must be paid and the agency still owes overtime after 40 hours a week (U.S. Department of Labor, Fact Sheet 79B).

The difference is the night. If your parent gets up three times a night, wanders, or must be turned every two hours, live-in care does not fit: the caregiver would never sleep. If your parent sleeps through and mainly needs someone present, live-in care may be enough.

What round-the-clock care includes

The caregivers who staff 24-hour care at a licensed Pennsylvania home care agency are called direct care workers. They provide non-medical care, which state regulation defines to include bathing, grooming and dressing, help with walking and transfers, meal preparation and feeding, toileting, and help with self-administered medications (28 Pa. Code § 611.55). Across a day:

Time of day	Typical tasks
Morning	Getting up, toileting, bathing, dressing, breakfast, medication reminders
Midday	Meals, light housekeeping, laundry, walks, appointments, companionship
Evening	Dinner, evening routine, skin care, safe transfer to bed
Overnight (shift care)	Checks every 1 to 2 hours, toileting, repositioning, calming confusion, calling family or 911
Overnight (live-in)	Caregiver sleeps; responds if woken; interrupted sleep is paid time

It does not include skilled nursing, wound care, injections or therapy. Those are home health services, ordered by a doctor and delivered by a separate, Medicare-certified home health agency; many families combine the two. Our personal care service page lists what a caregiver can and cannot do.

When families need it

Most families start with a few hours a day and add more. Four situations force the jump to round-the-clock care.

Late-stage dementia. The Alzheimer’s Association describes the late stage as a time when “intensive, around-the-clock care is usually required” and the person needs full-time help with personal care (Alzheimer’s Association). Night-time confusion and wandering usually begin well before that. Our guide to home care for Alzheimer’s patients covers the earlier stages.

Falls, especially at night. The CDC reports that more than 14 million older adults, one in four, report falling every year, and the fall death rate rose 21 percent between 2018 and 2024 (CDC, older adult falls data). A parent who fell once on the way to the bathroom at 3 am is the most common reason families add an overnight caregiver.

Hospital discharge. After a hip fracture, stroke or heart failure admission, families often book 24-hour care for the first two or three weeks, then step down. See what to expect in post-hospitalization home care.

End of life. Hospice sends nurses and aides for visits and is on call by phone. It does not place a caregiver in the home around the clock, and Medicare does not cover room and board for hospice care at home (Medicare.gov, hospice coverage). Many families add round-the-clock non-medical care in the final weeks so no one is alone. Our end-of-life planning guide covers the conversations that come first.

Not sure help is needed? Start with the Allentown home care guide.

What 24-hour home care costs in the Lehigh Valley

The most reliable public benchmark is the Cost of Care Survey, run by Genworth since 2004 and now published by its subsidiary CareScout. The 2025 edition collected more than 25,000 provider rates between July and November 2025 and was released on March 2, 2026 (CareScout 2025 Cost of Care Survey).

The survey publishes state medians in its data tables and metro figures only inside its online tool, so we could not verify a separate Allentown number. The Pennsylvania median for a non-medical in-home caregiver is $34 an hour, or $77,792 a year on the survey’s basis of 44 hours a week (CareScout 2025 state data tables, PDF). Lehigh Valley agency rates vary with the level of care, weekend and holiday differentials, and whether the overnight caregiver is awake. Treat these as a starting point.

Arrangement	Hours billed per week	Math at $34/hour (PA median, 2025)	Approximate monthly cost
12 hours a day, 7 days	84	12 x $34 = $408 a day	About $12,400
24-hour shift care, awake overnight	168	24 x $34 = $816 a day	About $24,800
Live-in care (two caregivers rotating)	Flat daily rate	Not published in the survey; ask for it in writing	Usually below shift care

Monthly figures use 30.4 days. Over a year, hourly round-the-clock care at the state median comes to roughly $298,000. That is why most families use it for a defined period, cover some shifts themselves, or choose live-in care when nights are quiet.

Who pays for 24-hour home care

Private pay. Most round-the-clock care in the Lehigh Valley is paid by the family, often from the parent’s savings or the sale of a home. Ask how the agency bills, whether there is a deposit, and what notice it needs to reduce hours.

Medicare does not cover it. Medicare’s home health benefit pays for part-time skilled care when a doctor orders it and the patient is homebound. Medicare.gov lists “24-hour-a-day care at your home” and “custodial or personal care … when this is the only care you need” among the services it does not cover (Medicare.gov, home health services).

Medicaid: Community HealthChoices (CHC). CHC serves people 21 or older who have both Medicare and Medicaid, or who qualify for Medicaid long-term services because they need help with everyday personal tasks (PA Department of Human Services, CHC). Enrollment starts with the Independent Enrollment Broker at 1-877-550-4227 (CHC contact information). The number of personal assistance hours is set by an assessment of need, not by what the family requests, so ask the service coordinator how many hours are authorized and whether they can be combined with private-pay hours. Our CHC waiver guide for the Lehigh Valley explains the application step by step.

Veterans. A veteran or surviving spouse on a VA pension may qualify for Aid and Attendance if they need “another person to help you perform daily activities, like bathing, feeding, and dressing” (VA.gov, Aid and Attendance). It is a monthly cash addition, not full coverage. See how veterans in Pennsylvania get support at home.

Long-term care insurance. Call the insurer before care starts. Ask for the daily benefit maximum, the elimination period, and whether it pays for non-medical care from a licensed home care agency.

How a 24-hour care team is organized

Round-the-clock care fails when it is a string of unrelated shifts. It works when it is one team. Expect these in writing:

1. An in-home assessment by a coordinator before care starts: mobility, cognition, medications, nights, layout of the house.
2. A written care plan every caregiver follows, with the night routine spelled out.
3. A small, consistent team. Three or four caregivers for shift care, two on a fixed rotation for live-in care.
4. A shared log in the home that the family can read: meals, fluids, toileting, sleep, falls, mood.
5. Overlap at shift change, even ten minutes, so nothing is lost.
6. A supervisor who visits, a number that reaches a person at 2 am, and a plan for when the overnight caregiver calls out sick.

Every direct care worker at a licensed Pennsylvania agency must pass a criminal history check, a competency exam or training program, and tuberculosis screening before the first shift, and the agency must review competency at least once a year (28 Pa. Code Chapter 611). In a well-run arrangement, a coordinator builds the schedule, the same few caregivers are assigned to the same client, and the family has one point of contact. Whatever agency you choose, ask to see the first two weeks’ schedule before you sign.

24-hour home care vs. assisted living vs. nursing home

Families weighing round-the-clock care almost always compare it with moving. The answer depends on what the person needs at night and how much the home matters. Costs are 2025 Pennsylvania medians from the same survey.

	24-hour home care (shift)	Assisted living	Nursing home (semi-private room)
2025 PA median cost	About $24,800 a month at $34/hour	$6,480 a month	$11,954 a month ($393 a day)
Staff-to-person ratio	1 to 1	Shared staff, call button	Shared staff, nurse on site
Nights	Awake caregiver in the home	Staff on the floor; response time varies	Nursing staff on duty
Skilled nursing	Separate home health agency	Limited; outside providers	Included
Familiar surroundings	Yes	No	No
Who usually pays	Private, CHC waiver, VA, LTC insurance	Private, LTC insurance	Medicaid after spend-down, private; Medicare only for short-term rehab
Best fit	Wants to stay home; family can fund or share shifts	Mostly independent; needs meals and light help	Needs daily nursing or cannot be managed safely at home

A private nursing home room in Pennsylvania runs $450 a day, or $13,688 a month, in the same survey. Nursing home care includes nursing; 24-hour home care does not, so a person with complex medical needs may still need a facility even when the family can afford care at home. Our guide to home care vs. a nursing home goes deeper.

Is 24-hour home care tax deductible?

Often, in part. If you itemize, the IRS lets you deduct medical expenses that are “more than 7.5% of your AGI,” and its rules for what counts are in Publication 502. Two provisions cover round-the-clock care at home (IRS Publication 502, Medical and Dental Expenses).

Nursing services. “You can include in medical expenses wages and other amounts you pay for nursing services,” and “the services need not be performed by a nurse” as long as they are the kind a nurse would perform: bathing and grooming, help with medication, care connected to the person’s condition. If the caregiver also cooks and cleans, the wages “must be divided between the time spent performing household and personal services and the time spent for nursing services.” Only the care portion counts. The shared log a good agency keeps in the home is the record that makes that split defensible.

Qualified long-term care services. For a “chronically ill individual” the rule is broader: maintenance and personal care services count if they are “provided pursuant to a plan of care prescribed by a licensed health care practitioner.” A person is chronically ill when a doctor or nurse has certified within the past 12 months that she is “unable to perform at least two activities of daily living without substantial assistance from another individual for at least 90 days,” or “requires substantial supervision to be protected from threats to health and safety due to severe cognitive impairment.” The six activities named are eating, toileting, transferring, bathing, dressing and continence.

Read those two tests against the triggers earlier in this article. A parent with late-stage dementia, or one who cannot bathe or reach the bathroom without help, is the person the definition describes.

Question	What Publication 502 says
Whose tax return?	The person who paid, if the parent qualifies as a dependent or the siblings have a multiple support agreement
What paperwork?	A written plan of care from the doctor or nurse practitioner, dated before care starts, plus the agency’s invoices
Payroll taxes on a caregiver you employ directly?	“You can include as a medical expense social security tax, FUTA, Medicare tax, and state employment taxes you pay for an attendant who provides medical care”
Housekeeping and companionship hours?	Not deductible as nursing services; they count only under the long-term care rule, with a plan of care

Two limits apply. Only what the family paid out of its own pocket counts: hours the CHC waiver or a long-term care insurer paid for are not the family’s expense, and any reimbursement comes off the total. And the deduction belongs to the year the bill is paid, so care that starts in late December and is invoiced in January lands on the following year’s return.

Keep three things together in one folder: the plan of care, the agency’s invoices and the caregiver log. The family that can show which hours were personal care and which were housekeeping is the family whose deduction survives a question from the IRS.

For 24 hour home care Allentown families pay about $298,000 a year at the state median, and a deductible share of that changes the math. Ask the doctor for the plan of care at the same appointment where you discuss full-time help, and ask the agency for a monthly statement that separates personal care hours from housekeeping. This is general information, not tax advice: confirm the numbers with a tax preparer before you count on them.

Frequently asked questions