Home care · Smith County, TX
Home care in Smith County
Of the 235,000 people in Smith County, about 39,800 are 65 or older — one in six residents. Most of them intend to stay in their own homes, and most of the care that makes that possible happens quietly, in living rooms, without anyone calling it "long-term care."
Below is what we'd tell a friend in Smith County: what care costs here, who provides it, what the facility alternative actually looks like, and which programs pay.
Smith County, in numbers
Full Texas guide →Residents 65+
39,803
17% of the county.
Live with a disability
12.4%
About 28,839 people — the population most likely to need help at home.
Median household income
$67,978
20 hrs/week of care would run about 46% of it.
Certified agencies
83
Medicare-certified home health agencies serving local ZIPs; 68 rated, averaging 3.5★.
Sources: CDC/ATSDR Social Vulnerability Index 2022 (ACS 2018–2022), County Health Rankings 2024, and CMS Care Compare provider files.
What home care costs in Smith County
Texas's going rate for agency home care is around $30/hr. Twenty hours a week — four hours a day, five days a week, the most common schedule families start with — comes to roughly $2,600 a month, or $31,200 a year.
Median household income in Smith County is $67,978 — that schedule runs about 46% of it. Manageable for some households here, and still worth checking whether a program can carry part of it.
Who provides care in Smith County
83 Medicare-certified home health agencies serve ZIP codes in Smith County. 68 of them carry a CMS quality star rating, averaging 3.5 out of 5. 62 report offering home health aide services.
That is above the Texas average of 2.93 — the agencies working here rate better than the state's typical. Worth knowing, because it means the local floor is higher than average, not that any single agency is a safe bet.
One distinction worth getting straight before you call anyone: those are Medicare-certified home health agencies — skilled, doctor-ordered, intermittent care, usually a nurse or therapist visiting for a few weeks after a hospital stay. That is not the same as the hourly, non-medical help most families are actually looking for: bathing, dressing, meals, driving, company. Medicare pays for the first. It does not pay for the second.
The alternative, locally
Smith County has 17 certified nursing homes holding 1,985 certified beds, averaging 2.4 out of 5 on CMS's overall rating. About 1,418 people live in them on an average day.
The Texas programs that pay for care at home
- STAR+PLUS HCBS
- Community First Choice
- Primary Home Care
Texas runs 3 Medicaid pathways that pay for care at home instead of a nursing home. Each has its own income, asset, and care-need rules, and approval takes weeks to months — so the application is worth starting before the need becomes urgent.
How each Texas program works →Caregiver training in TX
75 hrs
Minimum for certified aides (the federal minimum). Agencies are licensed by the TX Health & Human Services Commission.
Choosing an agency in Smith County
- Ask for the license. Texas licenses home care agencies through the TX Health & Human Services Commission. A legitimate agency shows its license without hesitating. One that changes the subject has told you something.
- Ask what the rate covers. Around $30/hr is typical in Texas. A real agency's rate covers a trained, background-checked, insured caregiver plus supervision and backup staffing when your regular person is sick. A rate well under the local range usually means one of those is missing.
- Don't confuse a fast answer with a good one. With 83 certified agencies serving Smith County, someone will always pick up. Ask specifically: can you staff the exact hours I need, with the same caregiver, starting when? Vague answers there predict vague service later.
- Ask about Medicaid now, not later. If money is going to be the constraint, ask about STAR+PLUS HCBS at the first call. Approval takes weeks to months, and private pay is what bridges the gap — so the sooner the application starts, the smaller that bridge is.
Want to talk it through?
We provide care in the Milwaukee, WI area — but we’re glad to help any family think through the options in Smith County.
Smith County home care questions, answered
How much does home care cost in Smith County, TX?
Agency home care in Texas runs around $30/hr for private pay. At 20 hours a week that is about $2,600 a month. For context, median household income in Smith County is $67,978. Rates move with the level of care and the schedule — short daily visits cost more per hour than long shifts.
Does Medicare pay for home care in Smith County?
Medicare pays for skilled home health — a nurse or therapist, doctor-ordered, for a limited stretch, usually after a hospital stay. 83 Medicare-certified agencies serve Smith County. Medicare does not pay for the hourly, non-medical help most families want — bathing, dressing, meals, driving, company. For that, the money comes from private pay, long-term care insurance, VA benefits, or Texas Medicaid.
Does Medicaid pay for home care in Smith County?
Yes — for people who qualify. Texas runs Medicaid programs that pay for care at home instead of a nursing home: STAR+PLUS HCBS, Community First Choice, Primary Home Care. Income, asset, and care-need rules apply, and approval usually takes weeks to months, so apply before you need it.
How are caregivers trained and vetted in Texas?
Certified home health aides in Texas complete at least 75 hours of training, the federal minimum. The state licenses home care agencies through the TX Health & Human Services Commission, so ask to see an agency's license before you hire.
Is home care better than a nursing home in Smith County?
It depends on the level of care needed, not on which one sounds nicer. Smith County's 17 certified facilities average 2.4 out of 5 stars on CMS ratings, against a Texas average of 2.65. Round-the-clock skilled nursing is something a facility does that home care cannot. But for help with bathing, meals, medication reminders, and company, care at home usually costs less and keeps someone in their own bed — and most people, asked plainly, say that is what they want.
Does Juniper at Home provide caregivers in Smith County?
Not directly — our own caregivers serve the Milwaukee area of Wisconsin. This page is a free guide for Smith County families: what care really costs here, who provides it, and which programs can help pay.
Bordering counties in Texas