PACE vs. IHSS vs. Nursing Home: Comparing Care Options in California
Leslie Kaz, RHU (CA Lic #0B32530), September 2026
In short
When a parent needs more help, California families often weigh three options: PACE, IHSS (In-Home Supportive Services), and nursing home care. They work very differently, and in California you can't use PACE and IHSS at the same time. (Source: Disability Rights California) Here's how they compare.
The short version
| PACE | IHSS | Nursing home | |
|---|---|---|---|
| What it is | A complete care program: medical care, prescriptions, day center, transportation, and home help, coordinated by one team | Medi-Cal-funded help at home, such as bathing, meals, housekeeping, laundry and errands | 24-hour care and supervision in a licensed facility |
| Where care happens | At home and at a PACE center | At home | In the facility |
| Medical care included? | Yes. PACE covers all Medicare- and Medi-Cal-covered care | No. It's in-home help, not medical care | Nursing and personal care in the facility |
| Who can provide the help | The PACE team and its network | A caregiver the person chooses, which can be a family member | Facility staff |
| Main eligibility | 55+, lives in a PACE service area, State-certified as needing a nursing-home level of care, can live safely at home at enrollment | On Medi-Cal (or SSI), 65+, blind or disabled, living at home, and needs help to stay safe at home | Medical need for a nursing-home level of care |
(Sources: CalPACE; Disability Rights California; Medicare.gov)
When PACE may be the better fit
- Your parent has several health conditions and many appointments, and the family is stretched thin coordinating them.
- They would benefit from a day center with activities, meals and therapy.
- You want one team handling doctors, medications, rides and home help together.
When IHSS may be the better fit
- Your parent mainly needs help with daily tasks at home and is happy with their current doctors.
- A family member or trusted person can serve as the paid caregiver.
When a nursing home may be needed
- Your parent needs round-the-clock care or supervision that can't be provided safely at home.
- Note: if a PACE participant later needs nursing home care, PACE covers it when medically necessary. (Source: Medicare.gov)
Frequently asked questions
Can my parent get IHSS and PACE at the same time?
No, not in California. PACE provides its own home care services instead.
Can a family member be paid as a caregiver?
Under IHSS, the caregiver can be a family member or someone else the person chooses. In PACE, home care is provided by the PACE team and its network.
Does PACE replace my parent's doctors?
Usually yes. PACE care comes from the PACE organization's doctors and network, other than emergencies.
Which option costs less?
It depends on Medicare and Medi-Cal status and the care needed. See our PACE costs guide, and talk with your county IHSS office about IHSS.
Not sure which option fits? Check your loved one's ZIP to see if PACE is available, then request a callback. Leslie can walk through PACE with you. For IHSS, contact your county IHSS office.
About the Author
Leslie Kaz, RHU is a licensed California insurance agent specializing in Medicare and PACE programs, operating through Syndicated Insurance Agency, LLC (CA License #0B32530). Leslie works as an independent advisor with three PACE partners — WelbeHealth, myPlace Health (SCAN), and InnovAge — and guides families through ZIP matching and enrollment coordination at no cost to the family.
Compensation. Guidance is at no cost to families. If enrollment occurs through this agency with a partner PACE organization, the agency may be compensated by that organization — not by the family.
Service area. Availability of PACE depends on ZIP code, program service area, and final eligibility as determined by the PACE organization and the State of California.
Final eligibility and cost are determined by the PACE organization and the State of California. This website does not guarantee $0 cost or enrollment.