This document compares home care and nursing homes as options for long-term senior care. An estimated 9 million Americans over 65 require long-term care currently, and that number is projected to rise to 12 million by 2020 as the population ages. Home care allows seniors to remain in their own home and is more cost effective than nursing homes, but nursing homes provide around-the-clock care. However, 90% of nursing homes are understaffed and the average resident receives only 3.83 hours of direct care per day. The annual cost of a nursing home, such as one in Manhattan, can be $164,250 compared to $48,000 for home health aide services.