Just one in seven councils in the UK is paying a "fair" price for home care for the elderly, according to a survey.
About 500,000 people rely on the support, which includes help with washing and dressing.
The UK Homecare Association poll of more than 200 councils found 28 paid a "minimum price" of £15.74 an hour.
This is the price the body, which represents the agencies that provide the home care for councils, believes reflects the national minimum wage.
The UKHCA warned if the squeeze on fees continued, the care sector would become "unsustainable".
The "minimum price" has been calculated by using the national minimum wage and then adding to that the costs of running the service, including travel costs for staff and pension contributions.