By Britt Hemsell, Ruby Care Senior Living Advisor | Contributor
When a loved one begins to need support at home, one of the first questions families ask is: “Do we need Home Health or Home Care?”
These terms sound similar. They both happen in the home. They can even happen at the same time. But they are not the same. Understanding the difference can prevent gaps in care, reduce hospital readmissions, and most importantly, ensure your loved one gets the right kind of support at the right time.
Having experienced this with family members multiple times I will share my experience and discuss the differences between the two and identify what Medicare or insurance helps cover.
Home Health
Home Health is medical care provided in the home by licensed healthcare professionals. It is ordered by a physician and typically covered by Medicare, Medicaid, or private insurance when certain criteria are met. Guidelines for coverage can be found in the CMS Medicare & You Handbook.
Home Health Includes:
– Skilled Nursing (RN/LVN)
– Physical Therapy (PT)
– Occupational Therapy (OT)
– Speech Therapy
– Medical Social Work
– Wound Care
– Medication management
– Post-surgical monitoring
Medicare Requirements
Under Centers for Medicare & Medicaid Services (CMS) guidelines, a patient must:
– Be under a doctor’s care
– Need intermittent skilled services
– Be considered homebound
– Receive care from a Medicare-certified agency
Home Health is common after:
– A hospitalization
– A fall
– Surgery (hip replacement, cardiac procedure, etc.)
– A new diagnosis
– Worsening chronic illness
It is typically short-term and purposeful and is often reevaluated on a 3-month basis by the doctor.
Think: “We are treating or stabilizing a medical condition.”
Home Care
Home Care (also called Personal Care or Companion Care) is non-medical support provided in the home.
It helps with daily living and safety, also referred to as Activities of Daily Life or ADLs. Home care is not considered medical treatment and is not commonly covered by Medicare
Home Care Includes:
– Bathing & dressing assistance
– Meal preparation
– Medication reminders (not management)
– Light housekeeping
– Transportation to appointments
– Companionship
– Fall prevention supervision
Home Care is:
– Private pay (most commonly)
– Sometimes covered by long-term care insurance
– Available short-term or long-term
– Not dependent on being homebound
Think: “We are supporting daily life and safety.”
Exception: Medicare will pay for a limited number of respite caregiving hours if the love one has been diagnosed with a form of dementia when approved through the CMS GUIDE Model. See our blog on How Am I Going to Afford Assisted Living or Home Care When I Need It? for additional ways to help pay for Home Care.
Why This Distinction Matters
In my work with families, I often hear: “We thought Medicare would cover someone staying all day.”
Medicare does not cover ADL (help with bathing, dressing, supervision) unless skilled services are also being provided, and even then, only intermittently. This misunderstanding can create stress during already overwhelming transitions.
Knowing the difference empowers families to:
– Plan financially
– Prevent caregiver burnout
– Reduce hospital readmissions
– Maintain dignity at home
When to Consider Home Health
– After a hospital or rehab stay
– If there are new wounds or medication changes
– If strength, balance, or speech has declined
– If a doctor recommends therapy at home
When to Consider Home Care
– A loved one is living alone
– There are memory concerns
– Meals are being skipped
– Hygiene is declining
– Family caregivers are overwhelmed
– There’s increased fall risk
– Loneliness and isolation are present
The goal is not just to keep someone at home. The goal is to keep them safe, supported, and thriving.
Sometimes that means layering services. Sometimes that means adjusting as needs change. And sometimes, when care becomes more than can safely be provided at home, it means exploring community living options. This is where my team of senior living professionals at Ruby Care Senior Living Advisors comes in to help when a transition is needed.
But the decision should always start with clarity.
If you are unsure which service your loved one needs, ask:
– Is this medical?
– Or is this daily living support?
– Is the support going to be needed for the short-term or long-term?
These questions often bring the answer into focus.