Home Health vs. Home Care: Understanding the Key Differences in Senior Support
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This article explains the differences between home health and home care, and provides an overview of the types of in-home care available.
- Home health is considered “skilled” care, and is provided by trained, licensed, or certified professionals.
- Home care is referred to by different subcategories, such as companion care, hands-on care, direct care, or custodial care.
- Home health is generally covered by Medicare, Medicaid, and other health insurance policies, while home care is not usually covered by health insurance.
There’s a lot of confusion regarding home health and home care. Is there a difference between the two? What about skilled home care? Non-medical personal care? Are these all distinct services or simply alternate names for the same thing?
In this article, we’ll look at some of the common terms used in the field of home care so you’ll have a better idea of what kind of in-home help your loved one may need.
“Home Health Care” or “Skilled Care”
Home health is considered “skilled” care, that is, medical care provided by trained, licensed, or certified professionals, such as nurses or physical therapists.
Many types of home health treatments exist for a wide array of conditions. A few examples include:
- Injections or intravenous (IV) drugs or infusions
- Wound care (pressure sores or surgical wounds)
- Patient/caregiver education
- Monitoring of serious or unstable health conditions, if safe to do so at home
- Pain management
- Fall reduction
- Maintain or improve strength or balance
- Learning new ways to function or take care of oneself with health challenges
Home health is usually provided on a temporary basis and there’s always a specific goal in mind.
Common goals of home health include:
- To heal from an illness, injury, surgery, or procedure
- To regain independence to the extent possible
- To maintain current abilities or level of functioning
- To minimize an expected decline in condition
Home health requires a doctor’s order and oversight. The home health professional will keep in communication with the doctor regarding your loved one’s progress toward their defined goal.
For many conditions, home health can be just as effective as staying in a hospital or skilled nursing facility, but it’s generally more comfortable and convenient, and less expensive.
Home health does NOT generally include:
- Long term or full-time care
- Meal delivery
- Household chore, transportation, or errand support (except to a limited extent as part of an overall care plan)
- Custodial or personal care (except to a limited extent as part of an overall care plan)
Home Care, Non-Medical Personal Care or Non-Skilled Care
Home care is called by a number of different names, including “non-medical home care” or “non-skilled care” to differentiate it from home health services.
Sometimes, home care is referred to by different subcategories – such as companion care, hands-on care, direct care, or custodial care – which can offer clues as to the scope of duties the care entails. In many cases, home care services entail multiple subcategories in one assignment.
A companion caregiver usually focuses on keeping their client company or engaged in pleasant or meaningful activities. They may also offer emotional support or safety reminders in some cases, such as for a forgetful older adult who often tries to get up to walk when it’s not safe to do so.
Companion care generally doesn’t include help with medical care, hands-on care, personal care, household chores, or errands.
Hands-On (or Direct) Care
Hands-on or direct care means the caregiver offers some level of physical assistance to their client with walking, personal care, activities of daily living, or other care tasks.
Custodial care refers to non-medical care that can be performed by unlicensed caregivers. It’s intended to support individuals who can’t care for themselves independently due to chronic health conditions. Examples of custodial care include help with errands or assistance using the bathroom, taking a shower, or eating.
Custodial care can be provided in various settings, including the home, facilities, or adult day programs.
Private Duty Care
Private duty caregivers are usually employed directly by their clients rather than by an agency (and “privately paid” caregivers always are).
However, some home care agencies refer to their caregivers as private duty caregivers (or private duty aides). If so, they’re usually scheduled to stay with their client for longer periods of time, with shifts lasting four to eight hours or more.
Typically private duty caregivers provide non-medical care, however, there are some cases in which they’re licensed or otherwise trained to assist with medical needs. Sometimes they provide monitoring or assistance to clients in a hospital or facility who need extra reassurance, companionship, or intervention for safety.
Paying for Home Health and Home Care
Home health is generally covered by Medicare, Medicaid, and other health insurance policies.
Home care is not usually covered by health insurance, but in some cases, Medicaid will pay for it. Home care is often covered, at least to some extent, by long-term care policies.
Medicare doesn’t cover non-medical home care services like meal delivery or round-the-clock care in the home. It won’t generally cover household chores or personal care, although, in some cases, home health aides may assist with chores or personal care on a limited basis as part of an overall home health care plan.
Medicare will pay for home health under certain circumstances, including:
- Medicare must consider the treatment to be “medically necessary”
- It must be ordered by a doctor or other authorized medical provider
- It must be safe and effective to provide the care at home, and it must be expected to improve in a reasonable and predictable period of time
- The care must be provided by a professional who contracts with Medicare.
- Your loved one must be “homebound” which means they have difficulty leaving their home without help from other people or special equipment.
If your loved one has Medicaid health insurance, it will generally pay for medically necessary home health services.
In some states, Medicaid may cover the costs of home care either through regular Medicaid health insurance or a special Medicaid waiver program.
Long Term Care Insurance
Some long-term care (LTC) insurance policies will cover home care services. Check with your loved one’s insurance agent or read their policy closely. There may be limitations, waiting periods, or other requirements to consider before your loved one can start claiming benefits.
Home health isn’t covered by LTC insurance.
Home health is generally covered by health insurance, so it’s uncommon to pay for it out of pocket. However, if you exhaust your coverage or feel strongly you’d like services that may not be deemed “medically necessary” there’s no reason you can’t pay for them yourself.
Home care expenses are most often paid out of pocket if no long-term care policy exists.
The Difference Between Home Health and Home Care
Home care and home health are two types of support provided in the home.
Home care refers to non-medical services, such as personal care, household chores, and errand support. It’s reasonable for non-medical people to be able to perform this work safely. It’s often used as a long-term support for individuals with chronic conditions.
On the other hand, home health – often called “skilled care” – is medical care provided by licensed professionals at the direction of a doctor. It’s provided on a goal-oriented basis for a defined period of time.
Both home care and home health can be integral parts of caring for an older adult. They can be provided separately or as part of an overall support plan. In fact, many agencies offer both services under one roof. Both home care and home health can make a big difference in the health, safety, and quality of life of your loved one.
TJ Falohun, co-founder and CEO of Olera, is a trained biomedical engineer passionate about developing novel digital health and medical technologies. His passion for innovative solutions drives him to write about his experience in elder care and to revolutionize the senior healthcare industry.
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