By Britt Hemsell, Senior Living Advisor at Ruby Care | Contributor
When family members start requiring assistance at home, a common question that arises is: “Should we opt for Home Health or Home Care services?”
Although these terms may appear similar—both services take place in the home and can even overlap—they are distinct. Grasping the differences can help bridge care gaps, lower the likelihood of hospital readmissions, and, most importantly, guarantee that your loved one receives the appropriate type of support at the necessary time.
Having navigated this situation with relatives several times, I will share insights based on those experiences while clarifying the differences between the two services, including what Medicare or insurance plans may cover.
Home Health
Home Health refers to medical care delivered at home by certified healthcare professionals. This service is prescribed by a physician and is usually reimbursed by Medicare, Medicaid, or private insurance provided specific conditions are met. Coverage guidelines can be found in the Centers for Medicare & Medicaid Services (CMS) Medicare & You Handbook.
Services under Home Health Include:
– Skilled Nursing (RN/LVN)
– Physical Therapy (PT)
– Occupational Therapy (OT)
– Speech Therapy
– Medical Social Work
– Wound Care
– Medication management
– Post-surgical monitoring
Medicare Requirements
According to CMS regulations, a patient must:
– Be receiving care from a physician
– Require intermittent skilled services
– Be classified as homebound
– Obtain services from a Medicare-certified agency
Home Health is usually seen after:
– A hospital stay
– An injury from a fall
– Surgical procedures (like hip replacement or cardiac operations)
– A new health diagnosis
– A decline in chronic illness
This service tends to be short-term and goal-oriented, with evaluations typically conducted every three months by the physician.
Consider it as: “We aim to treat or stabilize a medical issue.”
Home Care
Home Care, often referred to as Personal or Companion Care, involves non-medical assistance provided at home.
This type of care focuses on everyday living activities and safety, also known as Activities of Daily Living (ADLs). Home Care does not include medical treatment and is generally not reimbursed by Medicare.
Services Offered in Home Care Include:
– Assistance with bathing and dressing
– Meal preparation
– Medication reminders (not management)
– Light housekeeping tasks
– Transportation to appointments
– Providing companionship
– Supervision to prevent falls
Key Features of Home Care:
– Primarily funded through private payment
– May be covered by long-term care insurance in some instances
– Can be arranged for short-term or long-term needs
– Not contingent upon being homebound
Remember: “We are here to support daily living and ensure safety.”
Important Note: Medicare covers a limited number of respite caregiving hours if a loved one has been diagnosed with dementia, contingent upon approval through the CMS GUIDE Model. For more options on funding Home Care, check out our blog titled How Will I Afford Assisted Living or Home Care When Needed?.
Understanding the Importance of This Distinction
During my consultations with families, I frequently hear: “We assumed Medicare would cover a caregiver for the entire day.”
Medicare does not reimburse for assistance with ADLs (like bathing or dressing) unless skilled services are also included, and even then, only on an intermittent basis. This common misconception can add stress during already challenging transitions.
Being informed about these differences enables families to:
– Strategize financially
– Avoid caregiver fatigue
– Minimize hospital readmissions
– Preserve dignity at home
When to Think About Home Health
– Following a hospital or rehabilitation stay
– If there are newly developed wounds or medication adjustments
– If there’s a decline in strength, balance, or speech
– If a healthcare provider recommends at-home therapy
When to Think About Home Care
– A loved one is living independently
– There are concerns regarding memory
– Meals are frequently skipped
– Personal hygiene is declining
– Family caregivers are feeling overwhelmed
– Risk of falls has increased
– A sense of loneliness or isolation is present
The objective is not merely to keep someone at home, but to ensure they are safe, supported, and flourishing.
At times, this means integrating various services or adapting as needs evolve. When necessary, exploring community living options is essential for safety and well-being. My team at Ruby Care Senior Living Advisors is dedicated to providing support during these transitions.
However, making informed decisions should always start with clear awareness.
If you’re uncertain about which services your loved one requires, consider asking:
– Is this a medical need?
– Or does this pertain to daily living support?
– Is this support required for a short or long duration?
These inquiries often yield clarity on the matter.
