Home care vs. home health: what the difference means for your family

What home care actually looks like

Home care is the help that makes it possible for someone to stay in their own home safely. A caregiver arrives on a schedule you set. They help your mother shower without her being afraid of falling. They make lunch, run the laundry, change the bed, drive her to the pharmacy, and sit with her while she tells the same story for the fourth time that week — because being listened to is part of the care, not a break from it.

It is not clinical work, and that is the point. Nobody takes vital signs, dresses a wound or gives an injection. What a caregiver does is the ordinary, unglamorous, daily business of living, done alongside someone who can no longer do all of it alone.

Home care is usually ongoing. It can be a few hours a week or many hours a day, and it tends to grow slowly as needs change rather than ending on a fixed date.

Typical home care tasks:

• Bathing, dressing, grooming and toileting
• Help moving safely around the house and getting in and out of bed
• Meal preparation, light housekeeping, laundry and shopping
• Reminders — appointments, meals, and reminders to take medication the person takes themselves
• Companionship, conversation, and going along to appointments or errands
• Supervision for someone who should not be alone for long stretches

What home health actually looks like

Home health is medical care that happens to be delivered at home instead of in a facility. A registered nurse, physical therapist, occupational therapist or speech therapist visits, performs a clinical task, documents it, and leaves. Visits are typically shorter and less frequent than home care shifts — an hour, two or three times a week, rather than a four-hour block every morning.

It has to be ordered by a physician, and it has to be justified clinically. Wound care after surgery, IV or injectable medication, monitoring a new heart failure regimen, therapy to rebuild strength after a fracture: these are home health. So is the nurse who comes to teach a family how to manage a catheter or a feeding tube.

Home health is almost always temporary. It is authorized for an episode — often weeks, sometimes a couple of months — and when the clinical goal is met, it ends. Families are frequently surprised by this. The nurse who came three times a week after the hospital stops coming, and the underlying need for help with daily life is still there. That gap is where home care comes in.

Who pays for which

This is where the two diverge most sharply, and it is usually the reason the distinction matters to a family in the first place.

Medicare covers home health when a doctor certifies it is medically necessary and the person meets Medicare’s criteria. Medicare does not pay for ongoing non-medical home care — not for help with bathing, not for housekeeping, not for companionship. Families discover this late and it is a hard discovery.

Home care is paid for in other ways: privately, through a long-term care insurance policy, through VA Aid & Attendance for eligible veterans and surviving spouses, or through Ohio Medicaid’s PASSPORT waiver. Serenity is a contracted provider with the Council on Aging of Southwestern Ohio and accepts PASSPORT.

How to tell which one you are looking for

Ask what problem you are trying to solve. If the answer involves a clinical task — a wound, an injection, a therapy goal, a machine — you are looking for home health, and you will need a physician order. If the answer is that someone cannot manage the day safely on their own any more, you are looking for home care.

If you cannot tell, that is a completely reasonable place to be. Most families arrive at this question in the week after a hospital discharge, holding a folder of paperwork nobody explained. Call us, or tell us what is going on and we will point you in the right direction — whether or not the answer is us.