Home Health vs. Home Care: What’s the Difference?

Updated

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

There is understandably a great deal of confusion about the difference between home health and home care. For one thing, the word “home” is in both terms, which indicates that each of these valuable services can provide support to help people recover from illness or accidents at their primary residences. Moreover, the duties that home care staff provide can vary from state to state. Some states allow home care caregivers to perform various medically oriented tasks, and others don’t. 

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In many cases, families use both home health and home care together since each of these programs has different criteria to qualify. Unfortunately, many times a person’s needs can’t be met entirely by just one. It is not unusual for patients to go on and off both of these services over time.

So what’s the difference between these two? We will sort it all out for you and explain under what conditions home health makes the most sense and when home care can help. Taking advantage of both can offer several benefits.

Overview: Home Health vs. Home Care

Home health is skilled medical care usually provided in a person’s home and assisted living, independent living, and residential care homes. This type of care is usually covered by insurance.

Nursing homes already have 24-hour nursing so they do not offer home health. By contrast, home care is usually not covered by any insurance plans or Medicare, but can be paid for with a long-term care plan. When it comes to the type of care under each one, they can differ based on your state of residence and what kind of health insurance you have.


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Home health

Traditional Medicare and Medicare Advantage plans cover home health, but Medicare Advantage plans might have more limited companies they contract with to provide services. If you have traditional Medicare with a Medigap plan, you can choose any home health company that is Medicare certified. Since insurance covers home health, you must meet specific criteria. The medicare guidelines include the following: 

  • Patients must be under the care of a doctor, and follow a specific plan of care created and reviewed regularly by a doctor.
  • A doctor must certify that you require one of the following:
    • Intermittent skilled nursing care (other than drawing blood)
    • Physical therapy
    • speech-language pathology
    • continued occupational therapy services
  • These services must be specific, safe, and effective to be included in your treatment plan.
  • The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively.
  • Your specific treatment requires you to be homebound, with a doctor certifying that you will be homebound for the foreseeable future.

The guidelines also state that people cannot receive home health as a benefit if treatment is intermittent or part-time. However, patients can leave home for medical treatments, infrequent absences, or non-medical appointments such as religious services. Additionally, home health is still provided to those who attend adult day care.

As you can see, the criteria are strict, and once you are on home health, your progress and continued eligibility are under continuous review throughout your participation. 

Home care

Home care is a bit more complicated due to the variability of tasks based on where you live. Here are some of the main differences between home care and home health.

As mentioned above, home health is typically covered under insurance, whether through privately paid health insurance or programs like Medicare. Home care is not covered by insurance unless you have a long-term care policy that includes home care.

Given that home care is not covered under insurance, home care also does not require a doctor’s order. Anyone can contract for home care services when they need them.

Home care is not considered medical care, and therefore the home care staff are not necessarily licensed or certified. Home health has a lot of criteria for both skilled medical providers and patients with specific time-bound treatment plants. By contrast, home care does not require you to be homebound, nor does it have any other requirements such as time limits.

Home Health vs. Home Care: What Do They Offer?

Home health and home care, although both valuable, offer somewhat different services. As a family, it is important to understand what home care can do and what they can’t in the state where you live. If your loved one is discharged from home health and still has medical needs, home care may not be able to meet those needs due to state restrictions. 

What home health offers

  • Nursing
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Respiratory therapy
  • Social work
  • Home Health Aides

Aides under home health are not permitted to provide transportation, cooking, companionship, or cleaning. Under home health, the aide’s duties are to help with bathing, dressing, hygiene, and toileting. 

What home care offers

As mentioned, some states permit home care staff to perform minor medical tasks. Other states are much more restrictive. Here are some of the tasks that home care can help with:

  • Companionship
  • Transportation
  • Shopping
  • Meal preparation
  • Medication reminders
  • Taking vital signs such as blood pressure and temperature
  • Help with bathing, dressing, grooming, hygiene, and transfers
  • Blood sugar checks (in some states)
  • Administer medications (in some states)

There might be other tasks that home care caregivers can do in your state. Ask the agency you are considering to give you a detailed list of what kind of help they offer. 

Home Health vs. Home Care: Who Are They Typically For?

Home health is time-limited, and home care is not. Now that you know what each service has to offer, let's examine who they are typically for.

Who is home health for?

Home health is most often used when someone is in the hospital or nursing rehab with an injury or illness and requires medical support to go back home. In other cases, someone may have a slow decline due to medical conditions and get to the point where they need someone to monitor blood pressure, provide wound care, diabetic care, or other skilled support.

Other situations, such as a fall resulting in a broken bone, may require specific nursing support in addition to physical and occupational therapy to help someone recover function and mobility. As you may remember, for a person to be eligible for home health, they must be homebound, which means they can’t drive independently. 


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Who is home care for?

Due to the flexibility of home care, it is up to the patient and family to decide when they need it. When the burden of caregiving gets to be too much for families, they look to home care to provide some respite from those duties.

In most cases, someone starts home care because they need some assistance with bathing safely, grocery shopping and cooking nutritious meals, transportation, and other non-medical duties. Families often use home care services if they have a loved one with dementia who needs monitoring and companionship. For families that can afford it, some use home care 24-hours a day.

Home Health vs. Home Care: How Much Do They Cost?

Cost is a consideration for most families, and if finances are tight, the cost of care can prevent people from getting the help they need. Caring for aging parents takes planning and an understanding of how and when home health and home care make the most sense.

The cost of home health

Most insurance covers home health. But, keep in mind that it is time-limited, and once someone has recovered or is not making progress, they will likely be discharged from service. If you have private insurance, you will want to check with your insurance company to see what home health services are covered.

The cost of home care

Home care costs depend on these factors: where you live, the agency you contract with, and the amount of time you need the caregiver. According to Genworth, the monthly median cost for home care in 2020 was $23.50 an hour.

Home Health vs. Home Care: Pros and Cons of Each

As mentioned above, there are a lot of different situations that can require either home health, home care, or even both. However, when it comes to picking one for you and your loved one, you may want to weigh the pros and cons of each one.

Pros of home health

  • Home health has an array of medical services that can meet almost any need.
  • Home health is covered by most insurance, and therefore there are no out-of-pocket costs.
  • Home health can be restarted several times as long as the patient continues to meet the criteria.

Cons of home health

  • Home health does not provide 24-hour care.
  • Home health is time-limited
  • For someone who has complex medical needs, home health may not be able to accommodate those needs. 

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Pros of home care

  • Home care can fill in the gaps of care that home health can’t, such as transportation, meal preparation, shopping, and companionship.
  • Home care is flexible, and within reason, there are no criteria to meet.
  • Home care can take the burden off of family caregivers

Cons of home care

  • Many families simply can’t afford home care. Depending on the needs of the family member, costs can soar.
  • In some states, home care workers can’t offer simple tasks like giving medications. 
  • The home care industry is known for high turnover, so you may have to work with multiple caregivers.

Home Health vs. Home Care: How to Find the Best Care

Finding the best home health and home care could be affected by several considerations, some of which are out of your control. For example, if you live in a less populated area, you may have just a few choices of agencies. If you live in a large city, you could have more options than you know what to do with. Here are some general guidelines for finding the best care.

Home care

If you have many choices of home care agencies, there are several ways you can evaluate which ones give the best care.

  • Talk to your loved one’s doctor and other healthcare providers. They may have experience working with good agencies and can give detailed information on the kind of care they deliver.
  • Go online to read reviews. Some reviews have to be taken with a grain of salt, but you can probably get a pretty good idea of quality.
  • Post a question on Facebook or other social networking platforms like in your Next Door neighborhood, where people can give you first-hand experience with agencies.

Home health

Your insurance coverage may limit your choices of home health. If you are on a Medicare Advantage plan, call to see which agencies are contracted with your specific plan. Other suggestions:

  • Talk with home care agencies, who often work hand in hand with home health. 
  • Ask your loved one’s health providers who they use and like.
  • Don’t be dissuaded by a locally owned company.  They often provide care as good or better than large national companies.
  • Call and speak with the discharge planner of a skilled nursing rehab facility to get their opinion.

Home Health and Home Care: Two Valuable Services

Now that you understand the differences and similarities between home health and home care, you can make better decisions about care for your loved one. Mix and match home health and home care to provide support, rehabilitation, and companionship. 


Sources:
  1. “Home Health Services.” Your Medicare Coverage, Medicare.gov, 2021. Medicare.gov
  2. “Cost of Care Survey.” Aging and Your Finances, Genworth, 2021. Genworth.com
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