Home health care is medical and supportive care delivered in a patient’s home rather than in a hospital, nursing facility, or clinic. It ranges from skilled nursing and physical therapy to help with daily tasks like bathing and dressing. The key distinction that affects everything from insurance coverage to staffing is whether the care is “skilled” (requiring a licensed health professional) or “custodial” (assistance with everyday activities that doesn’t require medical training).
Skilled Care vs. Custodial Care
Skilled home health care involves services that must be performed by a registered nurse, licensed practical nurse, or licensed therapist. This includes wound care, IV therapy, administering medications, pain management, and monitoring a patient’s overall condition. It’s considered medically necessary for actively treating a condition, illness, or injury, and it typically requires a doctor’s order and a formal plan of care.
Custodial care covers help with activities of daily living: walking, grooming, bathing, dressing, toileting, and eating. These tasks can be safely handled by someone without clinical training. The distinction matters because Medicare and most insurance plans cover skilled care but generally do not cover custodial care on its own. If you or a family member needs only custodial support, the cost usually comes out of pocket or through long-term care insurance or Medicaid.
Services Provided in the Home
The range of home health services is broader than most people expect. Nursing care is the most common type. A registered nurse, working with the patient’s doctor, creates a care plan that can include wound dressing changes, ostomy care, IV therapy, medication administration, pain control, and general health monitoring.
Rehabilitation therapies are another major component. A physical therapist helps patients regain strength and mobility in muscles and joints. An occupational therapist works with patients who need to relearn daily functions like eating, bathing, or dressing after an illness, injury, or disability. A speech therapist helps patients with impaired speech regain the ability to communicate.
Beyond clinical care, home health can also include:
- Medical social services: Social workers provide counseling, help locate community resources, and sometimes serve as case managers coordinating complex care.
- Home health aides: Trained aides assist with personal needs like getting out of bed, walking, bathing, and dressing. Some have specialized training to help with more advanced care under a nurse’s supervision.
- Lab work and imaging: Blood draws, urine tests, and even portable X-rays can be done at home.
- Medical equipment and medication delivery: Supplies, medications, and equipment are delivered to the home, with training on how to use them if needed.
- Homemaker services: Help with meal preparation, laundry, grocery shopping, and general housekeeping while a patient recovers.
Some patients also receive physician home visits, home-delivered meals, or transportation to and from medical facilities for appointments and treatments.
How Home Health Care Gets Started
Home health care doesn’t begin with a phone call to an agency. For insurance-covered skilled care, a physician or qualified practitioner must first have a face-to-face encounter with the patient and document it. That encounter serves as the basis for certifying that the patient is eligible for home health services. The certifying physician attests to the date the encounter occurred and provides clinical documentation supporting the need for care.
From there, the physician works with the home health agency to develop a plan of care outlining which services the patient needs, how often, and for how long. This plan guides every visit and is reviewed regularly.
How Long Care Lasts
Medicare structures home health care in 30-day payment periods, bundled into 60-day certification cycles. At the end of each 60-day period, a decision is made about whether to recertify the patient for another 60 days. The recertification assessment typically happens during the last five days of the current period, so there’s no gap in care.
There is no cap on how many times a patient can be recertified. As long as the patient continues to meet eligibility requirements, care can continue indefinitely through successive 60-day cycles. This is an important point that surprises many families. Home health is not limited to a set number of visits or weeks.
What Medicare Covers (and What It Costs)
For all covered home health services, Medicare patients pay nothing out of pocket for the care itself. There is no copay for skilled nursing visits, therapy sessions, or home health aide services when they’re part of a certified plan of care.
The one exception is durable medical equipment, like walkers, hospital beds, or wheelchairs. After meeting the Part B deductible, patients pay 20% of the Medicare-approved amount for covered equipment.
To qualify for Medicare coverage, a patient generally needs to be considered “homebound,” meaning leaving home requires considerable effort or is medically inadvisable. Being homebound doesn’t mean you can never leave, just that doing so is difficult and infrequent. The patient must also need at least one skilled service (nursing, physical therapy, speech therapy, or occupational therapy) and receive care from a Medicare-certified agency.
How to Evaluate an Agency
Not all home health agencies perform equally. Medicare’s Care Compare tool lets you search for agencies by location and review their quality ratings. Agencies receive a star rating based on eight measures of patient care covering both processes (did the agency follow best practices?) and outcomes (did patients actually improve?). Ratings range from one to five stars.
These ratings carry real weight. Under the national Home Health Value-Based Purchasing model, agencies receive Medicare payment adjustments ranging from negative 5% to positive 5% based on how well they perform on quality measures compared to their peers. Agencies that consistently deliver better outcomes and patient experiences earn more, while lower-performing agencies see their payments reduced. This means agencies have a financial incentive to improve the care they deliver, and the star ratings give you a window into how well they’re doing.
When comparing agencies, look beyond the overall star rating. Check whether the agency offers the specific services your situation requires, ask about staff availability on evenings and weekends, and confirm that the agency is Medicare-certified if you plan to use Medicare coverage. Talking with the patient’s physician can also help, since many doctors have working relationships with local agencies and can recommend ones they trust.