The terms “Home Health” and “Home Care” are often used interchangeably, creating confusion for people seeking support services. While both are provided in the home setting, they are legally, medically, and financially distinct categories of support. Distinguishing between them is important because the professional staff, the level of medical intervention, and the funding sources differ substantially. Understanding these differences determines which services are available and how they will be paid for.
Home Health Services: Skilled, Physician-Ordered Care
Home Health is a medical model of care that focuses on treating an illness, injury, or managing a new or acute health condition. These services are always prescribed by a licensed physician as part of a formal plan of care, often following a hospitalization or a significant health change. The goal of this care is generally temporary, goal-oriented, and intermittent, helping a patient recover, regain function, and become safe and independent in their home.
The services provided are considered “skilled” because they require the expertise of a licensed medical professional. Examples include skilled nursing care (e.g., complex wound dressing, administering intravenous medications, or monitoring unstable health status). Rehabilitative services are also core components, including physical therapy (PT), occupational therapy (OT) to relearn activities of daily living, and speech-language pathology (SLP) to address swallowing or communication issues.
Home Care Services: Assistance with Daily Living
Home Care is a non-medical, supportive model of care designed to help maintain a person’s independence and safety over a longer period. This service does not require a physician’s order or a diagnosis of an acute illness to begin. It is often used by older adults with chronic conditions or disabilities who need ongoing assistance to remain safely in their familiar environment.
These services focus on Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), the routine tasks of everyday life. ADL assistance includes hands-on help with personal needs like bathing, dressing, grooming, and safe transferring or walking. IADLs cover tasks like meal preparation, light housekeeping, laundry, grocery shopping, transportation, and companionship. Home Care provides custodial support and is generally a long-term arrangement.
Staff Credentials and Agency Oversight
Home Health staff are licensed medical professionals governed by strict federal and state regulations. Care is delivered by Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and licensed therapists, all operating within the scope of their professional license. Home Health agencies must be certified by the Centers for Medicare and Medicaid Services (CMS) to receive federal reimbursement, requiring rigorous compliance and quality reporting.
By contrast, Home Care staff are Personal Care Aides (PCAs), Home Health Aides (HHAs), or companions who provide non-skilled assistance. While many Home Care aides are certified or trained, they are not licensed medical professionals. The regulatory oversight of Home Care agencies is often less stringent and varies widely by state.
Funding Mechanisms and Eligibility
Home Health and Home Care utilize separate funding streams. Home Health services are covered by Medicare, Medicaid, and most private insurance plans, but only under specific, strict criteria. To qualify, the patient must require intermittent skilled services, and for Medicare, they must be certified by a physician as homebound (leaving home requires a considerable and taxing effort).
Home Care services are not covered by Medicare or standard private health insurance. Because this is non-medical custodial care, it is primarily paid for out-of-pocket (private pay). Other funding sources include Long-Term Care Insurance policies or specific state-based Medicaid waivers, which cover non-medical services for eligible low-income individuals. Understanding this distinction is critical for financial planning.