Home care vs. home health care: what each one does for your family

Is home care the same thing as home health care?

No, even though the names sound almost the same. The simplest way to remember it: home health care is medical, and home care is everyday help.

Home health care means a registered nurse, a physical or occupational therapist, a speech therapist or a medical social worker comes to the house because a doctor ordered it. It usually follows an illness, an injury or a surgery, and it ends when the medical goals are met.

Home care (sometimes called in-home care, senior care or non-medical home care) means a trained caregiver helps with the things that have become hard: showering, getting dressed, cooking, laundry, errands, and simply having someone there. No doctor's order is needed, and it can last as long as your family wants it.

Hospital paperwork, insurance forms and even some agencies use the two terms loosely. That is why so many families tell us they were not sure who was coming, what they would do, or who was paying. If you searched for a "home health aide" because your dad needs help bathing and getting around, what you are probably looking for is home care.

Why does Pennsylvania treat them differently?

Pennsylvania licenses them separately. The Department of Health issues one kind of license to home health care agencies, which provide skilled medical care, and another to home care agencies, which provide non-medical help. Some companies hold both. Many hold only one.

It's Your Home Care is a licensed home care agency based in Harrisburg. We provide non-medical care only, and we work alongside the home health and hospice teams our clients already have. We do not provide nursing, and our caregivers do not take on a nurse's tasks.

What does a home care caregiver actually do?

A home care caregiver helps with daily life. For most families that includes:

• Personal care: bathing, dressing, grooming, toileting, oral care, help at mealtimes, and a steady arm getting in and out of bed, a chair or the car.
• Help around the house: Meal Preparation, light housekeeping and laundry, groceries, errands and rides to appointments.
• Medication Reminders, such as a reminder at breakfast or help opening a bottle. Caregivers do not give medications.
• Companion care and supervision, including for a parent living with memory loss.
• Respite care for a tired family caregiver, plus overnight care and 24-hour care.

Your parent and your family decide what help is wanted and when. We write it down in a care plan, and visits can be a few hours a week or around the clock. Many families start small and add hours as needs change.

What does a home health nurse or therapist do?

A home health team provides skilled care. That means a nurse plus at least one other kind of help, such as physical therapy, occupational therapy, speech therapy, a medical social worker or a home health aide, on a part-time schedule under a doctor's plan.

After a hospital stay, the home health nurse might check a surgical wound, give injections, watch for warning signs, and teach your family about a new diagnosis. The therapist works on strength, balance and walking. A home health aide may help with a bath a couple of times a week while the skilled visits continue.

Visits are short, often under an hour. When the goals in the doctor's plan are met, or your parent is no longer considered homebound, home health ends.

How do home care and home health compare?

Here is the quick version families tell us is most useful.

Does Medicare pay for home care or home health?

Medicare pays for home health, not for ongoing home care. Medicare covers home health when a doctor has certified the need, your parent is homebound (leaving the house takes a lot of effort or is not advised), part-time skilled nursing or therapy is needed, and a Medicare-certified home health agency provides it.

Medicare.gov is clear about what it does not cover: round-the-clock care at home, meal delivery, homemaker services, and personal care such as bathing and dressing when that is the only help someone needs.

That last point catches many families off guard. Once the nurse and therapist finish, Medicare stops paying for help at home, even if your mom still cannot shower on her own. Our article on whether Medicare pays for in-home caregivers explains more, and our guide to how Pennsylvania families pay for home care walks through the options that can fill the gap.

How can both teams help after a hospital stay?

They share the week. Here is what that often looks like after a hip replacement, a fall, pneumonia or a heart failure stay at a hospital such as UPMC Harrisburg, Penn State Health Milton S. Hershey Medical Center or Lancaster General.

1. Before discharge. The hospital case manager sets up home health if the doctor orders it. Ask for the agency's name and phone number and when the first nurse will come. You can tell the case manager if you have a preference.
2. The first days home. This is when families most often call us. The nurse may come for an hour the day after discharge, and the therapist two or three times that week. The rest of the day and night, someone still needs to help with the bathroom, make meals, keep track of new medications and notice if something seems off.
3. A home care caregiver helps with those hours. Our caregiver can bring your parent home from the hospital, pick up prescriptions, set up a bedroom on the first floor, help with toileting and dressing, give medication reminders and encourage the exercises the therapist left, without doing the therapy itself.
4. Each team does its own job. The nurse handles the incision, injections and any change in the medical plan. Our caregiver tells the family what they notice, such as swelling, a skipped meal or confusion at night, and with your permission passes it along to the nurse. In an emergency, the caregiver calls 911.
5. When home health ends, usually within a few weeks, home care can continue on the same schedule or fewer hours. Many families step down from daily visits to a few shifts a week as strength returns.

Our pages on coming home from the hospital, recovery after surgery and coming home from a rehab stay describe that first week in more detail.

Who is in charge when both teams are coming?

The doctor directs the home health plan. Your parent, or the person they choose, directs the home care plan. In real life, the family is the hub that connects everyone.

A simple habit helps: keep one notebook on the kitchen table where the nurse, the therapist and the caregiver each jot down what they did and what they noticed. Give each agency the other's phone number, and tell both who makes decisions if your parent cannot speak for themselves.

It helps to know the boundaries ahead of time. Home care caregivers do not change dressings, give injections, fill pill boxes from bottles or adjust oxygen. Those are nursing tasks. Caregivers also do not decide whether a symptom needs a doctor. What they do is notice and speak up, so the right person hears about it.

What happens when home health ends but Mom still needs help?

The skilled visits stop, but the need for everyday help often continues. The home health agency gives notice before discharge, and that is a good moment to look honestly at the day.

Can your mom shower safely? Get to the bathroom at night? Make a meal? Remember her medications without a reminder? If the answer to any of these is no, home care can pick up where home health leaves off.

Several things can help pay for it: private funds, long-term care insurance, VA benefits or a Pennsylvania program. If your parent is 60 or older, the county Area Agency on Aging can tell you about the OPTIONS program. If Medicaid might be possible, ask about Community HealthChoices. We are glad to talk through which of these might fit before you decide anything.

How do you check which kind of license an agency holds?

Look it up on the Pennsylvania Department of Health's license search before the first visit. It shows whether a company is licensed as a home care agency, a home care registry or a home health agency, and whether the license is current.

If an agency's website talks about nurses or skilled care, ask which license covers that work, because a home care license does not cover nursing. Our guide to checking a Pennsylvania home care license walks you through the search. To find a Medicare-certified home health agency near your parent, use Medicare's Care Compare tool.

Where does hospice fit in?

Hospice is a third, separate team. It offers comfort-focused medical care, nurse and aide visits, chaplains and family support when someone has a serious illness that is not expected to improve. Hospice is licensed and paid for separately from both home health and home care.

Hospice aides visit for short periods rather than staying for a shift. Many families add home care for the long hours in between and for nights. Our page on home care alongside hospice explains how the two fit together.

What is a good next step?

If a discharge is coming, ask the case manager three questions. Is home health being ordered, and by which agency? How many visits a week should we expect? What help will my parent need between visits?

If the answer to that last question is more than your family can manage, you do not have to figure it out alone. Call us at (717) 695-2704 or request an in-home consultation. In the Harrisburg area we can usually visit within one to two business days, a little longer in outer counties. We are happy to coordinate with whichever home health agency is involved, and to answer questions even if you are not ready to start.