Sometimes the realization comes suddenly. You are leaving the hospital after an illness or surgery, and you’re not sure how you’re going to manage once you get home.

Other times, it happens gradually. Getting dressed is harder. Meals aren’t being prepared. Medications are getting confusing. The stairs feel less safe. Your spouse is doing more and more for you.

Or perhaps you’re the adult child who has started noticing that Mom or Dad isn’t managing quite as well as they used to.

Whatever brings you to this point, the question is usually the same:

I think we need some help at home. Where do we start?

The first thing to know is that “help at home” isn’t one service. In the United States, it can mean several very different kinds of assistance, with different providers, eligibility requirements, and ways of paying for them.

Understanding what kind of help you actually need is the best place to begin.

Start With What Has Changed

Before worrying about Medicare, agencies, insurance, or costs, think about what is becoming difficult.

Can you or your loved one:

• Get in and out of bed or a chair safely?
• Bathe, dress, and use the bathroom independently?
• Prepare and eat regular meals?
• Take medications correctly?
• Walk safely through the home?
• Manage stairs?
• Keep medical appointments?
• Shop for groceries and other necessities?
• Keep up with laundry and basic housekeeping?
• Drive or arrange transportation?
• Remember important tasks and appointments?
• Respond appropriately in an emergency?

One difficulty doesn’t necessarily mean someone can no longer live independently. But several changes—or one serious safety concern—may mean it’s time for additional support.

A fall, new confusion, unexplained weight loss, missed medications, or difficulty with basic personal care deserves particular attention.

There Are Two Very Different Kinds of Help at Home

One of the most confusing parts of getting help is that home health and home care sound almost identical.

They aren’t.

Home health is healthcare.

Home health provides skilled medical or rehabilitation services in your home.

Depending on your needs, that might include:

• Skilled nursing
• Physical therapy
• Occupational therapy
• Speech-language therapy
• Medical social services
• Limited home health aide services when eligibility requirements are met

Someone recovering from a hip replacement, for example, might receive physical therapy at home. A person with a wound might need visits from a nurse. Someone recovering from a stroke might need nursing, physical therapy, occupational therapy, or speech therapy.

Home health generally requires an order or referral from an appropriate healthcare provider and must meet Medicare or other insurer requirements for coverage.

Home care helps with everyday life.

Home care—sometimes called personal care, companion care, or nonmedical home care—can provide help with things such as:

• Bathing and dressing
• Meal preparation
• Light housekeeping
• Laundry
• Shopping
• Transportation
• Companionship
• Supervision
• Help with everyday routines

This is often the kind of help families mean when they say, “We need someone to help Mom at home.”

And this is where many families encounter an unpleasant surprise.

Medicare generally does not pay for ongoing custodial care simply because someone needs help with everyday activities.

That distinction becomes very important when planning care.

You May Need Both

This isn’t necessarily an either/or decision.

Imagine an older adult comes home after being hospitalized for pneumonia. A home health nurse may visit to monitor recovery, and a physical therapist may work on strength and mobility.

But who makes breakfast?

Who helps with a shower?

Who does the laundry?

Who stays with the person if it isn’t safe to be alone?

Those needs may fall to family members, privately hired caregivers, community programs, or other services.

This gap between medical care at home and daily help at home is one of the most important things families need to understand.

If You’re Coming Home From the Hospital, Ask Before You Leave

Hospital discharge can be overwhelming. There may be new medications, new equipment, follow-up appointments, and instructions coming from several different people.

Don’t assume someone else has arranged help at home.

Ask the hospital doctor, nurse, case manager, or discharge planner:

“What help will I need when I get home?”

Also ask:

• Has home health been ordered?
• What services were ordered?
• Which agency will contact me?
• When should I expect the first visit?
• What medical equipment do I need?
• Who do I call if nobody contacts me?
• What activities will I need help with that home health won’t provide?

If you’re worried that going home isn’t safe, say so before discharge.

If You’re Already Home, Start With Your Healthcare Provider

If there has been a change in health or ability, your primary care clinician is often a good starting point.

Explain what is happening specifically.

Instead of simply saying:

“I’m having trouble at home,”

tell them:

“I’ve fallen twice this month and I’m having trouble getting into the shower.”

Or:

“My husband has dementia, and I can no longer safely leave him alone.”

Or:

“Since I came home from the hospital, I can’t get from the bedroom to the kitchen without becoming exhausted.”

Specific information helps the healthcare team determine whether there is a medical problem that needs evaluation and whether skilled home health, therapy, equipment, or another service may be appropriate.

What If the Problem Isn’t Medical?

You don’t necessarily need a medical problem to need help.

Perhaps your health is relatively stable, but grocery shopping has become difficult. Maybe you no longer drive. Perhaps maintaining the house is becoming overwhelming, or you simply need help bathing safely.

That’s when you may want to investigate home care and community-based services.

A useful starting point is your local Area Agency on Aging (AAA). These agencies help connect older adults and families with services available in their communities.

Depending on where you live, resources may include:

• Transportation
• Home-delivered meals
• Adult day programs
• Caregiver support
• Personal care assistance
• Benefits counseling
• Home modification programs
• Respite services

The federal Eldercare Locator, operated by the Administration for Community Living, can help you find your local aging services at

Eldercare.acl.gov or 1-800-677-1116.

What About Dementia?

Dementia deserves special consideration because a person may appear physically capable of living independently while no longer being safe without support.

Watch for things such as:

• Medications being missed or taken twice
• Food being left burning on the stove
• Getting lost in familiar places
• Unpaid or unusual bills
• Increased vulnerability to scams
• Poor nutrition
• Wandering
• Difficulty recognizing emergencies
• Leaving doors unlocked
• Changes in judgment

Someone with dementia may need supervision long before they need skilled nursing care.

That distinction matters because ongoing supervision is generally not what Medicare’s home health benefit was designed to provide.

Who Is Going to Provide the Rest of the Care?

This is a question worth asking early.

Families frequently build a care plan around one person—often a spouse or adult child—without really calling it a care plan.

Someone shops.

Someone drives.

Someone fills the pill organizer.

Someone helps with the shower.

Someone answers the phone at 2 a.m.

Eventually, that “someone” can become responsible for nearly everything.

If family members will be providing care, talk openly about what each person can realistically do. Consider work schedules, distance, health, finances, and other family responsibilities.

A care plan that depends on one exhausted person isn’t a very secure plan.

Then Comes the Question of Money

How care is paid for depends on the kind of care you need.

Medicare may cover eligible home health services when its requirements are met, but it generally does not cover ongoing personal or custodial care when that is the only care someone needs.

Medicaid may cover more extensive home- and community-based long-term services for people who meet their state’s financial and functional eligibility requirements.

Veterans benefits may help some eligible veterans and surviving spouses with care needs.

Long-term care insurance may cover certain home care services, depending on the policy.

And many families pay for some home care out of pocket, often combining paid assistance with unpaid help from relatives and community services.

There isn’t one payment system for help at home. That’s part of what makes navigating it so difficult.

Don’t Wait for a Crisis If You Can Avoid It

Sometimes there is no warning. A stroke, fall, or serious illness can change everything overnight.

But often there are warning signs.

If you’re beginning to think, “We’re managing, but barely,” that is a good time to start exploring options.

You don’t necessarily need eight hours of paid care every day. Sometimes relatively small changes can make remaining at home safer:

• A few hours of help several times a week
• Meal delivery
• Transportation
• A medication management system
• Grab bars and better lighting
• Physical or occupational therapy when medically appropriate
• An emergency response system
• Adult day services
• Help from several family members rather than one

The goal is to identify the problems and build support around them.

Start With Three Questions

If all of this still feels overwhelming, forget the terminology for a moment and start here:

1. What am I having trouble doing?

Write down the actual tasks or situations that concern you.

2. Is this primarily a medical need, an everyday living need, or both?

That helps determine whether you should be talking with a healthcare provider, a home health agency, a home care provider, community services—or some combination of them.

3. What is the most urgent safety concern?

You don’t have to solve everything today. Deal with the most important problem first.

Asking for Help Doesn’t Automatically Mean Leaving Home

Needing help at home doesn’t necessarily mean it’s time to move to assisted living or a nursing facility.

For many people, getting the right amount of help at the right time is exactly what allows them to remain at home longer.

The important thing is not to wait until everything becomes unmanageable before learning what your options are.

Start with what has changed. Talk with your healthcare provider when medical needs are involved. Find out what Medicare or other coverage may provide. Explore local aging services. Talk honestly with family members about what they can and cannot do.

Then build from there.

Because when you first realize, “I think I need help at home,” you don’t need to understand the entire American long-term care system.

You just need to know your next step.

Next in the Getting Help at Home series:
Home Health vs. Home Care: They Sound the Same, But They’re Not

This article is for general educational purposes and is not a substitute for medical, legal, insurance, or financial advice. Medicare, Medicaid, and other program eligibility and coverage rules can change and may vary by individual circumstances and state.