If you’ve started looking for help at home, you’ve probably run into two terms almost immediately:

Home health.

Home care.

They sound as though they should mean the same thing. They don’t.

The difference matters because the two services provide different kinds of help, have different requirements, and are paid for differently. Confusing them can leave families expecting help that never arrives—or paying for services they thought Medicare would cover.

So before you start calling agencies, it helps to understand one simple distinction:

Home health provides healthcare in your home. Home care helps you manage everyday life at home.

And sometimes, you need both.

What Is Home Health?

Home health is skilled healthcare delivered in your home.

It is generally intended for someone who needs medical care or rehabilitation but can receive that care safely without going to a hospital, rehabilitation facility, or outpatient clinic for every visit.

Home health services may include:

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

For example, someone recovering from hip surgery might have a physical therapist come to the house.

A person with a wound may need a nurse to assess it and provide wound care.

Someone recovering from a stroke may need physical, occupational, or speech therapy at home.

The key word is skilled.

These are services that require healthcare professionals or are connected to a skilled plan of care.

Who Orders Home Health?

For Medicare-covered home health, a physician or another allowed healthcare practitioner must certify that you need eligible home health services and establish or review your plan of care.

You cannot simply call Medicare and request ongoing home health because you’d like some assistance around the house.

Home health is commonly arranged after:

• Hospitalization
• Surgery
• Rehabilitation
• A significant illness
• A change in a chronic medical condition
• A decline in mobility or function that creates a need for skilled care

Your doctor or healthcare team may also recommend home health without a hospitalization if you meet the requirements.

What Does Medicare Require?

Medicare has specific requirements for its home health benefit.

In general, you must:

• Be under the care of a doctor or other allowed practitioner
• Need part-time or intermittent skilled nursing care, physical therapy, speech-language pathology, or meet requirements related to continued occupational therapy
• Be considered homebound
• Receive services from a Medicare-certified home health agency

“Homebound” doesn’t necessarily mean that you can never leave your house.

Medicare generally considers someone homebound when leaving home requires considerable and taxing effort or assistance because of illness or injury, and leaving home is not something the person normally does.

There are exceptions. For example, leaving home for medical treatment or occasional short outings does not automatically eliminate eligibility.

Because individual circumstances matter, the home health agency and healthcare provider determine whether the requirements are met.

What Does a Home Health Nurse Actually Do?

A home health nurse isn’t coming to spend the entire day with you.

Visits are generally focused on a particular medical need.

Depending on the patient’s condition and plan of care, a nurse might:

• Assess symptoms
• Monitor a medical condition
• Provide wound care
• Teach patients and caregivers how to manage medications
• Give certain injections or treatments
• Monitor recovery
• Teach disease-management skills
• Communicate changes to the healthcare provider

The nurse may visit periodically according to the plan of care.

This is one of the first places families can become confused.

They hear “a nurse is coming to the house” and imagine that someone will be there for several hours helping with everything the person needs.

That’s generally not how Medicare home health works.

What About Physical and Occupational Therapy?

Therapy is an important part of home health.

A physical therapist may work on:

• Walking
• Balance
• Strength
• Transfers
• Fall prevention
• Using a walker or other mobility device

An occupational therapist may help someone safely perform everyday activities such as:

• Getting dressed
• Bathing
• Using the bathroom
• Getting in and out of bed
• Preparing simple meals
• Navigating the home safely

A speech-language pathologist may help with problems involving:

• Speech and communication
• Swallowing
• Certain cognitive and communication difficulties

These professionals aren’t simply “helping around the house.” They are providing skilled therapy designed to improve or maintain function or teach safer ways of doing things.

What Is Home Care?

Home care is different.

Home care generally provides nonmedical assistance with everyday activities.

Depending on the agency, caregiver, state regulations, and individual needs, services might include:

• Bathing
• Dressing
• Grooming
• Toileting
• Meal preparation
• Light housekeeping
• Laundry
• Shopping
• Transportation
• Companionship
• Supervision
• Help with daily routines

This is often the assistance people are actually imagining when they say:

“Mom needs someone to come help her every day.”

Home care workers may be called personal care aides, home care aides, caregivers, companions, or other titles depending on the state and agency.

Here’s an Easy Way to See the Difference

Imagine an 82-year-old woman named Mary comes home after a fall.

She has a wound that needs monitoring and has become weak after several days in the hospital.

A home health nurse might come to assess the wound and monitor her recovery.

A physical therapist might work with her on strength, balance, and safe walking.

But Mary also needs someone to help her shower, prepare lunch, wash her clothes, and stay with her for several hours because her daughter is at work.

That’s home care.

Mary may need both.

And they may be paid for in completely different ways.

Doesn’t Medicare Pay for Someone to Help Me Bathe?

Sometimes—but this is where the details matter.

Under the Medicare home health benefit, a home health aide may provide certain personal care services if you qualify for home health and meet Medicare’s requirements.

However, Medicare does not cover home health aide services when personal care is the only care you need.

It also doesn’t turn the home health benefit into ongoing all-day custodial care.

So if someone needs help bathing, dressing, preparing meals, and being supervised every day—but doesn’t otherwise qualify for Medicare-covered skilled home health—Medicare generally isn’t going to pay for a caregiver to provide that ongoing assistance.

That distinction surprises many families.

Who Pays for Home Care?

Unlike Medicare-covered skilled home health, ongoing home care is often paid for through a combination of sources.

These can include:

• Personal income and savings
• Long-term care insurance
• Medicaid programs for people who qualify
• Certain veterans benefits
• State or local programs
• Family contributions

Coverage varies considerably.

Medicaid home- and community-based services, for example, vary by state and have financial and functional eligibility requirements.

Veterans may have access to certain programs depending on eligibility and circumstances.

Long-term care insurance policies vary widely in what they cover and when benefits begin.

For many families, however, at least some nonmedical home care ultimately becomes an out-of-pocket expense.

Why Isn’t This All One Service?

From the family’s perspective, it can seem ridiculous.

The person is at home and needs help. Why should one person handle the wound, another work on walking, another help with the shower, and the family figure out lunch?

Part of the answer is that the U.S. healthcare system separates medical care from much of what is considered long-term services and supports.

Medicare was primarily designed as health insurance. It was not designed to provide unlimited long-term custodial care.

But illness and aging don’t divide themselves quite so neatly.

Someone recovering from a serious illness doesn’t stop needing help when the nurse walks out the door.

A person with dementia may need relatively little skilled medical care while requiring many hours of supervision.

A person with severe arthritis may not need a nurse at all but may be unable to bathe or dress safely without assistance.

That’s the gap many families discover only after they need help.

What If I Have Dementia?

Dementia is a particularly good example of why understanding the difference matters.

A person with Alzheimer’s disease or another dementia might need:

• Medication reminders
• Meal preparation
• Supervision
• Help bathing and dressing
• Transportation
• Protection from wandering
• Assistance with daily routines
• Someone present because being alone is no longer safe

Those needs can be extensive.

But dementia itself does not automatically mean Medicare will pay for someone to remain in the home providing supervision for hours each day.

A person with dementia may qualify for skilled home health services if there is an eligible skilled need and Medicare’s other requirements are met.

But ongoing supervision and custodial care are different needs.

Families should understand that distinction early so they can plan realistically.

Can I Choose My Home Health Agency?

If you qualify for Medicare-covered home health, you generally have the right to participate in choosing among Medicare-certified agencies that serve your area and can accept you.

Hospitals and physicians may provide referrals or lists of agencies.

You can also compare Medicare-certified home health agencies through Medicare’s online Care Compare tool at Medicare.gov.

Availability matters, however. An agency may serve your geographic area but not have the staff or capacity to accept a new patient immediately.

What Should I Ask an Agency?

Whether you’re talking with a home health agency or a home care company, first make sure you’re talking about the same kind of service.

Ask:

• Are you a home health agency or a nonmedical home care agency?
• What services do you provide?
• Who will actually come into the home?
• How often and for how long?
• What does insurance or Medicare cover?
• What will I have to pay myself?
• What happens if my needs increase?
• Who do I call after hours?
• How are caregivers or clinicians screened?
• What happens if the assigned person doesn’t show up?

Don’t be embarrassed to ask very basic questions.

This system is confusing even for people who work in healthcare.

A Simple Rule to Remember

When you’re trying to figure out which kind of help you need, ask:

Do I need healthcare—or do I need help living my everyday life?

If you need nursing or rehabilitation because of an illness, injury, or medical condition, home health may be appropriate.

If you need help bathing, cooking, shopping, dressing, housekeeping, transportation, companionship, or supervision, you’re probably looking for home care or another community-based service.

If you need both, you may have both types of services in the home at the same time.

Understanding that distinction won’t solve every problem.

But it can prevent one of the most frustrating experiences families encounter: arranging “home health” and then discovering that the help they thought was coming isn’t actually what home health provides.

Knowing what you’re asking for is the first step toward getting the right help.

Next in the Getting Help at Home series:
Home Health: What It Is, Who Qualifies and How You Get It

Helpful U.S. resources: Medicare.gov provides current information about the Medicare home health benefit and Medicare-certified agencies. The federal Eldercare Locator at Eldercare.acl.gov or 1-800-677-1116 can connect older adults and families with local aging and community services.

This article is for general educational purposes and is not a substitute for medical, legal, insurance, or financial advice. Medicare, Medicaid, veterans benefits, and other program rules can change, and eligibility depends on individual circumstances.