Amy bigger picBy Amy Rowan

Options Counselor, Area Agency on Aging
Member of the ADRC

I frequently receive calls from discharge planners; family and community members and/or a client who need some kind of supportive service in the home. Some need help with housekeeping, shopping, meal prep or bathing, and some need help with medication management, bathing and some sort of medical care or therapy. There is a lot of confusion on who provides what service and who pays for what service.  Most of the time I hear home health and home care used interchangeably, but there is a huge difference between the two.

The difference is that “home care” is “non-clinical” or “unskilled” care and “home health” is “clinical” or “skilled” care.

Home Health Care

Services provided are “skilled” or “clinical”, including nursing, mediation administration, medical test, therapy, health status monitoring, wound care, etc.

Services are delivered by a registered nurse, certified nursing assistance, therapist or other skilled medical professionals.  This service needs to be prescribed by a physician.

Home health care is usually provided on a short term basis, and the client typically has to be deemed homebound.

Situations in which you may need home health:

  • Following an inpatient hospitalization, rehabilitation, or a stay at a skilled nursing facility.
  • Medication management for either compliance or a recent medication change, in order to monitor for side effects and assure a new medication is effective.
  • When there is an overall decline in functioning – in order to regain independence through therapy or learning new skills to compensate for their deficit.

How do you pay for home health? Since home health is considered “skilled” medical care need, it is covered by medical insurance, Medicare, Medicaid (including waiver programs), and by private paying.

Home Care

Services provided are “unskilled” or “non-clinical”, including meal preparation, house cleaning, helping dressing, bathing, grooming, transportation, reminders to take medicine, help with bill paying, etc.

Services are delivered by caregivers, usually called home care aides, personal care aides or companions, who are trained in senior care and care for persons with disabilities.

Home care is frequently provided on a long term basis, and the client may or may not be homebound.

Situations in which you may need home care:

  • Assistance is needed with activities of daily living ranging from grooming to meal preparation
  • You no longer drive and require transportation
  • You live alone, and may be at risk for social isolation
  • The need for companionship

How do you pay for home care? Since home care is “unskilled” non-medical care need, it is not covered by Medicare (ever) or most medical insurance policies. It is covered Medicaid, Medicaid Waiver programs, long term care insurance and by private paying.  Area Agency on Aging programs usually has programs through the Older Americans Act that can assist in funding for home care.

The charts below highlight some of the differences between home health and home care, both in terms of services provided and method of payment: (chart provided by

Services Comparison

home health service

Payment Options Comparison


Both home health and home care are very beneficial in helping seniors and persons with disabilities live independently in the community.  Both can be used simultaneously.  It is important to know your options and payment sources. Many seniors have purchased long term care insurance; call you insurance agent to see what your policy covers before you need to coverage. Also, call your local Area Agency on Aging (970.249.2436 ext. 201 or 203) for a list of all available home health and home care services in your community.