Home health or in-home care: which one do you actually need?

Home health care and in-home care are two different services. They sound like the same thing, they are often delivered in the same house in the same week, and confusing them is how families end up with a bill they were certain somebody else was paying.

The distinction is not about where the care happens. Both happen at home. It is about whether the care is medical.

Home health care is medical, and temporary

Home health is skilled medical care delivered at home by licensed clinicians. A nurse, a physical therapist, an occupational therapist, a speech therapist. It has to be ordered by a doctor, it is tied to a specific medical problem, and it is meant to end.

Typical home health looks like:

• Wound care and dressing changes after surgery
• Physical therapy after a hip replacement or a stroke
• Teaching a family how to manage a new diagnosis or a new device
• Injections, IV therapy, and monitoring of a specific condition

In Mississippi, agencies providing skilled medical services at home have to be licensed by the State Department of Health. If somebody is offering nursing care in your parent’s house, that license is a fair thing to ask about.

In-home care is not medical, and it is ongoing

In-home care, also called personal care, home care, or non-medical care, is help with daily living. Bathing, dressing, meals, housekeeping, errands, company, and being there so somebody is not alone. It does not require a doctor’s order, it is not tied to a diagnosis, and it can carry on for years.

This is what Hodges Elderly and Disable Services does. It is also what most families are actually looking for when they start searching, even when they use the phrase “home health” to describe it.

The part that costs people money

Medicare’s home health benefit has real gates on it. A doctor has to certify that the person needs skilled care. In most cases the person has to be considered homebound, meaning leaving home takes considerable effort. The care has to be intermittent rather than continuous. And the doctor has to recertify the whole plan every 60 days for it to carry on.

A home health aide can help with bathing and dressing under that benefit, but only alongside a skilled service. When the skilled need ends, so does the aide. That moment, when physical therapy finishes and the visits simply stop, is when a great many families discover that the daily help they had grown used to was never a long-term arrangement.

How to tell which one you need

You probably need home health if

• A doctor has just ordered therapy or nursing at home
• There is a wound, a catheter, an injection, or a new device
• Somebody is recovering from surgery, a stroke, or a hospital stay
• The goal is to get back to where they were before

You probably need in-home care if

• The problem is bathing, dressing, meals, laundry, or the house
• They are alone too much and it is starting to show
• They have stopped driving and are missing appointments
• You are the one doing all of it and you are running out of room
• Nothing has changed medically, it is just gradually gotten harder

Very often the answer is both

These two services run alongside each other constantly, and they are not in competition. A typical run of events looks like this. Your father falls and breaks a hip. He has surgery. He comes home with Medicare-covered home health for physical therapy three times a week. Meanwhile somebody still has to get him into the shower on the other four days, cook, do the washing, and drive him to the follow-up appointment. That second list is in-home care, and it is on the family unless the family arranges otherwise.

When the therapy ends after six or eight weeks, the home health stops and the second list does not.

So who does pay for in-home care?

Mostly families, out of pocket, at rates that in Mississippi are the lowest in the country. Beyond that there are three routes worth checking: the Medicaid Elderly and Disabled Waiver, a long-term care insurance policy if one was ever bought, and VA Aid and Attendance for wartime veterans and their surviving spouses.

Our guide on what in-home care costs in Mississippi goes through all four in more detail, with the actual numbers.

Medicare coverage decisions are made by Medicare, and the rules summarized here are general. For a specific situation, check with the person’s doctor and with Medicare directly.