Which of the two you are actually looking for

The two names are almost identical and the two services barely overlap. Nearly every fruitless week a family spends on the telephone about care at home comes from asking one kind of organization for the other kind of service.

Home healthHome care

Also called skilled home health, or just 'the nurse coming in'. Also called personal care, custodial care, or 'a caregiver'.

Skilled nursing or therapy, ordered by a clinicianBathing, dressing, meals, laundry, company, supervision

The first is medical treatment delivered at home. The second is help with daily life.

Intermittent visitsBlocks of hours, shifts, or live-in

Home health is visits of an hour or two, several times a week, for a defined episode.

Paid by Medicare when the tests are metPaid privately, by a state program, or by a long-term care policy

This is the difference that decides everything else.

Requires being confined to the homeRequires nothing but somebody to pay for it

A parent who can get out to a club or an appointment is often ineligible for the first and perfectly eligible for the second.

Both can run at the same time, and often should. A home health episode ends; the person still needs help with the bath afterwards.

1

What Medicare home health requires — all four, not any one

The regulation is explicit that a beneficiary must meet each of the requirements, not one of them. Families are often told they qualify because of a diagnosis, or refused because of one, and neither is how the test works.

  1. Confined to the home — or in an institution that is not a hospital, skilled nursing facility or nursing facility.
  2. Under the care of a physician or allowed practitioner, who establishes the plan of care.
  3. In need of at least one named skilled service, certified by that clinician: intermittent skilled nursing, physical therapy, speech-language pathology, or occupational therapy in the circumstances the rule sets out.
  4. Under a plan of care that meets the regulation, with the services furnished by or under arrangements made by a participating home health agency.

Two clarifications inside the skilled-service test decide real cases. Managing and evaluating the care plan can itself be the skilled service where the underlying conditions are such that only a registered nurse can ensure the unskilled care is doing its job. But a service is not skilled merely because a licensed nurse performed it — where it could be safely and effectively done by non-licensed staff without a nurse's direct supervision, it is not skilled even if a nurse did it.

Teaching is covered until it is clear it will not work. Once it becomes apparent after a reasonable period that the patient, family or caregiver could not or would not be trained, further teaching stops being covered — though the earlier teaching remains covered notwithstanding that it failed.

1

What the agency must tell you before it starts

The protections families need most arrive at the first visit, in a folder nobody reads. They are conditions the agency must meet to take Medicare at all.

You are entitled to all of this, in writing

  • Written notice of the patient's rights and of the agency's transfer and discharge policies, at the initial evaluation visit and before care starts.
  • The administrator's name, business address and business telephone number — specifically so that complaints can be made.
  • The same notice to a representative the patient chooses, within four business days of that first visit.
  • A statement, spoken and written, of how much of the care Medicare or another federal program is expected to pay for.
  • The charges for anything not covered, and any charge the patient must pay before care starts.
  • Notice of any change to those figures as soon as possible and before the next visit.
  • Written notice in advance if the agency believes a service may not be covered — and in advance of reducing or ending ongoing care.
  • The state's toll-free home health hotline, and the contact details for the Agency on Aging, Center for Independent Living, Protection and Advocacy Agency, Aging and Disability Resource Center and Quality Improvement Organization serving the area.

The last of those is quietly the most useful thing in the folder. The agency is required to hand a family the numbers of the local organizations that exist to help them — including the ones that arrange the home care Medicare will not pay for.

3

Paying for the help Medicare will not pay for

Once it is clear that what a parent needs is home care rather than home health, the question becomes who pays. There are four ordinary answers and they are not exclusive.

  • Privately, hourly or by shift, either through an agency or by employing somebody directly. Employing directly is cheaper and makes the family an employer, with the tax and insurance consequences that implies.
  • Through the Area Agency on Aging, which administers federally funded supportive services and can say what exists locally and what the waiting list looks like. The Eldercare Locator finds yours.
  • Through a long-term care insurance policy, if one exists. Most pay for personal care at home and many pay a family caregiver, and the trigger is usually an inability to perform a set number of activities of daily living.
  • Through a state Medicaid program, where a parent qualifies financially. That route is state-administered and is not part of Sahvelo's published guidance yet.

Employing a caregiver directly makes the household an employer. That is a legitimate and common choice, and it comes with payroll tax, verification of the right to work, and a question about insurance that is worth answering before rather than after the first fall.

Not sure which of these is yours?

Sahvelo answers from what it has verified, and asks when it needs one more fact.

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Sahvelo gives information drawn from statutes, agency guidance and official forms. It is not legal advice for your particular situation. Terms & disclaimer.

Questions people ask about this

  • They are cutting her visits from three a week to one.

    A reduction is not a termination and does not carry the two-day notice or the expedited appeal — those attach to cover ending altogether. What the agency does owe you is written notice in advance of reducing or ending ongoing care, and an explanation before the next visit of any change to what Medicare is expected to pay. Ask for both in writing, and ask which of the four eligibility tests the agency thinks is no longer met.34

  • She goes to church on Sundays. Does that mean she is not homebound?

    Not by itself. The regulation's first test is being confined to the home, and it is a clinical judgment made by the practitioner who establishes the plan of care rather than a rule about leaving the house. Sahvelo does not have a quoted federal definition of the term on this page and does not assert one. The right question is to the certifying clinician, and the right thing to describe is how hard leaving actually is, not how often it happens.1

  • We do not need a nurse. We need somebody to help her wash and eat.

    Then you are looking for home care, not home health, and Medicare will not pay for it on its own. The routes are private hire, an Area Agency on Aging, a long-term care policy, or a state Medicaid program. The home health agency's own folder is required to carry the Area Agency on Aging's contact details, which makes it a shortcut worth using. One thing to check before you accept that answer: if she is already receiving Medicare-covered skilled nursing or therapy at home, or a clinician thinks she needs it, then a part-time aide to help her wash and eat is covered alongside that skilled care. It is worth asking the certifying clinician directly rather than asking the agency's intake line.13

  • The agency says it is discharging her because of an argument with a caregiver.

    Discharge for cause is one of the seven listed grounds and it has procedural conditions attached. Before it discharges for cause the agency must advise the patient, the representative and the ordering practitioners that it is being considered, make efforts to resolve the problem, provide contact information for other agencies or providers who may be able to help, and document all of it in the clinical record. Ask whether each of those has happened.3

  • We do not want to complain in case they stop coming.

    The rule anticipates exactly that. The patient has the right to be free from any discrimination or reprisal for exercising their rights or for voicing grievances to the agency or to an outside entity, and the agency must investigate complaints, document both the complaint and its resolution, and take action to prevent retaliation while the investigation runs. The state hotline and the ombudsman are outside entities for this purpose.3

Related from the Sahvelo Journal: Medicare vs. Medicaid for a Parent's Long-Term Care

Where this sits in the process

Related

Sources

Three federal regulations: who qualifies, what an aide may be covered to do, and what the agency owes the patient.

  1. 42 C.F.R. § 409.42 (Home health services: Beneficiary qualifications for coverage)

    The four tests for Medicare home health, and the two clarifications that decide real cases.

    ecfr.gov Checked 2026-08-20

  2. 42 C.F.R. § 409.45 (Home health services: Dependent services requirements)

    When Medicare covers a home health aide for hands-on personal care, and the skilled-service condition that ends it.

    ecfr.gov Checked 2026-09-25

  3. 42 C.F.R. § 484.50 (Home health agencies: Condition of participation: Patient rights)

    What the agency must disclose about cost, notice before reducing care, and the seven grounds for discharge.

    ecfr.gov Checked 2026-08-20

  4. 42 C.F.R. § 405.1200 (Notifying beneficiaries of provider service terminations)

    The notice required before Medicare cover ends — which a reduction in services does not trigger.

    ecfr.gov Checked 2026-08-20

Sources last reviewed 2026-09-25. Where a source is marked pending re-verification, the page says so wherever the claim appears.