Home care

What it means

Home care is help with daily living, provided by an aide or companion rather than by a clinician. It needs no doctor's order and is arranged by the family or an agency.

It is paid for privately, by a long-term care policy once its trigger is met, by some state Medicaid waiver programs, or in some cases by a veterans' benefit.

Agencies differ in whether they employ caregivers or place them: an employment agency handles tax, insurance and cover for a sick day, and a registry does not.

Why it matters

It is the care most people actually need first, and the one nothing pays for by default. The gap between what a family assumes is covered and what is turns up here.

The employment question carries more weight than it appears to: hiring privately makes the family the employer, with the tax and liability that carries.

When you are likely to meet it

• When a parent is managing but not comfortably.
• When a hospital discharge sends somebody home who cannot manage alone.
• When comparing agencies and the prices differ for what sounds like the same thing.

Home care and home health

Two services with similar names, sold by similar-sounding agencies, and the difference decides who pays.

A person can have both at once — a nurse visiting three times a week under Medicare, and an aide every day that the family pays for.

How this varies by state

Whether a state's Medicaid program pays for care at home, and on what terms, is set by that state.

Related terms

• Activities of daily livingThe everyday self-care tasks — bathing, dressing, eating, using the toilet, moving from a bed to a chair, continence — that care assessments and insurance policies measure.
• Adult day servicesA daytime program providing supervision, activity and often health care outside the home.
• Area Agency on AgingA local agency, part of a national network, that arranges and coordinates services for older adults in its own area.
• Assisted livingHousing with help for daily tasks and staff on site, but without the licensed clinical care a nursing facility provides.
• Custodial careHelp with everyday living rather than medical treatment — bathing, dressing, eating, moving about. It is what most long-term care actually is.
• Home and community-based services waiverA Medicaid program paying for care at home instead of in a nursing facility.
• Home healthSkilled clinical care delivered at home, ordered by a doctor. Medicare may pay for it while the clinical need lasts.
• Independent livingAge-restricted housing with services and no personal care — the step before assisted living.
• Instrumental activities of daily livingThe harder-to-see tasks — money, medication, cooking, transport, the telephone. Difficulty here usually appears long before difficulty with bathing or dressing.
• Long-term care insuranceA policy that pays toward help with daily living — at home, in assisted living, or in a nursing facility — which health insurance and Medicare do not cover.
• MedicaidA joint federal and state program that pays for health care, including long-term care, for people with limited income and assets.
• Personal care agreementA written contract under which a family member is paid to provide care.
• Respite careShort-term care that gives an unpaid family caregiver a break — a few hours, a day, or a stay of some days.

Sahvelo guidance that uses this

• Housing transitions
• Home safety