Home Care vs Home Health: What each covers and when you typically use them

Medical Insurance (including Medicare) does NOT pay for a day in day out custodial care! This is largely an out-of-pocket expense.

Have a stroke, heart attack, fall and break something that basically makes you bed or chair bound and/or restricts your mobility?

Once you leave the hospital or rehab center, you will probably need family support and/or private pay nonmedical Home Care assistance!

If you have any kind of illness that places you in the hospital for an extended period of time or have a procedure that results in a lack of mobility, you may be discharged to your home or to a rehab setting.

If you go home, you probably will get a script for Home Health services (Physical Therapy) and may need Home Care as well.

If you go to rehab for a few weeks, when they send you home, the above still may apply.

Here’s a quick review of what both services entail

• Home Health Care involves the delivery of some type of skilled care (delivery of medications, wound care, home infusions, catheter care, ostomy care, physical therapy, occupational therapy, and rehab). These “skilled” services are tied to specific medical diagnoses associated with health care insurance reimbursable procedures. They are provided by Registered Nurses, LPNs, Physical Therapists, Occupational Therapists, etc. While providing these skilled services, the provider may authorize one or two bath visits a week (provided by a CNA). Typically these are authorized after a hospital and/or rehab stay; however, your health insurance provider (Medicare, etc.) may pay for in-home nurse visits and/or physical therapy to help you recuperate from an injury after a fall or to provide strengthening exercises/balancing programs to proactively prevent one, even if you haven’t been admitted to the hospital.

• Home Care is day-to-day custodial care. Services usually fall into three categories: homemaking, companionship, and personal care. The latter includes assistance with activities of daily living (ADLs) like bathing, toileting, eating, dressing, etc. These services are usually provided by a Certified Nursing Assistant (CNA) or Home Health Aide. 99% of the time, Medical insurance does not pay for these types of services. This is usually an out-of-pocket expense. Cost can range from $20.00 to $30.00 an hour. There is a caregiver shortage and it is very difficult to provide last-minute coverage or coverage for short shifts (shifts of less than 6 hours).

Here’s a little more detailed flow of events:

Home Health

• When you leave the hospital, social work/case management gets the primary physician to write a prescription (also referred to as a script or order) for Home Health.

• Within 48 hours of going home (longer over a weekend), a Home Health RN should call to make an appointment to come by and assess you. They basically confirm that the orders are appropriate and get signatures on their paperwork.

• Then PT and OT start coming out. You usually see them 2-3 times a week for a week or two and then they scale back to 1-2 times per week. PT works with you on stretching (range of motion) and strengthening exercises. OT provides training on how to best safely perform daily tasks. Sometimes they recommend you use certain tools (like a shower bench or walker). If covered by insurance they may order these for you or suggest you call your physician and have them order them.

• If one has a wound that needs dressing, a Nurse (RN) will come back out on a schedule to do this.

• Once they do your paper work, they file everything through your insurance and you only see a bill for items not covered by your medical insurance.

Home Care

This care is broken into three categories (Homemaking, Companionship, and Personal Care).

• Companionship activities would include just being there for safety supervision or to encourage and spot you while you do the range of motion exercises your PT person gives you (caregivers are not permitted by the state to perform passive range of motion exercises—doing the exercises for you) but they can assist as your coach as you do them. They can also drive you places if necessary.

• Homemaking- Caregivers can prepare meals, wash up afterwards, etc. They also do light housekeeping and laundry (though most try to limit this to the client’s area/ linens and clothes and their activities versus a while house cleaning and/or picking up after a spouse)

• Personal Care involves anything that is “hands-on”. 
• Assisting you out of bed
• Steadying you as you walk
• Assisting you with toileting
• Showering or assisting you in the shower (or sponge bath)
• Helping you put on your clothes
• The caregivers can clean around a wound but are not licensed to change one. This requires a nurse (RN) and typically Home Health covers this.
• Caregivers are not licensed to dispense medications. They can bring them to you and assist in opening containers for you 
• Costs
• In the past, typically for shifts of 4 hours or more (now more like 6). Shorter hours usually involve a premium
• All in cost for those companies using employees is currently between $25 and $30 an hour in our area
•  All in cost for those companies (Nurse Registries like Griswold Home Care) is currently between$20-25 an hour (ACH debit. Credit Card is 2-3% more) in our area