What Is Home Health Care? The Definitive Guide

Many people think of home health care and home care as the same thing, but the two are actually quite different. Home health care has an important medical component, while home care refers to in-home caregiver assistance.

Another way to tell the two apart is by identifying who your loved one might work with to receive the care they need. For example, a senior who needs help transferring from their bed to a wheelchair or assistance with meal planning would receive this help from a caregiver, not a medical professional. On the other hand, a senior who needs wound care, medication administration, or injections would need to receive care from a medical professional through a home health care agency.

While you might work with different agencies and caregivers, you could use a mixture of home care and home health services to meet your loved one’s needs.

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While in-home nursing care may be the first thing that comes to mind when thinking of home health care, there’s actually a range of health services your loved one can receive at home, all provided by a range of home health workers.

Skilled nursing care

Your loved one will need a doctor to prescribe a care plan, which will also help determine who provides the care. Depending on what your loved one needs, a registered nurse (RN), licensed practical or vocational nurse (LPN/LVN), or a certified nursing assistant (CNA) will visit them in their home to provide care.

The type of home health nurse you work with will depend on the level of care your loved one needs. A certified nursing assistant, for example, is best suited for seniors who need health monitoring such as blood pressure and other vital signs. A registered nurse, however, can handle advanced nursing tasks, such as administering medication and educating family members on how to help in their loved one’s care.

It’s also possible that your loved one would work with a certified nursing assistant or a home health aide. While they’re not nurses, certified nursing assistants and home health aides employed by home health agencies typically have specialized training and report to a registered nurse. Each state has its own training requirements, but a certified nursing assistant and home health aide can usually track vital statistics and assist with activities of daily living (ADLs).

Skilled nursing care includes the following:

• Wound care. This could involve changing the dressings and cleaning the area of a healing surgical wound, but it also applies to treating pressure wounds or bed sores.
• Ostomy care. This involves changing the ostomy bags and cleaning the surrounding skin to help ensure it stays free from infection.^[01]
• Nutrition therapy. This may involve counseling and patient education about the dietary needs of their condition. It may be prescribed for seniors with diabetes, heart disease, Crohn’s disease, or other conditions.^[02]
• Intravenous therapy. This could involve delivering medication through an IV, but it can also be used to help seniors stay hydrated and receive nutrients.
• Injections. This could be an insulin injection or a medication.
• Health monitoring. This involves keeping track of your loved one’s vital statistics, such as blood pressure and heart rate. It’s especially helpful for seniors who have a serious illness.

Aside from providing care, the nurse caring for your loved one will also provide a log of their care and should communicate it with your loved one’s doctor and anyone else on the care team.

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Physical therapy

A doctor may prescribe physical therapy for seniors recovering from an injury or health emergency, such as a stroke. Your loved one will receive care from a physical therapist or physical therapist assistant. They’ll come to your loved one’s home and work with them on the prescribed therapy.

The most common goal of physical therapy is to recover functional mobility. According to the American Physical Therapy Association, it can be easier for therapists to clearly define what the most relevant functional goals are when they can see a patient’s home.^[03] So, in this regard, prescribed, in-home therapy can offer a real advantage over therapy in an outpatient setting. Please note that, depending on what your loved one needs, they may be encouraged to practice the exercises independently or under supervision between sessions.

Your loved one can receive help with the following from a physical therapist:

• Gait reestablishment or adjustment
• Transfer training — for instance, down and up from the toilet, in and out of bed, etc.
• Fall prevention
• Home exercise program development ^[03]

Occupational therapy

Occupational therapists can help seniors in various ways, including relearning everyday actions, such as brushing hair when challenged by a limited range of motion. Much like with physical therapy, it can be very beneficial for seniors to meet with an occupational therapist in their home so the therapist can more directly help reach the prescribed goals.

Occupational therapy can also help with the following, and much more:

• Routines associated with diabetes management, such as blood sugar monitoring, hygiene, and foot care
• Strategies for seniors with heart failure or COPD to conserve energy while incorporating activities into their daily life
• Stress management for seniors with cognitive or behavioral health conditions ^[04]

Speech therapy

If your doctor has prescribed speech therapy, a speech-language pathologist can come to your loved one’s home to help them. As with other therapy services, it can be helpful for the therapist to see what your loved one needs to accomplish in a functional setting. A speech-language pathologist can help with the following:

• Swallowing techniques
• Spoken language expression
• Motor speech, or coordinating the muscles of the face, tongue, and larynx ^[05]

Patient education and medical social services

If your loved one has a new, significant diagnosis, they may work with a medical social worker as part of their home health care plan. These social workers can help you understand your loved one’s health condition and care plan, and they can direct you to helpful resources.

One of the largest benefits of home health care is the convenience of receiving it in a familiar setting where your loved one is likely the most comfortable. Especially when the goal of this care is rehabilitative — such as with physical, occupational, or speech therapy — it can be helpful to have sessions at home because that’s where the patient will spend most of their time and perform those essential, daily actions and activities.

Another benefit is that, because health care professionals offer these services, the care should be the same quality as what you’d receive in a skilled nursing facility.

There are a few drawbacks to home health care, however. If your loved one relies on durable medical equipment, such as oxygen or nebulizers, it can sometimes be difficult to get the equipment to their homes in a timely manner. Additionally, depending on where your loved one lives, safety may be a concern. If your loved one can’t maintain a clean environment, it can lead to the possibility of infection.((citation:6}}

Once you find a home health nurse or therapist, it can take some time for your loved one to feel comfortable having a stranger in their home. This is especially true in cases where they need a nurse with them for many hours at a time. Ideally, given some time, they’ll form a strong bond with their caregiver.

According to Genworth’s annual cost of care survey, the monthly median cost of a full-time home health aide working 44 hours per week is $5,148.^[07] With that price tag, it’s not surprising that many families look to insurance or other payment options, such as reverse mortgages, to help defray the costs.

Medicare

Medicare, which is available to Americans over 65, covers part-time or intermittent skilled nursing care. However, it doesn’t cover 24-hour skilled nursing care at home or homemaking services that aren’t in your loved one’s care plan.^[08]

Medicaid

Since Medicaid is administered at the state level, you’ll find that home health coverage may vary by state. Additionally, each state has its own Home and Community Based Services (HCBS) waivers that you can apply for. HCBS waivers are designed to offer people the opportunity to receive care at home, instead of in a nursing home.

It’s important to note that even if you meet the requirements for the waivers, your state may have a limited number of them available, which means you’d have to wait for a position to open up. You can find the waivers offered in your area on Medicaid’s state links page.

Long-term care insurance

If your loved one has a long-term care insurance policy, it may cover some of the costs associated with home health care. Each policy differs, so you’ll have to check the contract to see what’s covered.

Read more: Using Long-Term Care Insurance for In-Home Care

If your loved one needs help with activities of daily living — such as bathing or transferring — or help with chores around the house, you’d be better suited working with a home care agency. In fact, this type of assistance can actually supplement the care you receive from a home health care aide.

A nonmedical home caregiver, whether independent or hired through a home care agency, can help with the following:

• Respectful assistance with activities of daily living
• Transportation to appointments
• Tidying up around the house
• Grocery shopping and meal preparation
• Running errands
• Medication reminders
• Companionship

If your loved one has a care plan from their doctor, and you know they need to work with a nurse or therapist, then you should proceed to look for a home health agency. Your doctor may be able to offer recommendations or resources, or you may want to reach out to a friend who’s been in a similar situation.

It’s important to choose a home health agency that’s a good fit for the care your loved one needs, such as being a Medicare-approved agency. Ask the agency these questions to help you make this determination:

• Do you have RNs, LPNs, and/or CNAs on staff?
• What’s your backup plan if a nurse calls out sick or is unavailable?
• Do you try to match nurses with patients based on personality or shared interests?
• Can we interview nurses before choosing who would be the best fit for our loved one?

You’ll also want to ask about which insurance the agency accepts to help ensure they’re in-network and discuss payment options.

A Place for Mom’s Senior Living Advisors can help you find a home care agency that will provide just the right amount of care for your loved one, whether you’re looking for round-the-clock assistance or just need someone to help out for a few hours a week. Best of all, this service is available at no cost to you.