In-Home Care: Home Care vs. Home Health Care, What Aides Do, and Who Pays

Most people want to stay in their own home as they age, and in-home care is often what makes that possible. But when you start calling around, you will quickly hear two terms that sound almost identical: home care and home health care. They are different services, provided by different kinds of workers, and paid for in very different ways. Knowing which one your loved one needs saves time, money, and a lot of frustrating phone calls.

Two kinds of care at home

Home care (also called non-medical home care, personal care, private duty care, or companion care) is help with the ordinary tasks of daily life. An aide might help with bathing, dressing, toileting, meals, light housekeeping, laundry, errands, and keeping someone company. This is what most families mean when they say "Dad needs someone to come in." It can last for months or years.

Home health care is skilled, medical care delivered at home under a provider's order. It is usually short-term and goal-focused: a nurse treating a wound, a physical therapist helping someone walk again after a hip replacement, an occupational therapist teaching safe ways to bathe. Visits are scheduled and time-limited, not all-day coverage.

What a home care aide does (and doesn't do)

A good aide can make the difference between a parent struggling alone and a parent living safely at home. Typical tasks include:

• Help with bathing, grooming, dressing, and getting to the toilet
• Help moving safely from bed to chair, or walking with a walker
• Preparing meals and encouraging eating and drinking
• Reminders to take medications (what's allowed varies by state)
• Light housekeeping, laundry, and changing linens
• Rides or company on errands and appointments
• Companionship, conversation, and watching for changes

What a non-medical aide generally can't do is skilled nursing work, such as giving injections, managing IV lines, or treating wounds. State rules set the line, and it differs from state to state. If you hire through an agency, ask exactly which tasks its aides are allowed to perform.

When Medicare pays for home health care

Original Medicare covers home health care with no copay for the services themselves, but only when all of these are true, according to Medicare.gov:

• The person needs part-time or intermittent skilled care (nursing or therapy).
• They are homebound, meaning leaving home isn't advised or takes considerable effort and help.
• A doctor or other provider has seen them in person, certified the need, and ordered the care.
• The care comes from a Medicare-certified home health agency.

When those conditions are met, Medicare can also pay for a home health aide to help with personal care, but only while the skilled care is going on. Medicare does not pay for 24-hour care at home, meal delivery, homemaker services, or personal care when that is the only help someone needs. Medical equipment such as a walker is covered at 20% coinsurance after the Part B deductible.

In plain terms: Medicare helps with recovery. It does not pay for the long-term, everyday help most aging parents eventually need. Medicare.gov says directly that it "does not provide long-term care coverage or custodial care unless medical care is needed." For the full picture, see what Medicare covers.

What in-home care costs

The CareScout 2025 Cost of Care Survey (released March 2026, based on more than 25,000 provider rates) found:

• Non-medical in-home caregiver: national median of $35 per hour, up 3% from the prior year. At 44 hours a week, that works out to about $80,080 a year.
• Private duty nursing in the home: national median of $90 per hour, or $160 per visit.

Those are national midpoints. Rates in your county may be well above or below. Many agencies also set minimum shift lengths, often a few hours, so a "quick check-in" can cost more than you expect.

Illustrative example: a parent who needs help four hours each weekday morning would use about 20 hours a week. At $35 an hour, that is roughly $700 a week, or around $3,000 a month. Around-the-clock coverage costs many times that, which is why families often mix paid hours with family help and adult day programs.

Who pays for non-medical home care

Because Medicare doesn't cover it, most families combine several of these:

• Private pay. Savings, retirement income, or family contributions. This is still the most common source.
• Long-term care insurance. Many policies cover home care once the person needs help with a set number of daily activities. Check the elimination period and daily limits. See long-term care insurance.
• Medicaid. Nearly every state offers home and community-based services through Medicaid waivers, which can include personal care, homemaker, and respite services. States cap enrollment, so waiting lists are common. Apply early. See Medicaid for long-term care.
• Veterans' benefits. VA offers homemaker and home health aide care to eligible enrolled veterans, and VA pension with Aid and Attendance can help pay for care. See VA long-term care.
• Local programs. Area Agencies on Aging sometimes fund limited hours of help. The Eldercare Locator (1-800-677-1116) connects you to yours.

Some states also let Medicaid participants hire a family member as their paid caregiver. If a daughter, son, or spouse is already doing the work, it is worth asking about.

Agency or independent caregiver?

You can hire through a home care agency or hire a caregiver directly. Agencies usually cost more per hour, but they handle background checks, payroll taxes, insurance, training, and backup when an aide calls in sick. Hiring directly can cost less, but you become the employer, which can mean withholding taxes, verifying work eligibility, and finding coverage on short notice. Neither choice is wrong. It depends on your budget and how much management you can take on. Our guide to choosing a home care agency includes questions to ask either way.

Signs home care may no longer be enough

In-home care works well for many people for a long time. It may be time to look at other options if:

• Your loved one needs help at night as well as during the day, and paid hours are adding up fast.
• Wandering, getting lost, or unsafe behavior from dementia is becoming frequent.
• Falls keep happening even with help in place.
• The family caregiver is exhausted, getting sick, or can't keep up with work.

Needing more help is not a failure on anyone's part. Our guide to choosing the right level of care compares home care with assisted living, memory care, and nursing homes side by side.

Your next steps

1. Name the need. Is it medical recovery (home health) or daily living help (home care), or both?
2. Ask the doctor about home health. If your loved one is recovering from a hospital stay or illness and is homebound, ask whether a referral to a Medicare-certified agency makes sense.
3. Estimate hours. List the times of day help is needed and multiply by local hourly rates.
4. Check every payment source. Insurance policies, Medicaid waivers, VA benefits, and your Area Agency on Aging.
5. Interview at least two or three providers before you commit.

Last reviewed October 19, 2026. General information only, not medical, legal, or financial advice. Benefit rules and amounts change, so confirm with the agency before you decide. See our disclaimer.