A Guide to Non-Medical In-Home Care (And Why It's Not 'Home Health')

You get old. You get sick. You have a fall. Suddenly, the world shrinks. The four walls of your home aren't a comfort—they're a cage. You need help.

So you look. You make calls. And you drown in a sea of words that all sound the same. "Home health care." "Home care." "Personal care." "Companion care." They sound alike. They are not. One is medical, paid for by insurance. The other is about living, and it comes straight from your pocket.

You’re trying to make a smart decision, not get a dictionary. You need to know what you're buying. You need to know the difference. Let's cut through the smoke. This is what you actually need to know.

🗝️ Key Takeaways

• One word is everything: "Home Health Care" is medical. "Home Care" is non-medical.

• The Doctor: You need a doctor's prescription for Home Health Care. You need nothing but a phone call for Home Care.

• The Staff: Home Health sends licensed nurses and therapists. Home Care sends aides and companions to help with daily life.

• The Bill: Medicare and insurance generally pay for Home Health. You, or a long-term care policy, pay for Home Care.

• The Purpose: Home Health is for recovery from an illness, injury, or to manage a serious condition. Home Care is for maintaining independence and help with daily routines.

• Medicare's Limits: Medicare will not pay for 24-hour care at home, meal delivery, or basic housekeeping if that's the only care you need.

What Is This "Non-Medical Home Care" Stuff, Really?

This is the one you’re probably thinking of. This is about living, not just keeping a pulse. This is for when you need help maintaining your independence at home. It's non-medical, plain and simple. No doctor’s referral is required. The people who show up aren't there to check your vitals or change a wound dressing. They can't give you prescription meds—though they can remind you to take them.

Their job is to make life manageable. It breaks down into two main jobs.

Keeping the Ship Afloat (Companion Care)

Think of this as basic assistance. It's the stuff that piles up when you can't move like you used to. A homemaker or companion can handle the household.

1. Meal preparation

2. Laundry and changing bed linens

3. Grocery shopping

4. Light housekeeping

5. Running errands or providing transportation

6. Companionship—just having another human being in the room to keep you connected.

It's about support. It's about encouragement. It's about safety.

The Nitty-Gritty (Personal Care)

This is the next level up. It's still non-medical, but it's hands-on. This is for when the simple acts of daily living become a challenge. This is the "custodial" care.

The staff—often called home health aides—help with your basic personal needs.

• Bathing and grooming

• Dressing

• Getting out of bed and walking

• Feeding

• Help using the bathroom or with incontinence care

Some aides get specialized training to help with more complex tasks, but they're always under a nurse's supervision if things get medical. In many states, these folks need training and education to do the job.

Then What's All This "Home Health" Talk?

This is the other side of the coin. This is medical.

You don't just decide to get Home Health Care. A doctor prescribes it. It’s for people recovering from a hospital stay, an injury, or a serious illness. The whole point is to help you regain strength, get your independence back, and prevent you from ending up back in the emergency room. This is care that's often just as effective as what you'd get in a hospital or skilled nursing facility (SNF), but you get it in your own home.

The Skilled Professionals

When you get Home Health Care, you're not getting a companion. You're getting a licensed medical professional.

• Skilled Nursing Care: This is the most common. A registered nurse sets up a care plan with your doctor. They handle the serious stuff: wound care, IV therapy, injections, monitoring unstable health, and teaching you how to manage your own condition.

• Therapy: You may need help getting back on your feet. A physical therapist helps you regain strength in your muscles and joints. An occupational therapist helps you relearn daily functions—eating, dressing, bathing. A speech therapist helps you regain the ability to communicate.

• Other Pros: You might also get visits from a medical social worker to help you find community resources or act as a case manager.

The "Homebound" Catch

There's a big string attached, especially for Medicare. To qualify, you must be "homebound". This doesn't mean you're a prisoner. It means:

1. You have trouble leaving home without help (like a walker, wheelchair, or another person).

2. Leaving home isn't recommended because of your condition.

3. It takes a "major effort" to leave your home.

You can still leave for medical treatment. You can even make short, infrequent trips for things like religious services or attending adult day care. But you're not out running errands.

The Big Question: Who Pays for the Help?

This is the part that matters most. This is the bill, the cold, hard number. The answer is completely different for each type of care.

Home Health (The Medical Stuff)

This is the good news. When it's prescribed by a doctor and you meet the criteria (like being homebound), Medicare and other insurance policies generally cover home health services.

If you have Medicare, you pay nothing for the covered services themselves. It's covered by Part A or Part B. The home health agency is supposed to tell you—verbally and in writing—beforehand if any service they're giving you isn't covered by Medicare and what you'll have to pay.

There is one exception: medical equipment. After you meet your Part B deductible, you pay 20% of the Medicare-approved amount for durable medical equipment.

Home Care (The Non-Medical Stuff)

This is the bad news. This is the part that blindsides people.

Because it's non-medical, insurance usually doesn't touch it. Most non-medical home care is private pay. That means you pay for it, out of your own pocket. Medicare is very clear on this. It does not pay for:

• 24-hour-a-day care at home

• Home-delivered meals

• Homemaker services like shopping or cleaning, if that's the only care you need

• Custodial or personal care (bathing, dressing) when it's the only care you need

This is the trap. People need help with bathing and eating to stay out of a facility, but that's the very thing Medicare won't cover. Some long-term care policies, Medicaid, or Medicare Advantage plans might offer some benefits, but the default is that you are on your own for the bill.

Getting Started: How to Get Someone in the Door

So, you know the difference. You know who pays. What's the first step?

If You Need Medical (Home Health)

You don't make this call. Your provider does.

1. The Face-to-Face: A health care provider (like a doctor or nurse practitioner) must assess you in person before certifying you need home health services.

2. The Order: That provider must order your care.

3. The Agency: The care must come from a Medicare-certified home health agency. Your provider should give you a list of agencies in your area. They are required to tell you if they have a financial interest in any agency they recommend.

4. The Plan: The agency will visit, talk to you about your needs, and work with your doctor to create a care plan. They will visit as often as the doctor orders.

If You Need Non-Medical (Home Care)

This is simpler. It's also all on you.

• No Referral: You do not need a doctor's referral.

• The Call: You find an agency. You call them.

• The Bill: You figure out how to pay for it.

It's that simple. One is a medical process. The other is a private transaction.

You're dealing with illness, or injury, or just the slow weight of time. The last thing you need is confusion. Now you know. Home Health is medical, for recovery. Home Care is non-medical, for living. One is paid by insurance. The other is paid by you.

Don't let the words fool you. Decide what you actually need. Then make the call.