Care Options: Aging at Home vs. Home Healthcare

For many families, staying at home as long as possible is the clear preference. Understanding what help is available, and who pays for it, makes that more sustainable.

What does “aging in place” actually mean?

It means staying in your own home as you get older, rather than moving to a retirement or long-term care setting, according to HelpGuide. People usually do it with help: changes to the home, such as grab bars, ramps, or a bathroom on the ground floor, plus home care services and support from family. The National Institute on Aging suggests checking the home to make sure it is safe for the person’s needs. See Supporting Independence and Safety.

What is the difference between home care and home health care?

The terms sound alike but mean different things.

Home care is non-medical help. HelpGuide describes household help and personal care, which means help with daily activities such as dressing, bathing, or meal preparation, also called custodial care. Aides can provide it from a few hours a day to around-the-clock live-in care.

Home health care is medical care at home. Medicare covers skilled nursing and therapy ordered by a doctor, under conditions described below.

These are often combined rather than an either/or choice.

What does Medicare cover at home?

Medicare covers home health services if you need part-time or intermittent skilled care and you are homebound, according to Medicare.gov. Homebound means leaving home is not recommended because of your condition, or you normally cannot leave without major effort. A doctor must certify this, and the agency must be Medicare-certified. Medicare covers skilled nursing and therapy. Medicare also covers home health aide help with personal care, but only if you are also getting skilled services.

Medicare does not pay for:

• 24-hour-a-day care at home.
• meals delivered to your home.
• homemaker services, like shopping and cleaning, that are unrelated to your care plan.
• custodial or personal care, such as bathing and dressing, when it is the only care you need.

Who pays for the rest?

Often the family. Non-medical home care is commonly paid for privately. Medicaid also has home and community-based waiver programs, according to an HHS explainer. Ask your state Medicaid office whether you qualify. Area Agencies on Aging, found through the Eldercare Locator at 1-800-677-1116, also offer services. The Administration for Community Living lists help with transportation, in-home care, adult day care, and nutrition services. The National Family Caregiver Support Program includes respite. See Medicaid Considerations for Long-Term Care.

How do I know if aging at home is still the right choice?

Needs change, so revisit it. A doctor, a social worker, or a geriatric care manager can assess what the person needs. The National Institute on Aging describes a geriatric care manager as a licensed nurse or social worker who can identify needs and help build a care plan. If the person who provides most of the care is wearing out, see Caregiver Burnout and Respite Care. If a move is on the table, see Assisted Living, Memory Care, and Skilled Nursing.

What do we still not know?

Coverage and services vary by plan, state, and agency. Ask Medicare, your state Medicaid office, or your insurer about your situation.

This is general guidance, not medical, legal, or financial advice. Every family’s situation is different; a doctor, social worker, or attorney can advise on yours.