Home Care vs Home Health in Pennsylvania: What Medicare Covers

The hospital discharge planner says your parent needs "home health." The Area Agency on Aging says they need "home care." These sound identical but they're different services, regulated by different state agencies, paid by different sources, and staffed by different people. Confusing them can cost your family thousands of dollars.

The Core Difference

Home health is clinical care delivered by licensed nurses, physical therapists, and occupational therapists. It's regulated under 28 Pa. Code Chapter 601 and covered by Medicare at zero cost-share when your parent meets specific medical criteria.

Home care (also called non-medical home care or personal care) provides help with daily living activities — bathing, dressing, meal preparation, light housekeeping, medication reminders, and companionship. It's regulated under 28 Pa. Code Chapter 611. Medicare does not cover it. Families pay privately ($34/hour state median), through Medicaid CHC, or through the state-funded OPTIONS program.

What Medicare Home Health Covers

Medicare covers skilled, intermittent care when three conditions are met:

1. Your parent is homebound — leaving home requires considerable effort, and they generally don't leave except for medical appointments.
2. They have a documented skilled need — physical therapy after a hip replacement, wound care after surgery, medication management requiring a nurse.
3. A physician has signed an active plan of care ordering the specific services.

Under the federal ruling in Jimmo v. Sebelius, Medicare must cover skilled home health to maintain function or prevent decline — your parent doesn't need to be improving. This matters for chronic conditions like Parkinson's or advanced arthritis where the goal is stability, not recovery.

What Medicare home health includes:

• Skilled nursing visits (wound care, injections, catheter management)
• Physical therapy
• Occupational therapy
• Speech-language therapy
• Medical social work

What it explicitly does not include:

• Help with bathing, dressing, or grooming (unless a skilled nurse is already on the case and the aide visits are part of the clinical plan)
• Meal preparation or housekeeping
• Companionship or supervision
• 24-hour care or live-in support

The key limitation: Medicare home health is intermittent. A nurse might visit three times per week for 45 minutes. A physical therapist might come twice weekly. It's not the all-day help most families need when a parent can't safely be alone.

What Non-Medical Home Care Covers

Non-medical home care fills the gap Medicare leaves. A home care aide helps with:

• Bathing, grooming, and personal hygiene
• Dressing and undressing
• Meal preparation and feeding assistance
• Light housekeeping and laundry
• Mobility assistance (transfers, walking support)
• Medication reminders (not administration)
• Companionship and engagement
• Transportation to appointments

This is the daily, hands-on support that keeps a parent safe at home. It's also the service that costs money — either private-pay or through a public program.

How to Layer Both

The most effective home care plan uses both services simultaneously. They're not either/or — your parent can receive Medicare home health and non-medical home care at the same time from different providers.

A practical example: after a fall, your parent gets Medicare home health for physical therapy (three visits per week, covered at $0). Simultaneously, a non-medical home care aide comes daily for four hours to help with bathing, meals, and housekeeping ($34/hour private-pay, or covered by Medicaid CHC if eligible).

The home health agency handles the clinical rehabilitation. The home care aide handles the daily living support. The combined plan costs far less than a nursing facility and keeps your parent at home.

How to Tell Which One Your Parent Needs

If the need is medical — recovering from surgery, managing a wound, rehabilitating after a stroke — call a Medicare-certified home health agency. The hospital discharge planner should provide referrals and initiate the physician's order.

If the need is functional — can't bathe safely, forgets to eat, falls when walking to the bathroom — your parent needs non-medical home care. Contact your local Area Agency on Aging to assess eligibility for Medicaid CHC or the OPTIONS program before committing to private-pay.

If both needs exist — which is the case for most aging parents — you need both services from separate providers.

Finding Providers in Pennsylvania

For Medicare home health: ask the hospital or your parent's primary care physician for a referral. Medicare's Care Compare tool lists every certified agency by county with quality ratings.

For non-medical home care: Pennsylvania's Department of Health licenses home care agencies and home care registries under Chapter 611. Agencies employ the aides directly; registries connect families with independent aides. Agencies cost more per hour but handle scheduling, backup coverage, and supervision.

The Pennsylvania Home Care Navigator includes a diagnostic flowchart for determining which service type your parent needs, plus provider vetting checklists and a side-by-side comparison of every funding source available in the state.

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