Home Care vs Home Health in Washington: What's the Difference?

Your parent's doctor says they need "home health" after a hospital stay, but what you really want is someone to help with bathing, meals, and medication reminders every day. These are two completely different services in Washington, funded differently, provided by different people, and accessed through different pathways.

Getting them confused means applying to the wrong program, waiting weeks for services your parent doesn't need, or paying out-of-pocket for help that Medicaid would have covered.

Home Health: Skilled Medical Care at Home

Home health is a medical service prescribed by a physician. It's provided by licensed nurses (RNs, LPNs), physical therapists, occupational therapists, and speech therapists who come to your parent's home for specific clinical tasks.

What it covers: Wound care, IV medication administration, post-surgical monitoring, physical rehabilitation, catheter management, and clinical assessments.

Who pays: Medicare covers home health when your parent is homebound and needs intermittent skilled care. No copay, no deductible. Washington Medicaid (Apple Health) also covers it for eligible recipients.

Duration: Typically 60-day episodes that can be renewed, but visits are intermittent — maybe 2-3 times per week for 45-90 minutes. This is not daily hands-on care.

How to access: A physician must order home health services. The hospital discharge planner typically initiates this referral. Your parent must be "homebound" under Medicare's definition (leaving home requires considerable effort).

Home Care: Non-Medical Personal Assistance

Home care — also called personal care or non-medical home care — covers the daily tasks your parent can no longer do independently. This is the service most families actually need on an ongoing basis.

What it covers: Bathing, dressing, toileting, transferring, meal preparation, medication reminders, light housekeeping, essential shopping, and companionship.

Who provides it: Home Care Aides, Certified Nursing Assistants (CNAs), or family members enrolled as Individual Providers (IPs) through Consumer Direct Care Network Washington (CDWA).

Who pays: Washington Medicaid covers personal care through two programs — Community First Choice (CFC, a state plan entitlement with no waitlist) and COPES (a waiver that adds adult day care, home modifications, and transportation). Private-pay home care runs $27-38 per hour in Washington.

Duration: Ongoing, for as many hours as the CARE assessment authorizes — potentially years.

How to access: Apply for Apple Health long-term care through DSHS. Complete the CARE assessment, which scores your parent's ADL limitations and authorizes a specific number of weekly care hours.

The Key Differences at a Glance

Timing: Home health is episodic and short-term (weeks to months). Home care is ongoing and daily.

Skills: Home health requires licensed medical professionals. Home care can be provided by trained aides or family members.

Trigger: Home health starts with a physician's order, usually post-hospitalization. Home care starts with a DSHS CARE assessment, usually when daily tasks become unsafe.

Cost: Home health under Medicare is free at point of service. Home care under Medicaid requires financial eligibility (assets under $2,000 for an individual). Private-pay home care averages $5,500-$8,000 per month for 40 hours weekly in Washington.

When Your Parent Needs Both

Many families need both simultaneously. Your parent might receive home health visits twice weekly from a physical therapist after a hip replacement while also needing daily home care for bathing and meals. These services coordinate but come through different authorization channels.

The home health agency and the personal care provider operate independently. Your parent's DSHS case manager handles the home care side; the physician manages home health orders.

The Transition That Catches Families Off Guard

Here's where families get stuck: Medicare home health ends once your parent is no longer "homebound" or stops needing skilled nursing. But the daily personal care needs don't end. If you haven't already started the Medicaid home care application, there's a gap — sometimes weeks or months — where your parent has no daily support.

Start the Apple Health long-term care application while home health is still active. The 45-day processing timeline runs concurrently, so both services can overlap.

Quick Reference: Home Health vs Home Care

The Bottom Line

Home health fixes a medical problem. Home care supports daily life. Most aging parents eventually need home care — the personal assistance with everyday tasks that allows them to stay safely at home. If your parent is currently receiving home health after a hospitalization, start the Medicaid application now so there's no gap when home health ends.

For the complete step-by-step process of accessing both home health and home care in Washington — from the hospital discharge through the CARE assessment to your first authorized care hours — the Washington Home Care Guide covers every pathway and timeline.

See more Washington guides →