How to Request a Home Health Assessment for an Elderly Parent

The Assessment That Unlocks Everything

Before your parent can receive publicly funded home care — whether that's a visiting nurse, a personal support worker, physical therapy, or meal delivery — someone needs to formally evaluate what they need. This evaluation has different names in different countries (a home health assessment, a care needs assessment, a comprehensive assessment), but the function is the same: a trained professional visits your parent, evaluates their physical and cognitive abilities, identifies safety risks, and determines what level of care they qualify for.

The problem is that most families don't know how to request one, who to ask, or what happens when the system says no. And the process varies dramatically depending on where your parent lives.

United States: Medicare Home Health Assessment

In the US, Medicare covers home health services when three conditions are met: your parent is homebound (leaving home requires considerable effort), they need skilled care (nursing, physical therapy, speech therapy, or occupational therapy), and a physician certifies the need and orders the services.

How to initiate the process:

1. Ask the primary care physician or another qualified treating practitioner for an order. The practitioner must document that home health services are medically necessary and complete any required face-to-face certification. Without the required order and documentation, Medicare won't authorize covered services.

2. Choose a Medicare-certified home health agency. You can find agencies in your area through Medicare's Care Compare tool. The agency will send a nurse or therapist to your parent's home to conduct a comprehensive assessment — this is the OASIS (Outcome and Assessment Information Set) evaluation, which measures functional abilities, clinical needs, and home safety.

3. The assessment determines the care plan. Based on the OASIS results, the agency develops a plan of care specifying what services your parent will receive, how often, and for how long. Medicare generally covers covered home health services without a home-health copayment, but equipment and non-covered services may have separate costs.

If Medicare denies the referral or the agency determines your parent doesn't qualify, you can appeal. The denial notice will include instructions for requesting a redetermination. For Medicare Advantage plans, the plan itself handles appeals — contact the member services number on your parent's insurance card.

For home care beyond what Medicare covers — personal care assistance like bathing, dressing, meal preparation, and companionship — explore your state's Medicaid waiver programs (sometimes called Home and Community-Based Services waivers). These have their own assessment processes and waiting lists that vary by state.

United Kingdom: Care Act 2014 Assessment

Under the Care Act 2014, every adult in England has a legal right to a care needs assessment, regardless of their financial situation or the level of care they currently need. Your local authority (council) must carry out the assessment if it appears that the person may have needs for care and support.

How to request one:

Contact your parent's local authority adult social services department. You can call, write, or in many areas, submit the request online. You don't need a GP referral — anyone can request an assessment, including the person themselves, a family member, or a friend.

What happens during the assessment:

A social worker or care assessor visits your parent (usually at home) and evaluates their needs against the national eligibility criteria. They'll look at whether your parent can manage essential daily activities — nutrition, personal hygiene, toileting, maintaining a habitable home, accessing the community, and maintaining relationships.

If your parent meets the eligibility threshold, the local authority must prepare a care and support plan and arrange services. Whether they have to pay depends on a separate financial assessment — the local authority cannot refuse the needs assessment itself based on finances.

If the assessment finds your parent ineligible, you can request a review. If the review upholds the decision, escalate to the local authority's complaints process and then to the Local Government and Social Care Ombudsman.

NHS Continuing Healthcare (CHC) is a separate funding stream for people whose primary need is health-related rather than social care. If your parent has complex medical needs (advanced dementia, severe neurological conditions, intensive nursing requirements), request a CHC assessment through their GP or the hospital discharge team. CHC is fully funded by the NHS — there's no means test.

Canada: Provincial Home Care Assessment

Home care in Canada is provincially administered, so the process varies by province.

Ontario: Contact Ontario Health atHome (formerly the LHIN) to request an assessment. A care coordinator will visit your parent and evaluate their needs. Based on the assessment, they may qualify for personal support services, nursing visits, physiotherapy, occupational therapy, or meal programs. Services are publicly funded but may have wait times.

British Columbia: Contact your local Health Authority's Home Health program through the regional intake line. An assessment by a case manager determines eligibility for home support services, adult day programs, and assisted-living placement.

Alberta: Call Health Link (811) or contact your local Alberta Health Services home care office to request an assessment. A care manager evaluates needs and arranges services.

In all provinces, if your parent is being discharged from hospital and needs home care, ask the hospital discharge team to initiate the referral to the provincial home care program before discharge. If they haven't, ask the discharge planner or social worker explicitly.

Australia: My Aged Care Assessment

In Australia, the federal government coordinates aged care through the My Aged Care system.

Step 1: Register with My Aged Care. Call 1800 200 422 or register online. This is the gateway to all publicly subsidized aged care services.

Step 2: Assessment. For lower-level needs (help with housework, transport, social activities), your parent will receive a Regional Assessment Service (RAS) assessment. For more complex needs (nursing care, dementia support, personal care, allied health), they'll be referred for a comprehensive assessment by an Aged Care Assessment Team (ACAT; the name or intake pathway varies by state).

Step 3: Approval and services. The assessment determines which level of Home Care Package your parent is eligible for (Levels 1 through 4, from basic to high-level care needs). Once approved, your parent enters the national queue and will be assigned a package when one becomes available. Wait times can range from weeks to months depending on the level.

Transition Care Programme (TCP): If your parent is being discharged from hospital and needs short-term restorative care to avoid premature entry into residential care, ask the hospital's ACAT assessor about TCP. This program provides short-term rehabilitation and support services while a longer-term care plan is arranged.

When Home Care Is Denied

Across all countries, denials happen. The most effective approach:

1. Request the denial in writing with the specific reason and the criteria used
2. Gather supporting evidence — physician letters documenting clinical needs, incident reports (falls, medication errors at home), and your own observations about daily living difficulties
3. File a formal appeal using the process specified in the denial letter
4. Contact an advocacy organization for help — in the US, your State Health Insurance Assistance Program (SHIP) can help with Medicare appeals; in the UK, Age UK offers free advice on care assessments

The Healthcare Advocacy Toolkit includes country-specific checklists for each assessment pathway and templates for appealing denied home care services.