Finding home health care starts with understanding what type of help you actually need, then using the right tools to locate and vet agencies in your area. The process involves a few key steps: clarifying whether you need medical or non-medical care, checking your eligibility for coverage, searching for providers, and asking the right questions before signing anything.
Medical Care vs. Personal Care: Know What You Need
The term “home health care” covers two very different types of service, and the distinction matters because it affects who provides care, what insurance covers, and where you search.
Home health care is medical. A licensed nurse, physical therapist, or other clinician comes to your home to provide skilled treatment: wound care, injections, rehabilitation after surgery, medication management. These professionals are licensed and trained in their specialty.
Home care (sometimes called personal care or custodial care) is non-medical. A caregiver helps with daily activities like bathing, dressing, grooming, meal preparation, and getting around the house. These caregivers may or may not be licensed, though many have training in elder care or disability support.
Many families need both. Someone recovering from a hip replacement, for example, might need a physical therapist three times a week and a personal care aide for daily help with bathing and meals. Some agencies provide both types of service under one roof; others specialize in one or the other.
Check Whether Medicare or Medicaid Will Pay
If you need skilled medical care at home, Medicare may cover it fully, but only if specific conditions are met. You must be considered “homebound,” meaning that leaving your home requires a considerable and taxing effort due to illness or injury. You might need assistive devices like a walker or wheelchair, special transportation, or another person’s help to get out the door. Being homebound doesn’t mean you’re bedridden. You can still leave for doctor’s appointments, religious services, adult day care, or occasional events like a graduation or haircut.
Medicare also requires a face-to-face encounter with a physician or certain nurse practitioners. This visit must happen no more than 90 days before home health care begins, or within 30 days of the start date, and it must be related to the reason you need home care. The doctor who orders your care then creates a plan that specifies which services you need, how often, and for how long. This plan is reviewed and signed by your physician at least every 60 days.
For non-medical personal care, Medicare generally does not pay. This is where Medicaid may help, particularly through Home and Community-Based Services (HCBS) waivers. These state-run programs cover personal care and other support for people who would otherwise need nursing home care. Eligibility requires demonstrating a need for an institutional level of care, and each state sets its own rules and caps on how many people the program serves. Contact your state Medicaid office to find out whether a waiver is available and what the current waitlist looks like.
What Home Care Actually Costs Out of Pocket
When insurance doesn’t cover the bill, costs vary significantly by region and type of care. As of 2025, personal care assistance typically runs $25 to $40 per hour for help with bathing, dressing, and mobility. Skilled nursing care from a licensed nurse costs $50 to $80 per hour for services like medication administration and wound care. Live-in care, where a caregiver stays in the home around the clock, generally falls between $250 and $350 per day.
Even a few hours of daily personal care adds up quickly. At $30 per hour for four hours a day, five days a week, you’re looking at roughly $2,600 a month. Planning ahead and understanding your insurance options can make a significant difference.
How to Search for Agencies
The most reliable starting point for Medicare-certified home health agencies is the Care Compare tool on Medicare.gov. You can search by location and compare agencies side by side using two types of star ratings on a 1-to-5 scale: a quality of patient care rating based on eight care measures, and a patient survey rating based on feedback from people who actually used the service. These surveys cover categories like how well providers communicated, whether they reviewed medications and side effects, whether they discussed home safety, and how patients rated their overall experience.
Beyond Medicare’s tool, ask your doctor, hospital discharge planner, or social worker for recommendations. They refer patients to home health agencies regularly and often know which ones deliver consistent care and which ones don’t. If you’re looking for non-medical personal care that isn’t Medicare-certified, your local Area Agency on Aging is another solid resource. Every county in the U.S. has one, and they maintain lists of vetted providers.
What to Look for in an Agency
Not all agencies operate at the same standard. One of the strongest signals of quality is accreditation from an independent body like the Joint Commission. Agencies that earn the Joint Commission’s Gold Seal of Approval have gone through a rigorous evaluation of their patient care, safety practices, and organizational performance. Accreditation is voluntary and goes beyond basic licensing requirements, so it indicates an agency that’s actively investing in quality. Ask any agency you’re considering whether they hold accreditation and from whom.
Beyond accreditation, there are several specific questions worth asking before you commit:
- Background checks: How does the agency screen and verify the background and experience of its caregivers?
- Emergency availability: Is someone available around the clock for emergencies, and what types of emergency care can they provide?
- Supervision: How does the agency supervise caregivers working in your home? How often does a nurse or manager check in?
- Replacement staff: What happens if your regular caregiver is sick or quits? How quickly can a substitute be arranged?
- Insurance and bonding: Is the agency bonded and insured? This protects you if a caregiver is injured in your home or if something goes wrong.
- Care plan details: Will the agency create a written care plan, and how often is it updated?
Request references from current or recent clients. An agency that’s confident in its service will provide them without hesitation.
Hiring a Caregiver Directly
Some families skip agencies and hire an independent caregiver, often because it’s less expensive. This can work well, but it comes with legal and financial responsibilities that catch many people off guard. The IRS considers most in-home caregivers to be household employees, not independent contractors, because they work in your home and you direct what needs to be done. That means you’re the employer.
As a household employer, you’re responsible for withholding and paying employment taxes, filing a W-2 for the caregiver, and potentially carrying workers’ compensation insurance depending on your state. Publication 926 from the IRS, the Household Employer’s Tax Guide, walks through the specifics. Some exceptions exist for family members providing care, such as a spouse or a child under 21, but for anyone else, the tax obligations are real and ignoring them can result in penalties.
You also lose the protections that come with an agency: background checks, liability insurance, backup staff, and professional oversight. If you go this route, run your own background check, verify references thoroughly, and consult an accountant about your tax obligations before the first day of work.
Getting Care Started
For Medicare-covered home health, the process typically begins with a hospital discharge or a conversation with your primary care doctor. Your physician orders a comprehensive assessment, and the home health agency develops an individualized plan of care that specifies which disciplines are involved (nursing, physical therapy, occupational therapy, speech therapy, or home health aides), how often each visits, and what goals they’re working toward. Expect a nurse or therapist to visit your home within a day or two of the referral to do an initial evaluation.
For private-pay personal care, the timeline is usually faster. Most agencies can have a caregiver in your home within a few days of your initial call. Many offer a free in-home consultation where they assess your needs and match you with a caregiver whose skills and personality fit. Take advantage of this visit to see how the agency communicates and whether they ask thoughtful questions about your situation, preferences, and daily routine. The quality of that first interaction often reflects the quality of care that follows.