Getting a home health aide for an elderly family member typically starts with a doctor’s order or a needs assessment, depending on how you plan to pay. Medicare, Medicaid, veterans benefits, long-term care insurance, and private pay each have different entry points, and the path you take shapes how quickly services begin, what tasks the aide can perform, and what it costs. Here’s how each option works in practical terms.
What Home Health Aides Actually Do
Before navigating the paperwork, it helps to know what you’re arranging. A home health aide works under the direction of a nurse or other healthcare provider and can handle basic medical tasks: checking pulse, temperature, and breathing rate, helping with prescribed exercises, giving medications, changing bandages, and assisting with medical equipment like ventilators. This sets them apart from personal care aides, who are limited to nonmedical help like companionship, cooking, cleaning, and driving.
The level of care your family member needs determines which type of aide (and which funding source) fits. Most assessments look at how well someone can independently perform basic activities of daily living: bathing, dressing, toileting, eating, transferring in and out of a bed or chair, and maintaining continence. Difficulty with two or more of these activities usually signals a need for hands-on help.
Getting a Home Health Aide Through Medicare
Medicare covers home health aide services at no cost to you, but the eligibility rules are specific. Your family member must be considered “homebound,” meaning leaving home requires a major effort, special transportation, or help from another person due to illness or injury. They also need a skilled service, such as nursing care, physical therapy, or speech therapy, ordered by a doctor. The aide visits are only covered as part of that broader skilled care plan.
The process starts with a doctor visit. The physician must certify that your family member is homebound, needs intermittent skilled care, and has had a face-to-face encounter related to the reason home health is needed. The doctor then authorizes a plan of care and periodically reviews it. From there, a Medicare-certified home health agency sends a nurse or therapist to do an in-home assessment, and the aide visits are built into that care plan.
To get things moving, ask your family member’s primary care doctor for a home health referral. If your parent was recently hospitalized, the hospital discharge planner can coordinate this before they leave. Medicare will only pay for part-time or intermittent care, not a full-time aide, so if your family member needs someone for eight or more hours a day, you’ll need to look beyond Medicare for the additional hours.
Using Medicaid for Longer-Term Help
Medicaid is the main public funding source for ongoing, long-term home care that goes beyond what Medicare’s short-term model covers. Most states offer home and community-based services (HCBS) waivers specifically designed to keep elderly people in their homes rather than nursing facilities. These waivers can fund a home health aide for many more hours per week than Medicare allows.
Eligibility depends on both income and assets. Most states cap income at 300% of the Supplemental Security Income limit, which works out to $2,901 per month in 2025. Assets are typically limited to $2,000 per person, though rules vary by state. Your family member’s home, one vehicle, and certain other assets are usually excluded from that count.
The catch: HCBS waivers often have waiting lists, sometimes lasting months or even years depending on your state. Apply as early as possible by contacting your state Medicaid office or your local Area Agency on Aging. They’ll schedule a functional assessment to determine the level of care needed and place your family member on the waiver list. Some states also have Medicaid state plan services for home care that don’t involve a waiver and may have shorter wait times.
Veterans Benefits for Home Care
If your family member is a veteran, the VA offers several paths to home health aide coverage. The Aid and Attendance benefit adds up to $29,093 per year (for a veteran with no dependents) on top of the basic VA pension. This money can be used to pay for a home health aide privately. Veterans who don’t qualify for Aid and Attendance receive a base pension of $17,441 per year.
The VA also provides direct home health aide services through its own programs, including the Homemaker and Home Health Aide Program. To access either option, start with an application through the VA or visit your nearest VA medical center. A VA social worker can help determine which program fits your family member’s needs and service history.
Long-Term Care Insurance
If your family member purchased a long-term care insurance policy, it likely covers home health aide services. Before benefits kick in, you’ll need to satisfy the elimination period, which is the waiting period between when care begins and when the insurer starts paying. This ranges from 30 to 180 days depending on the policy, and some policies count only days when services are actually received while others count calendar days.
Most policies pay a maximum daily benefit amount that your family member chose when they bought the policy. If the daily benefit is $150 and the aide costs $200 per day, the family covers the $50 difference. Dig out the policy and call the insurer directly. They’ll explain what triggers benefits (usually the inability to perform two or more activities of daily living), what documentation they need from a doctor, and how to submit claims.
Paying Out of Pocket
When insurance and government programs don’t cover enough hours, or don’t apply at all, private pay fills the gap. The national median rate for home health aide services is $35 per hour, which adds up to roughly $280 for an eight-hour day or over $8,000 a month for full-time care. Rates vary significantly by region, running lower in rural areas and higher in major metro markets.
Agency vs. Hiring Directly
You have two basic options for finding the actual aide: go through a home health agency or hire someone independently. Each has real tradeoffs.
An agency handles recruiting, background checks, training, scheduling, payroll taxes, workers’ compensation insurance, and finding a substitute when your aide calls in sick. Most states (41 out of 51, including Washington, D.C.) require agencies to conduct background checks on prospective employees, and 35 states specify criminal convictions that automatically disqualify someone from employment. You pay a higher hourly rate for this convenience, but you avoid significant administrative and legal burden.
Hiring directly costs less per hour because there’s no agency markup, but the IRS considers a home health aide working in your family’s home to be a household employee, not an independent contractor. That means you’re legally responsible for processing payroll, withholding and paying employment taxes, carrying workers’ compensation and liability insurance, and filing a W-2. Misclassifying an aide as a 1099 independent contractor can result in back taxes and penalties. Most families underestimate this responsibility. If the idea of becoming an employer sounds overwhelming, an agency is the simpler path.
A middle option exists: fiscal intermediary services, sometimes offered through Medicaid programs, handle the payroll and tax paperwork while letting you choose and direct the aide yourself.
Steps to Get Started
- Talk to the doctor. Whether you’re pursuing Medicare coverage or just need a professional assessment of care needs, the primary care physician is the starting point. Ask specifically about a home health referral.
- Contact your Area Agency on Aging. Call the Eldercare Locator at 1-800-677-1116 to find your local office. They can walk you through Medicaid waiver applications, connect you with vetted agencies, and identify state-funded programs you might not know about.
- Check all funding sources. Many families combine Medicare for skilled nursing visits, Medicaid or private pay for daily aide hours, and VA benefits or long-term care insurance when applicable. These programs aren’t mutually exclusive.
- Interview agencies or aides. Ask about training credentials, backup staffing plans, supervision by a registered nurse, and how they handle complaints. If hiring directly, run your own background check through your state’s registry and check references thoroughly.
- Request a care plan in writing. Whether through an agency or an independent aide, document the specific tasks, schedule, and expectations. This protects everyone and makes it easier to evaluate whether the arrangement is working.
The timeline from first doctor’s visit to an aide showing up at the door varies. Medicare-covered home health can begin within days of a hospital discharge or a week or two after a doctor’s referral. Medicaid waivers take longer due to applications and potential waitlists. Private-pay arrangements through an agency can often start within a few days of your initial call.