Getting home health care for a parent starts with understanding what type of care they need, who pays for it, and how to find a qualified agency. The process differs depending on whether your parent needs medical care (like wound treatment or physical therapy) or daily living help (like bathing, dressing, and meal prep), because insurance covers these very differently. Here’s how to move through each step.
Skilled Care vs. Personal Care: The Key Distinction
The single most important thing to understand before you start making calls is the difference between skilled care and custodial (personal) care. Skilled care involves services that must be performed by a licensed medical professional: physical therapy, occupational therapy, wound care, injections, and monitoring of unstable medical conditions. Medicare covers skilled care under specific circumstances. Custodial care covers help with everyday activities like bathing, dressing, eating, getting in and out of bed, and managing meals. Medicare does not cover custodial care in virtually all instances.
This distinction determines your entire path. If your parent needs skilled nursing visits after a hospitalization, Medicare will likely pay. If your parent needs someone in the home several hours a day to help them live safely, you’re looking at Medicaid, private insurance, veterans’ benefits, or out-of-pocket costs.
How Medicare Home Health Works
Medicare will pay for home health services when three conditions are met: your parent is “homebound,” they need part-time or intermittent skilled care, and a doctor certifies both of these things.
Homebound doesn’t mean bedridden. It means leaving home isn’t recommended because of their condition, or that getting out of the house requires considerable effort, such as using a wheelchair, walker, cane, or special transportation. Your parent can still leave for medical appointments, religious services, or occasional short outings and keep their homebound status. Attending adult day care is also allowed.
“Part-time or intermittent” typically means up to 8 hours a day of combined skilled nursing and home health aide services, with a maximum of 28 hours per week. In some cases, a doctor can authorize up to 35 hours per week for a limited time. If your parent needs more than part-time skilled care, they won’t qualify for Medicare home health, and a facility setting may be more appropriate.
Getting the Doctor’s Certification
Medicare requires a face-to-face encounter between your parent and their physician (or a nurse practitioner or physician assistant). This visit must happen within 90 days before home health starts, or within 30 days after it begins. If home health is ordered for a new condition that wasn’t apparent during a recent visit, the doctor must see your parent within 30 days of admission.
The doctor then writes a brief narrative explaining how your parent’s condition supports both homebound status and the need for skilled services. This certification is what officially opens the door. Start by calling your parent’s primary care doctor or the hospital discharge planner and asking them to initiate a home health referral. Discharge planners in particular do this routinely and can connect you with certified agencies quickly.
When Your Parent Needs Daily Living Help
If your parent mostly needs help with cooking, cleaning, bathing, or someone to keep them safe throughout the day, you’re looking at custodial or personal care. This is what most families actually need, and it’s also the harder category to pay for.
The median hourly wage for home health and personal care aides is about $16 per hour, but that’s the worker’s pay. Agencies typically charge families $25 to $35 per hour after their margins are included. At 30 hours a week, that adds up to $3,000 to $4,500 a month out of pocket. Full-time care costs substantially more. Understanding your payment options before you hire anyone will save you from financial surprises.
Medicaid and State Waiver Programs
Medicaid is the largest payer of long-term personal care in the United States. Every state operates Home and Community-Based Services (HCBS) waiver programs that provide in-home care to people who would otherwise need nursing home placement. These programs can cover personal care aides, homemaker services, adult day programs, home modifications, and more.
Eligibility has two parts. Functionally, your parent must need a level of care that would qualify them for a nursing facility in your state. Financially, Medicaid has income and asset limits, though HCBS waivers often allow states to use more generous thresholds than standard Medicaid. Some states apply spousal impoverishment protections, which shield a portion of a married couple’s income and assets so the healthier spouse isn’t left destitute.
The biggest catch with HCBS waivers is wait times. Many states have waiting lists that stretch months or even years. Apply as early as possible. Contact your state’s Medicaid office or your local Area Agency on Aging to learn which waivers are available, what the current wait looks like, and how to get your parent on the list. The Eldercare Locator (eldercare.acl.gov or 1-800-677-1116) can connect you with your local agency.
Veterans’ Benefits for Home Care
If your parent is a veteran receiving a VA pension, the Aid and Attendance benefit can add a monthly stipend specifically to help pay for in-home care. Your parent may qualify if at least one of the following is true: they need another person to help with daily activities like bathing, feeding, or dressing; they spend a large portion of the day in bed due to illness; they’re in a nursing home because of disability-related loss of function; or their corrected eyesight is 5/200 or worse in both eyes.
A separate Housebound allowance is available for veterans who spend most of their time at home because of a permanent disability. These benefits can be combined with other coverage. Apply through the VA’s website or contact a veterans’ service organization for help with the paperwork, which can be complex.
Long-Term Care Insurance
If your parent purchased a long-term care insurance policy years ago, now is the time to pull it out and read the fine print. Most policies begin paying benefits when the policyholder needs help with two or more of six activities of daily living (bathing, dressing, eating, toileting, transferring, and continence) or has a cognitive impairment like dementia.
Even after meeting this “benefit trigger,” there’s typically an elimination period before payments start. Think of it like a deductible measured in time rather than dollars. Most policies use a 30, 60, or 90-day elimination period, chosen when the policy was originally purchased. During that window, you’ll pay for care out of pocket. Call the insurance company early to start the claims process, because the clock on the elimination period doesn’t start until you file.
The PACE Program
The Program of All-Inclusive Care for the Elderly (PACE) is a lesser-known option worth investigating. PACE organizations coordinate all medical and personal care for qualifying adults, including in-home services, adult day care, transportation, and specialist visits. To qualify, your parent must be 55 or older, live in the service area of a PACE organization, be eligible for nursing-home-level care, and be able to live safely in the community at enrollment. Medicaid and Medicare both fund PACE, and people who don’t qualify for either can sometimes pay privately. PACE isn’t available everywhere, but it operates in over 30 states.
How to Choose a Home Health Agency
Once you know how care will be paid for, you need to find a reputable agency. Medicare’s Care Compare tool (medicare.gov/care-compare) rates Medicare-certified home health agencies on a five-star scale using two sets of measures.
The quality of patient care rating tracks seven specific outcomes: whether care started promptly, whether patients improved in walking, getting in and out of bed, bathing, managing shortness of breath, and handling their medications, and whether the agency avoided preventable hospitalizations. The patient survey rating captures families’ and patients’ direct experiences, including how well providers communicated, how they handled specific care issues, and an overall satisfaction score.
Compare at least three agencies in your parent’s area. Beyond the star ratings, ask these practical questions when you call:
- Staffing consistency: Will the same aide or nurse visit regularly, or will it rotate? Consistency matters enormously for an older person’s comfort and safety.
- Backup plans: What happens when a caregiver calls in sick?
- Supervision: How often does a registered nurse supervise home health aides?
- Responsiveness: Can you reach someone after hours if there’s a problem?
- Care planning: Will they involve you and your parent in creating and updating the care plan?
Steps to Get Started This Week
The process can feel overwhelming, but breaking it into concrete actions helps. First, assess what your parent actually needs. Write down the tasks they struggle with, how many hours a day they need help, and whether any of those tasks are medical in nature. Second, call their doctor to discuss a home health referral if skilled care is needed. If your parent is being discharged from a hospital, talk to the discharge planner before they leave.
Third, determine the payment path. Check Medicare eligibility if skilled care is involved. Contact your state Medicaid office or Area Agency on Aging about HCBS waivers if personal care is the primary need. Dig out any long-term care insurance policies. If your parent is a veteran, call the VA or a local veterans’ service organization. Many families end up using a combination of sources.
Finally, research agencies using Care Compare, get references, and interview at least a few options before signing a service agreement. Agencies should be willing to do an in-home assessment of your parent before care begins, at no charge. If one rushes past that step, move on to the next.