Setting up home health care starts with understanding what level of care your loved one needs, then finding the right provider, preparing the home, and sorting out how to pay for it. The process typically takes one to four weeks from the initial decision to having a caregiver walk through the door, though urgent situations can move faster. Here’s how to work through each step.
Assess What Level of Care Is Needed
Before contacting any agency or caregiver, you need a clear picture of what your loved one can and can’t do on their own. Health care professionals use two categories to frame this: basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
Basic ADLs are the physical essentials: bathing, dressing, eating, using the bathroom, and moving from a bed to a chair. IADLs are more complex tasks that require planning and organization: managing medications, cooking, handling money, doing laundry, and arranging transportation. Someone who struggles only with IADLs may need a companion or homemaker a few hours a day. Someone who needs help with multiple basic ADLs likely needs a certified home health aide or skilled nursing care.
The distinction between these two broad types of care matters for everything that follows. Skilled care involves registered nurses, physical therapists, occupational therapists, or speech therapists performing medical tasks under a doctor’s supervision. Custodial care (sometimes called personal care or non-medical care) focuses on help with daily routines like bathing, grooming, and meal preparation. Many families need a combination of both: a nurse who visits several times a week for wound care or medication management, plus an aide who helps with bathing and meals every day.
Build a Care Plan
A written care plan keeps everyone, from family members to professional caregivers, on the same page. The CDC recommends including: the person’s name, date of birth, and contact information; all health conditions; every medication with dosages and timing; contact information for each health care provider; health insurance details; and emergency contacts. This document becomes the reference point for anyone providing care in the home.
Beyond the basics, your care plan should spell out daily routines (wake time, meals, exercise, rest), specific tasks the caregiver is responsible for, and any restrictions or precautions. If your loved one has dementia, note behavioral triggers and calming strategies. If they’re recovering from surgery, include the rehab goals and timeline their doctor laid out. Update the plan at least once a year, or whenever there’s a change in health status or medications.
Make the Home Safe
A home safety walkthrough is one of the most overlooked steps, and one of the most important. Falls are the leading cause of injury for older adults, and most of the risk factors are fixable.
Work through each area of the house:
- Throughout the home: Clear clutter from all walking paths. Remove throw rugs or secure them with non-slip backing. Make sure lighting is bright at the top and bottom of every staircase and in hallways. Tuck away extension cords and electrical cords.
- Stairs: Install handrails on both sides, extending past the first and last steps. Mark step edges with bright or reflective tape. If stairs aren’t manageable, consider a ramp or a stair gate.
- Bathroom: Add grab bars near the toilet and inside the tub or shower. Place non-slip mats or adhesive strips on wet surfaces. A plastic shower stool and hand-held shower head make bathing safer and easier. Set the water heater to 120°F to prevent scalding.
- Outdoors: Ensure exterior lighting is adequate. If a walker or wheelchair is needed, modify entrances with a ramp. Motion-activated lights near the front door are helpful.
Post emergency phone numbers and the home address near every phone. This sounds obvious, but in a crisis, even family members can blank on an address when speaking to a 911 dispatcher.
Decide Between an Agency and a Private Caregiver
You have two main hiring paths: going through a home health agency or hiring an independent caregiver directly. Each comes with trade-offs.
An agency handles recruitment, background checks, training, scheduling, payroll taxes, and substitute coverage when a caregiver calls in sick. You pay more per hour, but you avoid the administrative burden. A certified home health aide through an agency typically costs $28 to $35 per hour nationally, while specialized care for conditions like dementia runs $32 to $43 or more. Skilled nursing visits are significantly higher, often $50 to $80 per hour.
Hiring independently is usually cheaper per hour, but you become a household employer. The IRS requires you to pay Social Security and Medicare taxes (6.2% and 1.45%, respectively, matched by the employee) once you pay a household worker $3,000 or more in cash wages in a calendar year. If you pay $1,000 or more in any calendar quarter, you also owe federal unemployment tax on the first $7,000 of wages. Most states require workers’ compensation insurance as well. You’re also responsible for verifying the caregiver’s qualifications, running background checks, and finding backup coverage on your own.
Vet Agencies Carefully
If you go the agency route, the federal government provides a free comparison tool. Medicare’s Care Compare website rates home health agencies on two dimensions: quality of patient care and patient satisfaction. The quality rating is built from seven measures, including how quickly care starts after a referral, whether patients improve in walking and bathing, and how often patients end up back in the hospital. The patient satisfaction rating captures how well providers communicate, how well specific care issues are handled, and the overall experience rating from surveys.
Agencies need data from at least 20 completed care episodes to receive a quality rating and 40 completed patient surveys for a satisfaction rating, so a brand-new or very small agency may not have star ratings yet. That’s not automatically a red flag, but it does mean you’ll need to do more of your own digging. Ask any agency you’re considering: How do you screen and train caregivers? What happens if my regular caregiver is unavailable? How do you handle complaints? Can I speak with current clients or their families?
Understand How to Pay for It
Medicare
Medicare covers home health services, but only under specific conditions. You must be considered “homebound,” meaning leaving your home requires considerable effort because of illness or injury, whether that means needing a wheelchair, special transportation, or physical help from another person. A health care provider must see you face-to-face and certify that you need skilled care, and that care must be ordered by a doctor and delivered by a Medicare-certified agency. When these criteria are met, Medicare pays 100% for skilled nursing, therapy, and medical social services with no copay. It does not cover 24-hour care, custodial-only care, or meal delivery.
Medicaid and HCBS Waivers
Medicaid offers a broader safety net for people with limited income and assets. Through Home and Community-Based Services (HCBS) waivers, states can pay for services like personal care aides, homemaker services, adult day programs, and respite care. To qualify, you generally need to demonstrate a level of care need that would otherwise require a nursing home, and you must meet your state’s financial eligibility criteria. Each state designs its own waiver programs, so the specific services available, income limits, and waiting lists vary widely. Contact your state Medicaid office or local Area Agency on Aging to find out what’s available where you live.
Private Pay and Long-Term Care Insurance
Many families pay out of pocket, at least in part. At a national median of roughly $30 per hour for a home health aide, the cost of eight hours of daily care five days a week adds up to about $62,000 a year. Long-term care insurance policies, if purchased before care is needed, can cover a significant portion of these costs. If your loved one has a policy, review it now for the daily benefit amount, elimination period (the waiting period before benefits kick in), and any requirements for triggering coverage, which is usually the inability to perform two or more ADLs independently.
Consider Remote Monitoring Equipment
Home health care doesn’t stop when the caregiver leaves for the day. Remote patient monitoring devices can fill the gaps by sending health data directly to a care team. Common devices include blood pressure monitors, glucose monitors, heart rate monitors, pulse oximeters, and digital scales. Johns Hopkins, among other health systems, provides equipment that connects to its own cellular network, so the patient doesn’t need internet access at home. These devices let a nurse spot a concerning trend, like rising blood pressure or sudden weight gain from fluid retention, before it becomes an emergency room visit.
If your loved one’s home health agency offers remote monitoring, it’s worth asking about. For patients with heart failure, diabetes, or chronic lung disease, these devices can reduce preventable hospital readmissions, which is one of the quality measures Medicare tracks when rating agencies.
Get the Timing Right
The best time to set up home health care is before it’s urgently needed. If your loved one is scheduled for surgery, start the process two to three weeks beforehand so you have a caregiver lined up for discharge day. If you’re noticing a gradual decline, beginning with a few hours of help per week is easier to adjust than scrambling after a fall or hospitalization. Many agencies offer a free initial consultation to assess needs and walk through the home, which gives you a baseline even if you’re not ready to start services immediately.
For hospital discharges, the hospital’s discharge planner or social worker will often coordinate the initial referral to a home health agency. Make sure you’re part of that conversation so the care plan reflects what’s actually happening at home, not just what’s in the medical chart.