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What Is Home Health Care And How Does It Work?

At its most basic level, home health care is exactly what the name suggests: "It's care for someone within their home," says Joe Pecora Jr., vice president of Home Healthcare Workers of America, a national union representing home healthcare workers.

The type of care varies. Depending on a person's needs, home health care can consist of medical care like wound care and/or non-medical care like help with bathing or meal preparation.

Different Types of Home Health Care

There are two primary types of home health care:

Medical CareThis type of home health care—often called skilled care—is provided by a medical professional, such as a physician, registered nurse or physical therapist. Services they could provide include wound care and physical, occupational and speech therapy, says Yount. Other potential services include patient and caregiver education, injections and nutrition therapy. Medical home health care is prescribed by a doctor.

Non-Medical CareNon-medical care includes "assistance with activities of daily living—so, things like bathing, dressing, meal preparation, transportation to and from physician appointments, running errands, shopping and housekeeping," says Yount. It's provided by home health or home care aides.

What to Expect From Home Health Care

When a new patient signs up for home health care through BrightStar Care, a national home health care provider, a registered nurse meets with the family at home to understand their goals and exactly what services they need. The nurse then prepares a detailed personalized care plan, says Shelly Sun, the company's CEO and founder. That meeting helps BrightStar Care "match a caregiver with the right skills, the right personality and the right schedule compatibility with the individual we're going to be taking care of in their home," says Sun. She stresses that anyone signing up for high-quality home health care should expect a similar process.

Once home health care starts, the patient and provider work together to determine the appropriate days and hours for visits. "It varies greatly—from one hour at a time to 24-hour care," says Pecora.

In addition to hands-on care for a patient, home health care providers "act as a liaison," assisting with communication between the patient and their healthcare team. "They are the eyes and ears for the physician inside the home," says Yount. "The doctor only sees them intermittently, so sometimes [the home health aide] can head off larger medical issues by seeing signs and symptoms earlier."

What States Get Right And Wrong When It Comes To Home-Based Care Support

When it comes to long-term care services and home-based care, some states are much further ahead than others. But one thing most of those states agree on is that there's still room to improve.

Last month, when AARP released its long-term services and supports state scorecard report, Minnesota came out on top, ranking number one on the list. That means the state scored high when it comes to factors such as affordability and access, choices of settings and providers, safety and quality, and more.

"Minnesota has long taken pride in doing very well in providing care for Minnesotans, whether it be the older adults or people with disabilities, so I think we have continued to work on that," Kathy Messerli, executive director at the Minnesota Home Care Association, told Home Health Care News. "I would also say that while it's hard to find a silver lining for the pandemic, one of them was certainly an increased awareness of the services that could be provided in the home, and the quality and the outcomes that come from that."

This increased awareness has activated lawmakers and state regulators to move in a direction that is positive for providers, according to Messerli.

The Minnesota Home Care Association has also been active when it comes to increasing home-based care utilization. In order to achieve this, the organization has worked to educate physicians.

"We found early in the pandemic when we were presenting to [physicians], they said, 'We're really not recommending home care to our patients, because we're just not sure whether or not they're qualified,'" Messerli said. "One of my board members was able to say, 'Let us figure out if they're qualified, just get the referral done.'" We are really trying to elevate the awareness of home care, home health, and what all can be done in the home."

The organization has also been able to advocate for higher reimbursement rates, which often leads to higher pay. In the 2022 session, the state received a 7% increase in Medicaid rates for home care.

Additionally, Minnesota's Community First Services and Supports (CFSS) program will allow families, parents and spouses — or informal caregivers — to be paid to take care of their loved ones.

"They have really taken a broader scope to say, 'What do we need to do to support providers who don't have enough workforce?'" Messerli said. "Part of that answer is we need to get the families engaged."

Despite Minnesota being a generally favorable environment for the delivery of home-based care, there is always more that can be done to further improve conditions.

For example, start of care evaluations conducted by providers are currently compensated as normal visits, which are presumed to be an hour.

"We all know it takes two, three to four, sometimes even six times as long, to do those evaluations and do all the follow up paperwork," Messerli said.

Massachusetts — another state that scored a high ranking — also benefited from a shift in the mindset of policymakers regarding aging in place and at-home care services, Jake Krilovich, executive director of the Home Care Alliance of Massachusetts, told HHCN.

Krilovich pointed out that the state has always been somewhat at the forefront of access to care.

"We have the [Frail Elder Waiver] program that has been in place for many years, which is designed to find dual-eligible patients that would qualify for a nursing home, [but the waiver] allows them to stay at home with some support," he said. "I think the program has been a model for the country, as other states have looked to adopt it."

Like Messerli, Krilovich believes that there's more that can be done to make things easier for home-based care providers to deliver services.

"We have Medicaid rates that are $40-$50 lower than commercial payers, or even Medicare," he said. "As Medicare's looking to cut reimbursement on their end, trying to make 2+2=4 gets harder."

Krilovich also urged Massachusetts to look at ways to alleviate the burdens that providers face due to the state's prior authorization requirements.

"Constantly going back and forth between the provider and the payer, about whether a patient needs six nursing visits, or if a patient needs seven nursing visits, all takes time, and ultimately, who pays for it at the end is the patient," he said. "I'm not advocating against prior authorization, I just think it's important to look at these provider burdens."

In terms of performance, South Carolina is on the other end of the spectrum.

The state came in at 49 of 51 in AARP's report, only ahead of Alabama and West Virginia. But this doesn't tell the whole story, according to Tim Rogers, president and CEO of the South Carolina Home Care & Hospice Association.

"For home care costs, South Carolina ranks 14th," he told HHCN. "The cost of private home care has not risen in South Carolina like it has in Georgia, Virginia, North Carolina, New York or California. South Carolina had a very good score when ranking access to home care agencies versus nursing homes."

The AARP report ranked states overall, but it also detailed individual rankings for various performance indicators.

Even with this additional context, Rogers doesn't deny that problems exist in South Carolina. He is quick to point out what is being done to make improvements in the state.

"Robert Kerr, the director of the South Carolina Department of Health and Human Services, has an open door to all health care services," he said. "We have met with him multiple times, and he has been very forthright in what he can do to gain federal dollars, he's working with the legislature on state dollars for Medicaid home care services, and listening to us on innovative approaches."

Though change won't happen overnight, South Carolina has already begun to see positive momentum.

"Rome was not built in a day, but we got rate increases last year, and this year for home care, aide services, as well as private-duty nursing," Rogers said. "We also finally achieved, after a roughly four-year discussion, the policy that will eventually come into play called coexisting care. This means a Medicaid recipient doesn't have to give up their hospice care or their in-home aid, they can have it at the same time. Up until now, they've had to choose, and I think that's a travesty."

Rogers expects coexisting care to be a reality by 2024. He credits Eunice Medina – chief of staff and deputy director of programs at the South Carolina Department of Health and Human Services – for working with the organization regarding this issue.

Ultimately, Rogers still thinks there's still more to be done, especially when it comes to reimbursement rates.

"We've got to do a better job, and we've got to impress upon this to the legislature, in order to attract in-home aides, nurse aides, attendants, as well as nurses, registered nurses and LPNs," he said. "We've got to be able to reimburse these agencies at a higher rate."

Does Medicare Cover Home Health Care? (2023)

Medicare Part A and Part B cover home health care if the services needed are considered reasonable and necessary for the person's specific illness or injury, says Ari Parker, co-founder and head advisor at Chapter, an independent Medicare advisor organization. Furthermore, you must be under the care of a doctor who declares you homebound to qualify for home health care under Medicare.

"Medicare covers skilled nursing care, physical therapy, occupational therapy and speech-language pathology services. In addition, Medicare covers home health aide services and Medicare social services, which is when a doctor may recommend counseling to help with social and emotional concerns that could hinder the recovery process," adds Parker.

While Medicare covers part-time or intermittent skilled nursing, physical and occupational therapy and other qualified services in the home, it becomes less beneficial when the level of home health care shifts toward custodial or constant care.

"Medicare will not cover 24-hour-a-day care, delivery of meals or home care services, such as cleaning, laundry or support with activities of daily living (ADLs), such as bathing, toileting or dressing," says Chris Orestis, Certified Senior Advisor and president of Retirement Genius, a website dedicated to helping seniors navigate retirement.

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