Understanding the Difference Between Home Health and Home Care


At some point in our journey of long-term care at home, we may be required to solicit additional assistance. But one of the biggest areas in question involves understanding the differences between Home Health and Home Care services. This is even true when searching for the various services online. In some ways, they can look very similar. But they aren't. In this blog, we will discuss how services differ between home health and home care, when each service may be needed, what insurance covers, and how to budget for your long-term care needs. Can home care and home health be utilized simultaneously? Also, when it comes to choosing home care companions - what's better, going with private or agency caregivers?


Home Health

Home Health is usually paid by medical insurance and requires a prescription from a medical provider. It generally is required after a hospitalization, procedure, or infection. The goal is to rehabilitate the patient to their original baseline or to their best ability after the incident that prompted the need for care. Home health will include a social worker, nurse, aide and therapists - including occupational, physical and speech therapy.


Nurses generally visit weekly or as needed, while aids come several times a week to help with personal care are such as showering. Therapists rotate throughout the home several times during the week with 30-minute to 1-hour sessions. Home health is always temporary, and can last from two weeks to three months depending on insurance policies, assessments, and qualifications. Generally, patients only qualify for home health if there is an inability to attend outpatient medical or therapy services.


Home Care

Home care includes all non-medical services and activities of daily living. A prescription from a medical provider is not needed. It is completely up to the discretion of those in care and their care partners as to who they choose to hire to come into their home. Companions are generally hired to sit and assist those in their care throughout their time in the home. That can also include light housework, meal preparation, and assistance with errands.


Home Care is ideal for those living at home alone, but is also utilized by care partners for much needed respite and breaks. Home care can range from a minimum of one, 4-hour shift a week, to 24x7 in home care. It can also be used at the same time as home health services. Even those that may be living in assisted living or memory care facilities could opt in to additional home care services for one on one, personalized and fully devoted care to their loved ones.


Generally, the rate for home care companions averages $20-25 per hour for quality care. While medical insurance cannot be applied to home care services, long-term care insurance generally is applicable.


When it comes to home care companion services, there are many options. Some may choose family, friends or community volunteers to assist with companion services. Many Area Agencies on Aging offer senior companion matching services. Some may be volunteer based at no fee, while others may require to you pay an affordable hourly rate. Additionally, many elder care and government agencies can help you understand if you qualify for additional monetary assistance through grants or scholarships to help offset payment for caregiver support and reimbursement - even extending to some family members.


When it comes to choosing what type of caregiver to hire - there are basically two choices: private, also called independent caregivers, or by contracting through an agency. Let's break them down:


Independent Caregivers

Independent or private caregivers are employed directly by the family. There is no intermediary agency between the care recipient and the caregiver. Some independent caregivers are also able to provide medical care depending on credentials (if trained to do so,) but this is much less common with agency providers.


Using an independent caregiver can save a family 20-30% in hourly rates. Average hourly rates for independent caregivers are $15-17 per hour. However, there are hidden costs of being an employer that should be considered, including hiring, managing and making payments. It is difficult to discern if an independent caregiver can provide more quality care than an agency provided caregiver. It truly depends on the care provider. So, don't let broad strokes from others' previous experiences taint what might be the best option for you.


There is also a false perception that hiring an independent caregiver is somehow illegal. This is not the case. However, paying an independent caregiver under the table is illegal. Paying the caregiver under the table is not in the family's best interest because it is highly likely that by doing so, the family is missing out on some tax benefits. The IRS has recently ruled that caregivers must be classified as employees, not independent contractors. For those that like the thought of using an independent caregiver but don't want to take on the burden of managing payroll, affordable, third-party services exist to help families pay independent caregivers legally. There are many services, such as care.com, that are now available to help you customize a payroll process, file tax returns automatically, as well as seek out HR specialists. Some even provide search engines of potential care providers in your local area.


While you may get the help you need when it comes to administering payment legally and even tapping into a search of available caregivers, you are still responsible for seeking out who you choose to hire/fire as an independent caregiver. Some appreciate having this control over who comes into their home. But it also requires you posting a job description, receiving and reviewing applications, setting up interviews, and making sure the candidate meets all your qualifications. Are they insured? How many years of experience do they have? Do they have references? Have they worked with someone previously that has the same needs as your loved one? All screenings and background checks are on you as the employer.


Choosing to go with an independent caregiver can be a more cumbersome process, but it also gives you more control in your selection. If you already know someone you trust, or that has worked with someone previously - choosing an independent approach may be ideal for you.


Home Care Agencies

Home care agencies are licensed businesses that employ caregivers and send them to the home of your loved one to provide in-home care. Home care agencies are generally more expensive than hiring independent caregivers, averaging $21-25 per hour. However, home care agencies offset the tasks of hiring, managing and making payments to caregivers. Additionally, if you do have long-term care insurance, they can make the filing of claims much easier for appropriate reimbursement. They can also simplify the complicated process of deducting Social Security and other taxes. Should an issue arise, or a caregiver need to be replaced, the agency can handle these matters on your behalf.


Home Care Agencies typically have screening processes already in place, including drug testing and background checks. They also can provide workmen's comp insurance for those in your home should there be an issue or accident, reducing the fear of a potential lawsuit as an employer.


When it comes to working with agencies, there can be less flexibility in the continuity of services. Most agencies are going to require a minimum hourly shift weekly. Also, by working with an agency, you may not always get the same care companion. You are guaranteed more continuity based on the more shifts you choose. Most agency owners will stress that they try to achieve continuity of service, but it can't be guaranteed. However, the good news is that if the caregiver can't come that day - there is someone generally available for back-up, whereas if you hire only one independent caregiver you may not be as fortunate to fill your employee's shoes if or when they need to be absent.


What would I do?

Bringing someone into your home is a very personal choice and one that should not be made lightly. For some of us, we may only be able to go with an independent caregiver due to access and availability of local agencies serving our area. For others, we may not be able to locate quality independent caregivers on our own - or even know how to go about being an employer.


It depends on your personal situation. If you already know someone you trust with excellent references that you believe can provide good care and will be easy to work with - independent caregiving may be the best and most affordable option for you.


When it came to my dad, I felt more comfortable contracting with an agency. I sought out a local, family-owned agency that I felt had my dad's best interests at heart when it came to matching him with the right companion. I was more comfortable letting them handle the paperwork that came with filing claims for long-term care insurance, and a simplified payment process. I also liked the fact that if someone wasn't working out - it wasn't on me to fire them or try to find a replacement. I understood that it might not always be ideal or that I would have the perfect consistent companion, and I knew that it might take more coaching on my end for making sure my dad's needs were addressed, but I was happy with my decision.


Engage Care Partners can help you discern which option might be best for you and provide you with a listing of local resources in the Greater Birmingham and Shelby County areas for private caregivers and recommended agencies. We have successfully helped families find perfect matches when it comes to companion care services. For more information, call 1.205.843.1908, or email us at brooklyn.white@engagecarepartners.com


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