While the retirement community industry continues to expand, most older adults still prefer to remain in their own homes for as long as possible. That choice can seem economical at first glance, but costs can rise quickly if home care services become necessary.
In my work presenting to prospective residents at continuing care retirement communities (CCRCs), I regularly speak with seniors across the country and hear firsthand what concerns them most. One recurring confusion I encounter is the difference between a home healthcare provider and a home care provider. The terms sound similar, yet they are distinct: home healthcare involves medical services and may be covered in part by Medicare for a limited time, whereas home care focuses on nonmedical assistance and is not covered by Medicare.
Home healthcare providers
Home healthcare providers—often called home health aides—typically have formal medical training and must pass competency testing. They may hold credentials such as certified nursing assistant (CNA), licensed practical nurse (LPN), or be licensed therapists, like physical or occupational therapists (PT or OT).
Home healthcare includes medical and therapeutic services performed in the home, such as wound care, IV or injection administration, rehabilitation therapies, patient and caregiver education, and monitoring of medical conditions. The goal is to treat an illness or injury and restore as much independence as possible, often following a hospital stay.
If the provider and agency are Medicare-certified, Medicare Part A and/or Part B can cover part-time or intermittent skilled nursing care, as well as physical therapy, speech-language pathology, or occupational therapy for a prescribed period. A physician must certify that you are homebound and require these services, periodically review your plan of care, and a Medicare-certified home health agency must coordinate the services. Note that if you require more than intermittent skilled nursing care, you will not be eligible for this Medicare benefit.
Home care providers
A home care provider, also called a personal care aide or home care aide, helps with daily tasks and personal care rather than medical treatment. Formal certification is not typically required for this role. Home care providers may be employed directly by a senior or their family or hired through agencies that may provide supervision by a licensed nurse or social worker.
Home care services support aging in place by assisting with activities of daily living (ADLs) such as bathing, dressing, toileting, meal preparation, and medication reminders. Home care aides also handle household chores, shopping, errands, and provide companionship.
It is important to understand that Medicare does not cover the cost of nonmedical home care. Some long-term care insurance policies may cover part of these services, and Medicaid may cover them for individuals who meet financial eligibility requirements and receive care from a Medicaid-certified provider.
For authoritative information about Medicare coverage, visit the official Medicare website.
Care costs that can really add up
Between 50 and 70 percent of people over age 65 will eventually need significant help with daily tasks and personal care. When both home care and home healthcare are needed, the total hours and cost can increase quickly as needs progress.
For context, the average monthly cost for about 44 hours of in-home care was roughly $3,800 in recent studies. By comparison, the national average for assisted living has often been comparable or slightly lower, depending on care levels and location. Twenty-four-hour skilled nursing care in a facility—the most intensive level—can cost $7,000 to $8,000 per month or more. Whether skilled care is delivered at home or in a facility, it is a substantial expense.
Additional paid services that support aging at home—such as adult day programs, respite care, bill paying and recordkeeping, or assistive equipment—can add another $500 to $1,000 per month depending on needs and choices.
Understanding which services are covered by Medicare, long-term care insurance, or Medicaid is essential for financial planning. Staying at home may not be as cost-effective as it initially appears. Running the numbers may prompt consideration of alternatives, such as a CCRC or other senior living options, that can provide a more predictable continuum of care and potentially lower overall costs.
Thinking of a CCRC? Check out our free online community search tool.