Frequently asked questions
Understanding the types of care
Home health care is medical care delivered in your home by licensed professionals like nurses and therapists. It requires a doctor's order and is typically covered by Medicare or insurance after a hospitalization or illness. Personal care (also called PCS or home care) is non-medical help with daily activities like bathing, dressing, and meal preparation. It does not require a doctor's order but is often covered by Medicaid or paid out of pocket.
Hospice care is specialized comfort-focused care for people with a terminal illness who are no longer pursuing curative treatment and have a life expectancy of six months or less (as certified by a physician). Hospice focuses on quality of life, pain management, and emotional and spiritual support for both the patient and their family. It can be provided at home, in a hospice facility, or in a nursing home.
A home health agency sends licensed medical professionals — such as registered nurses, physical therapists, occupational therapists, speech therapists, and home health aides — to your home to provide skilled medical care. Services might include wound care, medication management, rehabilitation after surgery, monitoring of chronic conditions like diabetes or heart failure, and teaching patients and caregivers how to manage a condition at home.
PCS stands for Personal Care Services. A PCS agency provides non-medical in-home support to help people with daily tasks they can no longer do independently. This includes help with bathing, grooming, dressing, toileting, meal preparation, light housekeeping, and companionship. PCS agencies do not provide medical care and do not require a doctor's order.
Insurance and coverage
Yes — Medicare Part A and Part B cover home health care if you meet certain criteria: you must be homebound (meaning leaving home requires considerable effort), you must need skilled care (such as skilled nursing or therapy), your doctor must order the care and create a care plan, and the agency must be Medicare-certified. There is no copay for Medicare-covered home health services.
A Medicare-certified agency has been approved by the Centers for Medicare & Medicaid Services (CMS) to provide services that Medicare will pay for. Certification requires the agency to meet federal health and safety standards and pass regular inspections. On HomeCarePathway, you can filter specifically for Medicare-certified agencies.
Medicaid coverage varies by state. In Idaho, Medicaid may cover both home health care and personal care services for eligible individuals. Eligibility is based on income, disability status, and medical need. Contact your local Idaho Department of Health and Welfare office or ask your discharge planner about Medicaid waiver programs that may cover in-home care.
Many agencies accept private pay (paying out of pocket). Some agencies offer sliding-scale fees or can help connect you with financial assistance programs. When searching on HomeCarePathway, you can filter by "Private Pay" to find agencies that work with self-pay patients.
Choosing and working with an agency
CMS rates Medicare-certified home health agencies on a scale of 1 to 5 stars based on quality of care measures including how well patients improve, how often patients are hospitalized, and patient satisfaction surveys. A higher star rating generally indicates better outcomes. HomeCarePathway displays each agency's official CMS star rating directly on their listing.
To qualify for Medicare home health benefits, a patient must be considered "homebound." This means leaving home requires a considerable and taxing effort due to illness or injury. You can still leave home for medical appointments, religious services, or occasional special events — but your condition must make leaving home difficult. Your doctor determines and certifies your homebound status.
Good questions to ask include: Do you accept my insurance? How quickly can you start services? Are your nurses and therapists licensed and background-checked? Do you have staff available on weekends and evenings? Who do I call if there is a problem after hours? Do you have experience with my specific condition or needs?
A care plan is a written document created by your doctor and the home health agency that outlines your diagnosis, the specific services you will receive, how often a nurse or therapist will visit, your treatment goals, and how long care is expected to continue. Your care plan must be reviewed and updated regularly.
Medical terminology glossary
Plain-language definitions of terms you may encounter when researching home care.
- ADLs (Activities of Daily Living)
- The basic self-care tasks a person needs to do every day, including bathing, dressing, eating, toileting, transferring (moving from bed to chair), and walking. Many home care and personal care services are designed around helping with ADLs.
- Care Coordination
- The process of organizing a patient's care across multiple providers and services to make sure everyone involved — doctors, nurses, therapists, and family members — is working toward the same goals.
- Care Plan
- A written document that outlines a patient's medical needs, the services they will receive, how often those services will be provided, and the goals of treatment. Required for all Medicare-certified home health services.
- Caregiver
- A person (paid or unpaid) who provides assistance to someone who cannot fully care for themselves. Caregivers may be family members, friends, or professional home health or personal care workers.
- CMS (Centers for Medicare & Medicaid Services)
- The federal agency that administers Medicare, Medicaid, and related healthcare programs. CMS certifies home health and hospice agencies and publishes quality star ratings through its Care Compare tool.
- Custodial Care
- Non-medical care that helps a person with daily activities like bathing, dressing, and eating. Custodial care is not covered by Medicare but may be covered by Medicaid or long-term care insurance.
- Discharge Planner
- A hospital staff member (usually a nurse or social worker) who helps coordinate a patient's transition from the hospital to home or another care setting. Discharge planners are required by federal regulations to provide patients with an unbiased list of available home health agencies rather than recommending a specific one.
- DME (Durable Medical Equipment)
- Medical equipment prescribed for home use, such as wheelchairs, walkers, hospital beds, oxygen equipment, and CPAP machines. DME is often covered by Medicare Part B.
- Episode of Care
- A defined period of home health services, typically 60 days under Medicare. At the end of an episode, the agency reassesses whether additional care is needed and whether Medicare will continue to cover it.
- Homebound
- A Medicare eligibility requirement meaning that a patient's condition makes leaving home a considerable effort. Patients must be certified as homebound by their doctor to qualify for Medicare home health benefits.
- Home Health Aide
- A trained and certified worker who provides personal care and basic health-related services in a patient's home under the supervision of a nurse or therapist. Services include bathing, dressing, and some medication reminders.
- Hospice
- A philosophy and type of care focused on comfort, dignity, and quality of life for people with a terminal illness who have chosen to stop curative treatment. Hospice provides medical, emotional, social, and spiritual support to both patients and their families.
- IADLs (Instrumental Activities of Daily Living)
- More complex daily tasks beyond basic self-care, including managing medications, preparing meals, managing finances, using the telephone, shopping, and housekeeping. Difficulty with IADLs often signals a need for home care support.
- Intermittent Care
- Home health care provided on a part-time, scheduled basis rather than around the clock. Medicare covers intermittent skilled nursing or therapy visits, not 24-hour care.
- LPN (Licensed Practical Nurse)
- A licensed nurse who provides basic nursing care under the supervision of a registered nurse or physician. LPNs commonly provide home health services including wound care, medication administration, and monitoring of vital signs.
- Medicaid
- A joint federal and state program that provides health coverage for people with low incomes and limited resources. Medicaid may cover home health care and personal care services depending on the state and the individual's eligibility.
- Medicare
- The federal health insurance program for people aged 65 and older, and for younger people with certain disabilities. Medicare Part A and Part B cover medically necessary home health care from Medicare-certified agencies when specific eligibility requirements are met.
- Medicare-Certified
- An agency that has been approved by CMS to provide services covered by Medicare. Certification requires meeting federal health and safety standards. Only Medicare-certified agencies can bill Medicare for home health services.
- OT / Occupational Therapist
- A licensed therapist who helps patients regain or improve their ability to perform daily activities after illness, injury, or surgery. OT services at home may include exercises, adaptive equipment recommendations, and home safety assessments.
- Palliative Care
- Specialized medical care focused on relieving symptoms, pain, and stress related to serious illness. Unlike hospice, palliative care can be provided alongside curative treatment at any stage of illness.
- PCS (Personal Care Services)
- Non-medical in-home services that help people with daily activities such as bathing, dressing, grooming, meal preparation, and light housekeeping. PCS does not require a doctor's order and is distinct from skilled home health care.
- Physical Therapist (PT)
- A licensed therapist who helps patients restore movement, strength, and function after injury, surgery, or illness. Physical therapy at home may include exercises, balance training, and mobility instruction.
- Plan of Care
- See Care Plan.
- Private Pay
- Paying for home care services out of pocket, without using insurance. Patients who do not qualify for Medicare or Medicaid coverage, or whose coverage has been exhausted, may pay privately.
- RN (Registered Nurse)
- A licensed nurse with a higher level of training than an LPN. RNs commonly serve as case managers for home health patients, conducting assessments, developing care plans, and providing skilled nursing services.
- Respite Care
- Temporary relief for a primary caregiver. Respite care provides a substitute caregiver so that family members or regular caregivers can take a break. It can be provided at home or in a facility and is covered by Medicare hospice benefit for up to five consecutive days.
- Skilled Care
- Medical care that must be provided by or under the supervision of a licensed nurse or therapist. Skilled care is required to qualify for Medicare home health benefits and includes services like wound care, IV therapy, physical therapy, and complex medication management.
- Skilled Nursing Facility (SNF)
- A residential facility (sometimes called a nursing home or rehab facility) that provides 24-hour nursing care and rehabilitation services. SNF care is distinct from home health care, which is provided in a patient's own home.
- Speech-Language Pathologist (SLP)
- A licensed therapist who treats communication disorders and swallowing difficulties. SLP services at home are commonly provided after stroke, head injury, or surgeries affecting speech or swallowing.
- Superbill
- An itemized receipt provided by a healthcare provider that contains all the information needed to submit a claim to an insurance company. Patients paying privately may request a superbill for potential reimbursement.
- Telehealth / Remote Monitoring
- The use of technology (video visits, remote monitoring devices) to deliver or supplement home health services. Some agencies use remote monitoring to track vital signs between in-person visits.
- Transfer
- The act of moving a patient from one surface to another, such as from a bed to a wheelchair or from a chair to the toilet. Safe transfer techniques are an important part of home health and personal care training.
- Waiver Program
- A Medicaid program that allows states to provide long-term care services to eligible individuals in their homes or communities rather than in an institution. Idaho's Medicaid waiver programs may cover home and community-based services including personal care.
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