Choosing the right care for a loved one is one of the most important decisions you can make. The best option depends on their medical needs, lifestyle, and budget. While many people use “home health care” and “private duty home care” interchangeably, they have important distinctions that affect how you or your loved one pays for services.
What Is the Difference Between Home Care and Home Health Care?
Home health care is generally a shorter-term medical solution. When your loved one needs support with daily life, private duty care offers flexible, continuous care.
Home Health Care
Home health care provides medical services aimed at recovery and rehabilitation. Licensed health care professionals can administer medication, perform physical therapy, or monitor vital signs. This option suits care after hospitalization for surgery, injury, or illness. Coverage may include home health aides, counseling, occupational, speech, and physical therapy, or skilled nursing care, depending on your loved one’s needs and what they qualify for.
The duration of home health services depends on your loved one’s condition. Recovery and self-care are the end goals. It’s important to note that, even if your loved one meets all eligibility criteria for Medicare services, Medicare does not cover the costs of:
- Around-the-clock care
- Housekeeping services
- Personal care tasks like shopping and meal planning
- Acts of daily living (ADLs) that aren’t related to an injury or illness, including bathing or bathroom assistance
While every home health agency has its own scheduling policies, your loved one is not guaranteed to receive care from the same aide or skilled nurse each visit.
Private Duty Home Care
Private duty home care is a long-term solution. You can use private duty services as much or as little as your loved one needs them. From occasional visits to round-the-clock support, private duty agencies can accommodate you. This flexibility lets you decide on the level of care that suits your circumstances. There are no requirements to qualify for care.
Private duty caregivers spend more time with their patients, which builds a more comfortable relationship built on trust and familiarity. Unlike home health care, you can request the same caregiver each time, and the private duty agency will work with you to determine a good fit in terms of personality and communication styles.
A private duty care professional visits your loved one for an in-home assessment. During this visit, they review exactly what your loved one needs and create a customized care plan. Unlike Medicare-covered home health services, a doctor doesn’t need to approve of the care plan. Your payment to a private care provider will cover whatever services you or your loved one wants to include, whether that is assistance with ADLs, supervision, medication reminders, or beyond.
Financial Planning for Private Duty vs. Home Health
How you pay for home health vs. private duty home care differs. Private pay for home care means you pay for services out of pocket, while qualifying for Medicare-covered home health services has its own criteria.
Qualifying for Medicare Coverage for Home Health Services
Medicare-covered home health services generally fall under the Part B umbrella, while Part A relates to qualifying types of care after the individual has spent time in a hospital or skilled nursing facility. To qualify for home health care, your loved one may need to meet these criteria:
- Homebound: Medicare and Medicaid only cover home health services in cases where your loved one can’t leave the house. This means they have trouble getting around or a doctor has advised them to stay home because of their health.
- Intermittent care: Your loved one must require only part-time or intermittent care to manage or improve a health condition. This typically means services for up to eight hours per day for up to 28 hours weekly, but their doctor may recommend and approve a few additional hours if necessary.
- Ordered home care: A health care provider must assess your loved one and verify that they need home health care.
- Medicare requirements: Your loved one must enroll in Medicare Part A and/or B, and the home health services provider must be Medicare-certified.
Under Original Medicare, all approved home health services will cost $0 and 20% of the Medicare-approved total for specific medical equipment after your loved one meets their Part B deductible.
Financing Options for Private Duty Home Care
Private duty home care is not covered by Medicare. This allows for more flexibility — your loved one can pick and choose which services they need and how often they want to receive them. There is no qualification to meet or eligibility requirements to fulfill. Specific costs for these services vary depending on several factors, and your loved one will undergo a personalized assessment to determine the right fit for them. The private duty agency will provide a more detailed breakdown of the estimated cost at this time. This level of customization lets you curate a care plan that fits comfortably within you or your loved one’s budget.
While many insurance companies don’t provide coverage for private duty home services, look for a private home care provider that accepts insurance coverage just in case. For example, Relevar Home Care accepts all long-term care, auto and workers’ compensation insurance. Contact your loved one’s insurance provider to confirm coverage. If their insurance plan does include some private duty home care coverage, they will be billed directly. If not, your loved one will receive a bill on a weekly or monthly basis, depending on the agency. Invoices must be paid when they are received. Your loved one may have to pay an initial deposit for services — be sure to ask during their personalized assessment.
When determining private pay costs, don’t forget to factor in the amount of assets available to your loved one, including pensions, family contributions, and savings accounts.
How Can Relevar Home Care Help You Care for Your Loved One?
Relevar Home Care understands that your loved one’s well-being is your top priority. Private duty home care gives them the help they need in the comfort of a familiar environment. Our professionals are passionate about enhancing each patient’s quality of life. Whether your loved one needs in-home medical or nonmedical services, Relevar Home Care can assist. Every caregiver we employ has undergone a thorough background check, and our services are customizable to fit your loved one’s needs, wants, and schedule. No long-term agreements are required.
We provide award-winning care throughout Macomb, St. Clair, Oakland, and Wayne counties in Michigan. Every older adult has a right to age with dignity. Our caregivers treat them with respect and compassion.
Let us bring you peace of mind knowing your loved one is well-cared for. To learn more about our services, call us at 586-784-6949 or contact us online today.
