Home Health Care versus Home Care… aren’t they the same thing? The answer is no. To the average person, home health and home care sounds like the same service. Many people, including nurses, use the two titles interchangeably, but in reality they are quite different.
One of the main differences in the two services is the agency’s state license. A home health agency is licensed by the state as a “Home Health Agency” and a home care agency is licensed by the state as a “Home Care Agency” or possibly an “In Home Care Provider”. That’s easy enough to understand! Each license has rules regarding the types of services that each agency is allowed to offer. There are major differences in the two licenses. I won’t go into detail about licensing…honestly because it has to do with Medicare and certificates of need and so on….so just know that home health agencies do provide Medicare services, but home care agencies do not. Home health agencies provide Medicare services such as home health aide, LPN and RN nurse visits, physical therapy, occupational therapy, and speech therapy. Home care agencies provide services for individuals with payment sources other than Medicare, such as Medicaid, private pay, or long term care insurance.
So what are the differences in services? We’ll start with home health aides versus home care aides. Home health clients may be eligible to receive the services of a home health aide if the RN Case Manager performs the initial evaluation and documents the need. Home health aides normally visit a client twice weekly for two or three weeks. Visits consist of assistance with bathing, dressing, or ambulation and last approximately two hours each visit. Home health clients are typically recovering from an event, such as surgery, and will resume their regular routines after recovery. Home health aide services are not long term or suitable for individuals that require assistance on a daily basis. Home care clients generally need assistance with activities of daily living due to a permanent condition or disability. Individuals that receive home care services are not expected to make a recovery like home health clients. Home care clients are evaluated by the appropriate professional for long term services based on their individual needs. If the client qualifies, they could possibly receive 4 or more hours of in home aide services daily. Because each client’s situation is different, there is no standard daily service hours. Programs for home health aides or in home aides vary by state, so check with your local offices for more information.
Now let’s talk about nursing services. Home health nurses visit multiple clients on a daily basis in order to monitor the client’s progress, or lack of progress, as they recover. Each client receives individualized care from the home health nurse, such as wound care, catheter changes, or blood draws. The home health nurse must document each task according to policies in order for the home health agency to successfully bill and receive reimbursement. Charting must be completed within a set time frame depending on the type of visit. Most home health nurses are paid by the unit or point instead of an hourly wage. The nurse receives a salary for an agreed upon minimum amount of units for the week. Once you meet the weekly minimum in terms of units, any additional units accumulated are paid per unit or visit. Each type of visit counts as a set amount of units. For example, a regular visit to monitor a client counts as 1 unit, but a start of care visit, or admission visit, counts as 2.5 units, depending on the agency. It takes more time to admit a client for home health services versus a regular visit to check on a client and monitor their progress. As a Home Health Nurse with this type of pay structure, the more time you spend with one client, the less you make. Or you work long hours to make up for the time it takes to do the paperwork of an admission. On a good note, most home health agencies pay nurses for mileage starting with the first client of the day and ending with the last. Be sure to keep an accurate track of your daily mileage because it can add up! There are many nurses who work for home health agencies that are able to manipulate their schedule in order to perform the maximum number of visits each week and earn a great salary.
Home care nursing is quite different from home health nursing. Home care nurses typically provide one-on-one services to clients in their homes in the form of predetermined shifts. The length of the shift, as well as the time of day for the shift, are based on the approved amount of daily service hours, family preference, client needs, and staff availability. The amount of daily service hours is determined by a detailed evaluation which includes the client’s diagnosis, needs, limitations, support system, and many other factors. Home care nurses work with clients of all ages and conditions. A baby that’s been diagnosed with spinal muscular atrophy, or SMA, and requires a tracheostomy, a ventilator, and a feeding tube should qualify for home care nursing. In some states, a feeding tube can be managed by an unlicensed caregiver, but the tracheostomy and ventilator cannot. An adult that’s been diagnosed with Lou Gehrig’s Disease may require a tracheostomy, a ventilator, and a feeding tube, as well, and also should qualify for home care nursing. Home care nurses follow their agency’s guidelines for charting, which varies between paper charting and electronic medical records. Nurses provide home care in the individual’s home or other approved location. Many nurses prefer home care because they enjoy one-on-one care and consider the job less stressful. Home care clients generally keep the same schedule, so you can plan your shifts in advance. You also become familiar with the client’s routine, as well as their likes and dislikes, which give you an advantage when providing care. On the other hand, the home environment and family dynamics may not be ideal. Cleanliness of the home, or lack of, is a common complaint among home care nurses. That’s not to say all homes have this issue, you just have to find the right fit for you! Home care agencies also hire nurses as managers or supervisors to perform initial assessments, supervisory visits, annual reassessments, and various office duties. The types of home visits and paperwork differ from home health nursing. A small home care agency may only need one nurse to perform the tasks, but a larger agency may require multiple nurses based on the number of clients and their service area. A nurse manager spends a portion of their time in the office, but the majority of their schedule consists of traveling to client’s homes. The average amount of time a nurse manager spends at a client’s home ranges from 30 minutes to 1 1/2 hours, depending on the type of visit. Mileage reimbursement for in home nursing visits is based on each agency’s policy.
I hope this gives you an idea of the main differences between home health agencies and home care agencies. Each position gives you the chance to help individuals remain in their homes safely. Many nurses enjoy working for both home health or home care companies for a variety of reasons. Each assignment is a new adventure and you never know what to expect!
**All clients may not have a payment source that will reimburse for home health or care services and these are just generic examples.
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