Understanding your options for choosing appropriate care for you or a loved one is no small task.  It is important to understand the differences in care, and to match the situation with appropriate care.  Here is a short summary of your options:

Private Duty Home Care (care for which services are paid directly) can be non-medical or medical. “Private duty services are basically any supportive type of services. They run the gamut of errands and transportation, to companionship, to personal care, to nursing. Basically, whatever services someone needs to stay at home, or to supplement care in a facility for which they have the resources to pay, can fall under private duty or privately paid services. There is not usually a doctor’s order needed, nor is there necessarily even a medical component to the services. The definition of private duty is therefore hard, as it really can be any type of service that is provided to someone who is frail or elderly to allow that person to have more independence in his or her lifestyle or choice of living situation.” Excerpted from Caring Magazine, August 2008, Merrily Orsini, MSSW, author.

Home Health Care is skilled nursing care and certain other health care services one receives in a home setting for the treatment of an illness or injury. Medicare covers some home health care if all the criteria below are met:

1) A doctor decides medical care at home is needed, and makes a plan for that care at home, and

2) At least one of the following: intermittent (and not full time) skilled nursing care, or physical therapy or speech language pathology services, or a continued need for occupational therapy is needed, and

3) The patient is homebound—meaning being normally unable to leave home and leaving home is a major effort. If one does leave home, it must be infrequent, for a short time. The patient may, however, attend religious services or leave the house to get medical treatment, including therapeutic or psychosocial care. Receiving care in an adult day-care program that is licensed or certified by a state or accredited to furnish adult day care services is also permitted while receiving home health benefits paid for by Medicare, and

4) The care must be medically reasonable and necessary. It must be related to problems encountered by the illness or injury and the care plan must address realistic outcomes. The plan and care needed has to show potential for an improvement in health/activities of daily living, and

5) The home health agency providing the care must be approved by the Medicare program


Hospice Care is a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments. Hospice care neither prolongs life nor hastens death. Hospice staff and volunteers offer a specialized knowledge of medical care, including pain management. It is generally depicted as end-of-life care and can be in a home or a hospital setting, but one requirement is that someone be with the dying patient at all times. Most hospices accept patients who have a life expectancy of six months or less and who are referred by their personal physician.


To help you choose the right Home Health Care provider, please use the helpful link at https://www.medicare.gov/homehealthcompare/ .  It is in your best interest to use agencies that have a 3-star rating or better.  Once you have narrowed your list down, call the agency and ask to speak to a nurse who can better explain their services; or you may also want to schedule a time to visit with a representative of their agency.