Home Care vs Home Health: What's the Difference and What You Need to Know

If you are researching care options for a parent in Burien, SeaTac, Des Moines, or anywhere in South King County, you have probably encountered two terms that sound almost identical but mean very different things: home care and home health. The confusion between these two is one of the most common sources of frustration I hear from families, and it matters because the wrong assumption can cost you thousands of dollars or leave your parent without the care they actually need.

I recently had a conversation about this exact topic with a professional who lives and works in this space every day. Watch the full discussion in the video embedded above. Below, I am going to break down the difference in plain language, explain what insurance covers (and what it does not), and help you figure out which type of care your parent may need right now.

What Is Home Health Care?

Home health care is skilled medical care delivered in your parent's home by licensed professionals. Think of it as bringing the clinic to the living room. Home health services are ordered by a doctor and provided by registered nurses, physical therapists, occupational therapists, speech-language pathologists, and medical social workers.

The types of services that fall under home health include:

• Wound care and dressing changes
• IV therapy and injections
• Physical, occupational, and speech therapy
• Monitoring serious health conditions and vital signs
• Pain management
• Medication management and education
• Post-surgical recovery support
• Chronic disease management (diabetes, heart failure, COPD)

Home health care is typically short-term and goal-oriented. Your parent receives it after a hospitalization, surgery, or a change in medical condition, and it continues until the medical goals are met or the doctor determines it is no longer needed. In Washington State, home health agencies must be licensed by the Department of Health, and agencies seeking Medicare certification must also receive approval from the state's Certificate of Need program.

What Is Home Care?

Home care (sometimes called personal care, companion care, or non-medical home care) is non-medical assistance with daily living activities. Home care workers help with the tasks that your parent needs support with every day but that do not require a nurse or therapist.

Home care services typically include:

• Bathing, grooming, and personal hygiene assistance
• Help with dressing
• Meal preparation and feeding assistance
• Light housekeeping and laundry
• Medication reminders (not administration)
• Companionship and conversation
• Transportation to appointments or errands
• Help with mobility and transfers
• Supervision for safety, especially for those with cognitive decline

Home care is ongoing and can continue for months or years, for as long as your parent needs support. In Washington State, home care agencies are also licensed by the Department of Health, but with different requirements than home health agencies. Home care agencies are staffed by trained caregivers and certified nursing assistants rather than nurses and therapists.

How Does Insurance Coverage Differ Between the Two?

This is where the distinction really matters for your family's budget.

Home health care is covered by Medicare. If your parent's doctor orders home health services and your parent meets the eligibility requirements, Medicare Part A covers the cost at $0 to the family. To qualify, your parent must be considered "homebound" (meaning leaving home requires considerable effort) and must need skilled nursing care or therapy on a part-time or intermittent basis. Medicare also covers 80% of the cost of any durable medical equipment, like walkers or hospital beds, prescribed during home health care.

Home care is generally NOT covered by Medicare. Medicare does not pay for custodial care, which includes help with bathing, dressing, meals, housekeeping, and companionship. This catches many families off guard. They assume that because their parent has Medicare, the aide who comes to help Mom shower three times a week is covered. In most cases, it is not.

So how do families pay for home care? There are several paths:

• Private pay: Out-of-pocket costs for home care in King County typically range from $35 to $50 per hour, depending on the agency and level of care.
• Medicaid (COPES waiver): Washington State's Community Options Program Entry System covers in-home personal care for eligible individuals. Eligibility is based on both functional need and financial criteria. Contact DSHS or Community Living Connections at 1-844-348-5464 for an assessment.
• Long-term care insurance: If your parent purchased a long-term care policy, it may cover home care services. Check the policy details carefully.
• Veterans benefits: The VA's Aid and Attendance benefit can help cover home care costs for qualifying veterans and surviving spouses.
• Some Medicare Advantage plans may offer limited home care benefits, such as a temporary aide or meal delivery, though these supplemental benefits vary by plan.

Can My Parent Receive Both Home Care and Home Health at the Same Time?

Yes, and many families do. A common scenario looks like this: your mother comes home from a hip replacement surgery at Highline Medical Center. Her doctor orders home health care, which includes a physical therapist who visits three times a week and a nurse who checks the surgical site. Medicare covers all of it.

But Mom also needs help getting dressed in the morning, someone to prepare meals, and a hand getting in and out of the shower safely. The physical therapist is there for 45 minutes. The nurse visits for 30 minutes. The other 23 hours of the day, Mom is on her own. That is where home care fills the gap. A home care aide comes for four hours each morning to help with personal care, breakfast, and light housekeeping.

The home health portion is covered by Medicare. The home care portion is paid privately or through Medicaid. Two different services, two different payment structures, working together to keep your parent safe and recovering at home.

How Do I Know Which Type of Care My Parent Needs?

Start with this simple question: Does my parent need medical treatment or daily living support?

If your parent needs wound care after surgery, physical therapy to regain strength, monitoring of a chronic condition, or skilled nursing for a medical issue, they need home health care. Talk to their doctor about a referral.

If your parent needs help getting through the day safely, including bathing, cooking, cleaning, medication reminders, or simply having someone present so they are not alone and at risk of falling, they need home care. Contact a licensed home care agency in King County to discuss a care plan.

If your parent needs both, which is common during recovery periods and for those with progressive conditions like dementia, they may benefit from both services working in coordination.

When Is Home Care No Longer Enough?

This is the question families often arrive at after months or years of patching together in-home support. Home care is wonderful when the needs are moderate and predictable. But there comes a point for many families when the math stops working.

Here are the signs I see most often in families who eventually transition a parent to an adult family home:

• The parent needs help during nighttime hours, and hiring overnight care pushes costs above $15,000 to $20,000 per month
• The parent has dementia and is wandering, which creates safety risks that a part-time caregiver cannot address
• The family is coordinating multiple caregivers across multiple shifts, and gaps in coverage are causing problems
• The parent is increasingly isolated, and the home care aide is their only source of social interaction
• The primary family caregiver is burned out, and adding more home care hours is not solving the underlying exhaustion
• The parent's care needs have escalated to the point where they need someone available around the clock

When home care hours approach the cost of full-time residential care, a licensed adult family home becomes worth exploring. In Washington State, adult family homes are licensed to serve up to eight residents, with staff-to-resident ratios that provide continuous support. At Burien Best Care Home, our 1:3 caregiver-to-resident ratio means your parent has consistent, trained caregivers who know them by name, know their routines, and know the difference between a good day and a day that needs extra patience.

The transition from home care to an adult family home is not a step down. For many families, it is a step into sustainability. It is the moment when you stop managing a patchwork of aides, schedules, and backup plans, and start having your parent cared for inside a community that is built for exactly this stage of life.

How Are Home Care Agencies Regulated in Washington State?

Both home care and home health agencies in Washington are licensed and regulated by the Washington State Department of Health. However, the licensing requirements differ significantly, which is worth understanding when you are choosing a provider.

Home health agencies must have a clinical director who is a registered nurse or physician. They are required to conduct comprehensive assessments of all patients and participate in the federal OASIS (Outcome Assessment Information Set) reporting system. To receive Medicare certification, they must also receive approval from the state's Certificate of Need program.

Home care agencies are required to have a supervisor of direct care services and must conduct criminal background checks on all staff. They must maintain commercial general liability insurance and pass a state survey process. While the clinical requirements are less intensive (because the services are non-medical), the oversight is still meaningful.

When choosing either type of provider in the Burien or King County area, ask for their license number, ask about staff training and turnover, ask how they handle emergencies, and ask for references from current clients. A good agency will welcome these questions.

What Should Families Do Right Now?

If you are trying to figure out the right care setup for your parent, here are three steps you can take this week.

First, clarify what your parent actually needs right now. Make a list: Are the needs medical (wound care, therapy, medication management) or daily living (bathing, meals, companionship, safety supervision)? Or both? This list will guide every conversation you have with providers.

Second, call your parent's doctor. If your parent has medical needs that could be addressed at home, ask about a referral for home health services. This is often the fastest path to getting Medicare-covered skilled care started.

Third, if daily living support is the primary need, contact two or three home care agencies in King County for an in-home assessment. Most agencies offer free assessments where they evaluate your parent's needs and propose a care plan with hours and costs. This gives you real numbers to work with.

And if you are already at the point where home care hours are stretching your budget or your parent's needs have outgrown what an in-home aide can provide, it may be time to visit a few adult family homes in the area. A visit costs nothing and commits you to nothing. It just gives you a picture of what the next chapter could look like.

Watch the full conversation in the video above for additional details on how these two types of care work together and how families in our community are navigating these decisions.

A Gentle Next Step

At Burien Best Care Home, we welcome families at every stage of the decision-making process. Some families visit us when they are just beginning to explore options. Others come when home care is no longer meeting their parent's needs and they need a more sustainable solution. Wherever you are in the journey, we are happy to talk.

Schedule a visit to Burien Best Care Home to see our home, meet our caregivers, and ask any questions you have about the care options available to your family. Or download our Family Guide for a comprehensive overview of what life looks like inside a licensed adult family home.

You are doing the right thing by researching your options. The fact that you are reading this article means your parent is lucky to have you in their corner.

About the Author

Becca Pitts is the owner of Burien Best Care Home, bringing over 20 years of dedicated senior care experience to Burien, WA. She hosts the Your Best Season video series on YouTube, where she sits down with local professionals to discuss the topics families navigating senior care need most. She also runs Your Best Season, a senior transitions education platform, and Your Next Step Home, helping Washington families navigate real estate transitions.

*Burien Best Care Home is a licensed adult family home in Burien, WA, serving families throughout King County. We accept private pay and Medicaid (COPES). Call us or visit our contact page to start a conversation.*