"Home health care" includes services such as:

• House calls that physicians, nurse practitioners, and physician assistants make to a person’s home.
• Care that nurses, personal care aides, and rehabilitation therapists provide in the home of people with medical needs. These staff often work for home health agencies.
• Modifications to the home and technologies that help people with medical needs and disabilities carry out daily activities.

Geriatric Assessment

Older adults who have difficulty getting out of their homes often have many health problems and disabilities. So, they need a comprehensive geriatric assessment.  This assessment will help the healthcare professional:

• Find out a person’s basic levels of health and abilities
• Diagnose medical conditions
• Develop treatment and follow-up plans
• Manage care and recommend long-term care (nursing homes, assisted living) if needed

The healthcare professional uses this assessment to examine an older adult’s:

• Physical and mental health
  • Vision, hearing, and balance
  • Medications and nutrition
  • Cognition (ability to think, learn and remember)
  • Ability to carry out daily activities
  • Quality of life
  • Social activity and supports
  • Home environment

Advantages of Assessment at Home

Doing the assessment at home allows the healthcare provider to see how the older adult and any family caregivers are able to cope with medical care and any disabilities at home. Home visits can improve engagement of patient with care.

The healthcare provider can also evaluate the caregiver’s:

• Ability to meet the needs of the older adult.
• Needs related to their health or care they give to the older adult. For example, the caregiver may need respite (short breaks from caring) or training.

A primary care provider, who may be a physician, nurse practitioner, or other healthcare professional, usually leads a healthcare team that manages a person’s health care at home. The team may include:

• Doctors, nurses, and social workers
• Therapists (speech, physical, occupational, and respiratory)
• Personal care aides
• Medical equipment suppliers
• Family caregivers, who may be providing much of the day to day care

The team works with the older adult or their representative and family caregivers to meet the adult’s goals for healthcare. The team’s goals are to:

• Find out the older adult’s health needs and choices related to health care
• Develop, certify, and recertify the older adult's plan of care. Certifying involves making sure that the older adult’s home health care meets rules for insurance coverage. Medicare is the health insurer for almost all older adults so this program’s rules most often apply.

Home health refers to services provided by nurses, rehabilitation therapists (physical/occupational/speech therapy), and aides who are part of home healthcare agencies. 

Home health care can help people who: 

• Have trouble getting around
• Have wounds needing treatment or other medical services that require a skilled nurse
• Need to learn more about their medical condition and how to avoid future problems.
• Need help with bathing, dressing, and meal preparation.
• Need care and emotional support when dying.

Medicare Coverage

Medicare covers home health care within limits. The rules are that:

• A person must be “confined to home.”  This means that the person has a great deal of difficulty leaving home. A person is able to leave the home for brief outings and still be able to get home health coverage.
• A person must have a need for medically-related services, such as skilled nursing or physical therapy

Read the Centers for Medicaid and Medicare Service booklet on Medicare and Home Health Care for more information.

House Call Services      

House calls happen when a healthcare professional provides medical care at a person’s home. For example, doctors can examine a person at home to see how their care is coming along and what their home is like. This may allow them to deal with problems that don’t come up during an office visit.

For example, a house call may show that:

• Family caregivers have too much work
• The older adult is being abused
• Medications are not being used correctly or medication patient is taking can be much different than what was recommended by patient’s healthcare team
• Loose rugs and other things create a risk of falls

House calls also help older adults who have a hard time leaving home to go to a medical appointment.

Limits of House Calls and Home Health

Most older adults can stay in their own homes. However, sometimes this may not be possible. For example:

• An older adult may not have any family caregivers.
• Family caregivers may have health problems and too much stress. This could limit how much care they can safely give the older adult. 
• Serious medical problems may require an older adult to have repeated testing, breathing treatments, or intravenous medications that require a stay in a hospital or skilled nursing home.
• The home may be a problem. For example, home health staff may not be able to go to an unsafe neighborhood or the person’s home doesn’t have room for medical equipment.
• Cost of care in the home may be too much for the older adult. 

Home Assessment & Modification

A complete geriatric assessment in the older adult’s home may find that changes to the home or technology can help them carry out daily activities.

Environmental modifications 

Examples of environmental modifications include:

• A hand-held shower head, a shower seat, bathtub grab-bars, or a bedside commode to make bathing and toileting easier.
• Removal of barriers to using wheelchairs and walkers (such as door sills), addition of chair lifts and outdoor ramps to improve an older adult’s ability to move around.

An occupational therapist can identify other personal care aids for carrying out daily  activities and housekeeping chores.

A number of home safety checklists are available to help with home assessment.

Assistive technology 

Some of the technologies that can help older adults be more independent include:

• Necklace or wrist technology that the older person can use to call for help.
• Emergency response systems that require the older adult to push a button by a certain time each day.  If they do not push the button, it will trigger an emergency response or checkup phone call.
• Technologies that can help:
  • Give and track medications
  • Monitor and transmit vital signs, like blood pressure
• Video links to healthcare providers
• Remote controls for heating, lighting, and opening doors,
• Mobile testing technology (home diagnostics), including x-rays, electrocardiograms (ECGs), and hand-held laboratory devices. These technologies allow for better medical care in the home.

Payment for Home Health Care

Often, Medicare will pay for home health care and for healthcare professionals to see the older adults in their own homes.

However, Medicare generally doesn’t pay for home modifications, simpler assistive technology and the type of home care that isn’t medically-related (help with personal care). So, the older adult will have to pay for care out of their own pockets.

Medicaid is an option when older adults have few financial resources or have spent them down on their care.

Each state Medicaid program pays for home care and modifications in different ways. So, the older adult or their representative needs to find out how Medicaid works in their state.

Last Updated June 2023