Not all personal care services provided in the home are the same, and the differences and terms can be confusing. The types of care available can vary depending on whether skilled or non-skilled assistance is needed, the duration of care needed, insurance coverage, and other factors. The information below helps to clarify some of these differences.
Skilled nursing care (RN or LPN) to assist a patient often after a hospital stay with post-surgery or wound care through recovery. Medicare and private insurances will only cover Home Health as long as there is a need requiring an RN or LPN. Not covered is assistance for daily living activities such as bathing, cooking, transportation, toileting, transferring into and out of bed, or dressing.
AGENCY-DIRECTED IN-HOME CARE
An alternative to an individual going into a nursing home for someone aging or with a chronic illness who needs additional support to live independently. Provides both skilled nursing (RN or LPN) and assistance for daily living activities. An agency manages the skilled nursing and personal care attendants. Funded through Medicaid, private insurance, and private-pay. Because of the complex and heavy restrictions, there is no agency-directed care through Medicare.
SELF-DIRECTED IN-HOME CARE
Self-Directed in-home care is another alternative to an individual going into a nursing home, however, whereas agency directed in-home care is the agency managing the personal care attendants for the individuals needing assistance, self-directed in-home care allows the individual to manage the personal care attendant(s) themselves. Self-directed in-home care allows the individual to hire the individual(s) they choose (even a family member), set their
schedule, and control other aspects of their care. Medicaid, and some private insurance providers, then compensate the personal care attendants directly. Medicare does not provide
self-direction as an option.
FAMILY-DIRECTED IN-HOME CARE
Like self-directed in-home care, family-directed in-home care is normally when a spouse needs assistance with daily living activities to care for their loved one but cannot manage all of their spouse’s needs by themselves. Help provided may include assisting with bathing, being present while the spouse works or runs errands, helping to transfer in and out of bed, and other similar activities, but skilled nursing (RN or LPN) services are not provided. Medicare and Medicaid do not provide these services, however, some private insurance companies will cover an allowance for these services. Otherwise, the family pays an agency to provide assistance.
End of life care when the individual decides to no longer pursue treatment. Hospice provides assistance to the family and even at nursing homes for comfort care but care is not daily or around the clock.