What Are the Different Types of In-Home Care for Aging Parents?
Oh Crap! I’m a Caregiver, Part 5: What each kind of care means, when you might use it, where you can find it, and how it may be paid for.
In this post: An explanation of the different types of care available to elderly loved ones living at home.
My mom was in and out of the hospital when she battled cancer, and very sick throughout her two and a half years of treatment. Each time she was discharged, I’d get a call a few days later about palliative care.
No one ever mentioned it in the hospital or at any doctor’s appointment. I had no idea how the person calling got my name. When I asked questions, what they described sounded like hospice, and we weren’t ready for that yet.
I Googled “palliative care,” and the first link that came up was for a local hospice center, confirming my (mis)understanding.
No one ever explained the difference.
I wish someone had because palliative care was exactly what we needed. I just didn’t know it.
One of the hardest parts of caregiving is that everyone throws around care terms like you’re supposed to know what they mean when you’ve never had these conversations before.
I’ve learned not to be afraid to ask questions and keep asking them until I understand the answer. But we’re not all wired that way, and it can be intimidating when medical providers come across as condescending, patronizing, or dismissive.
When you’re new to caregiving, the terminology alone can be overwhelming.
This post will help you feel caught up and better prepared the next time you have to discuss the services your loved one may need, and so you can make better-informed decisions.
People often use “home care” as a catch-all term for any care services provided in the home. Last week, we discussed services for basic needs such as lawn care, housekeeping, and grocery delivery. This article builds on that post.
Companion Care
What is it?
Companion care is non-medical support that focuses on providing supervision, conversation, light help, and reminders. It can also reduce isolation. You may discover that your loved one looks forward to their companion’s visit.
Companion care providers can become another set of eyes and ears, letting you know about any changes or concerns they observe.
This support is non-medical and exists to ensure that your loved one isn’t always alone.
When might you use it?
Your loved one is lonely or isolated.
They need companionship but not necessarily skilled care.
You need someone to sit with them while you work, run errands, or rest.
Where can you find it?
Companion care can be found on online sites such as Care.com. You may also find this type of care through churches, senior centers, and volunteer organizations. Another option is to list family and friends. This gives them the opportunity to become involved in your loved one’s care.
Who covers the cost?
The cost for companion care is usually out of pocket. Sometimes long-term care insurance may help. Medicare generally does not pay for non-medical long-term care services. Medicaid coverage may exist in some cases, depending on state programs and eligibility.
Check with local church and community organizations to see if volunteers are offering this type of care in your area. Always make sure that you use a reputable organization that conducts thorough background checks on their companions. And don’t forget to ask family and friends.
I do not recommend hiring a companion through local neighborhood forums unless you know the person you’re hiring.
Personal Care / In-Home Assistance
What is it?
This type of care may provide companion care but is often more skilled than work done solely by companions. While a companion might help with light housework and reminders, organizations that provide personal care and in-home assistance have providers who are better trained to address a wide range of non-medical needs and support. They are also often trained in basic first aid and CPR.
These caregivers can help with daily needs such as bathing, dressing, toileting, grooming, meal help, and transportation. Some organizations allow their caregivers to provide medication reminders but not dispense medication. “It’s time to take your medicine,” but not “Here is your medicine.”
When might you use it?
Bathing is becoming unsafe.
Dressing is harder, or basic grooming is no longer on their radar.
Mobility and transfers are becoming difficult.
Your loved one struggles with memory loss or cognitive decline.
Your loved one can stay home, but not fully alone.
You need a break.
Where can you find it?
Personal care and in-home assistance can be found through organizations like Seniors Helping Seniors and Visiting Angels.
Who covers the cost?
Often out of pocket unless covered through Medicaid HCBS (based on financial criteria), certain state waiver programs, or long-term care insurance. Medicare generally does not cover routine non-medical personal care as long-term care. Many families pay for these services out of pocket.
Skilled Nursing/Home Health Care
What is it?
Home health care is medical care delivered at home, often after an illness, injury, hospital stay, or when ordered by a provider. It may include nursing, medication support, wound care, therapy, and medical monitoring. It is usually “short-term,” with a predetermined number of visits. Licensed medical professionals such as nurses, therapists, and certified nursing assistants (CNAs) provide this care.
When might you use it?
After a hospitalization.
After surgery.
For wound care.
When therapy is needed at home, such as physical therapy.
When medical monitoring is necessary for a period of time (e.g., blood pressure, blood sugar, oxygen level).
Where can you find it?
This type of care usually comes at the recommendation of a doctor or other medical provider. They can recommend reputable agencies in your area. When insurance or Medicare covers this service, they often select a provider.
Who covers the cost?
This care may be covered by Medicare and other insurance (such as a Medicare Advantage plan) if eligibility requirements are met and the services are medically necessary. Medicare-certified home health is a distinct category from ordinary non-medical caregiving. If your loved one is a veteran, they may have coverage through their VA benefits. You can also pay for these services out of pocket if you want this level of care outside of a medical recommendation.
Physical Therapy / Occupational Therapy / Speech Therapy at Home
What is it?
In addition to the reasons listed in the previous section, this type of care is often prescribed following a hospital stay or prescribed by a doctor. Reasons for providing rehabilitation services at home might include improving movement, safety, strength, balance, daily functioning, swallowing, or communication.
When might you use it?
After a fall.
After a stroke or other illness.
When mobility, function, or safety declines.
When daily tasks become harder.
When the ability to communicate or swallow declines.
Where can you find it?
This type of care usually comes at the recommendation of a doctor or other medical provider. They can recommend reputable agencies in your area. When insurance or Medicare covers this service, they often select a provider.
Who covers the cost?
This care may be covered by Medicare and other insurance (such as a Medicare Advantage plan) if eligibility requirements are met and the services are medically necessary. If your loved one is a veteran, they may have coverage through their VA benefits. You can also pay for these services out of pocket if you want this level of care outside of a medical recommendation.
Respite Care
What is it?
This one’s for you, dear caregiver. You may think you don’t need a break, but trust me… If you don’t yet, you will. The longer caregiving continues, the more essential this will become. Respite care can be for a few hours or longer, depending on the provider. This can happen at home, in a facility, or through adult day care. It can be provided regularly (e.g., during your work hours) or on an as-needed basis.
When might you use it?
When you are exhausted.
When you need time away or need a vacation.
When you need time for other family members, work, appointments, or your own healthcare.
When you are reaching burnout (or already have).
Where can you find it?
Respite care can be found in several ways.
Start by asking other family members to step in and help. My aunt and uncle have both come and stayed with Dad when I needed to get away for a week.
If that’s not an option, the organizations listed above can provide respite care.
If your loved one is a veteran, check with the VA for resources and eligibility in your area.
Even when your loved one isn’t in hospice care, they may be eligible for overnight stays at a hospice facility. Criteria vary by organization.
Who covers the cost?
Unless a kind and loving family member provides the respite, this care is usually paid out of pocket. However, Medicaid programs may cover some respite care, and Medicare hospice includes limited inpatient respite under hospice rules. It’s best to check with the organization providing the respite.
Adult Day Care
What is it?
Adult day care is structured daytime care outside the home that may include supervision, activities, meals, socialization, and sometimes health-related support. It can be a lifesaver because not only does it allow you to focus on other responsibilities without constant worry or interruptions, but it also serves as a social outlet for your loved one. This type of care may be for a few hours or all day. Most are not available during evening hours.
When might you use it?
Your loved one is safe at home overnight, but should not be alone all day.
They need structure and socialization.
You need daytime coverage for work, other responsibilities, or rest.
You need regular respite without full-time residential care.
Where can you find it?
Local senior centers, churches, veterans’ organizations, and other community organizations are usually the providers of this type of care.
Look online for “adult daycare programs in my area.” Make sure to use reputable organizations.
Who covers the cost?
Insurance and Medicare don’t usually cover this cost; however, some programs are free. For example, the town we live in offers seniors a free, four-hour activity with lunch included once a week. But all-day programs typically have a cost that is paid out of pocket.
Palliative Care
What is it?
Palliative care focuses on symptom relief, comfort, and quality of life for people with serious illness. Unlike hospice, it is not limited to end-of-life care and can be provided alongside treatment.
This care differs in that it involves a team working together. Your team might include doctors, nurse practitioners, nurses, social workers, chaplains, and other specialists, depending on your loved one’s needs.
When might you use it?
During a serious illness such as cancer.
During an illness or recovery with complex or severe symptoms.
You need an added layer of support.
Your loved one is still pursuing treatment, but needs comfort-focused care.
Where can you find it?
Ask your loved one’s doctor or hospital caseworker. They can help you find this care and explain your loved one’s coverage. This was offered to me when my mom had cancer, and I declined it because I didn’t understand what it was. I won’t make that mistake again. I truly believe it would have made a huge difference for her and me.
Who covers the cost?
Coverage varies by service and plan. It may be covered when billed as medical care, specialist visits, or hospital- or clinic-based services, but it is not the same benefit as hospice. This is one of the places where families often need to ask specific questions about the plan. That’s why I recommend talking with a caseworker or your doctor’s financial office about your options. Veterans’ benefits may also cover palliative care. You may also pay out-of-pocket.
Hospice Care
What is it?
Hospice provides comfort-focused care for someone with a terminal illness (end-of-life) when the focus shifts from cure to quality of life and comfort. They may provide symptom relief, in-home medical care related to quality of life and comfort, and support for both patient and family. God bless hospice workers!
When might you use it?
A provider believes your loved one is nearing the end of life under hospice criteria.
The goal is comfort rather than aggressive curative treatment.
Pain, symptoms, support, and family guidance become the central focus.
Your loved one chooses to discontinue treatment.
Your loved one needs end-of-life care.
Where can you find it?
For-profit and non-profit hospice organizations can be found in most locations within the United States. Your loved one’s doctor or hospital can provide recommendations, or you can check with friends and family who have used hospice care in the past.
Who covers the cost?
Medicare covers hospice for eligible beneficiaries, and hospice can often be provided at home. Medicare also covers limited inpatient respite under hospice. Veterans’ benefits may also cover hospice care. You may also pay out-of-pocket.
Program of All-Inclusive Care for the Elderly (PACE)
What is it?
PACE is a “comprehensive medical and social services government program provided to certain frail elderly people.” I was not aware of this program until I began researching this article, but it may be worth looking into.
If your loved one qualifies for PACE, they may be covered for a long list of benefits, including:
Adult day care
Home care
Nursing home care
Physical therapy
Social services
Transportation
When might you use it?
When your elderly loved one has “very limited financial resources.”
They meet local eligibility criteria.
Where can you find it?
Visit the PACE website to learn more about the criteria and coverage in your area.
Who covers the cost?
Most participants in PACE are dually eligible for Medicare and Medicaid. This care does not typically include out-of-pocket costs.
How do you decide which services are best for your loved one and for you?
I’ll answer this question with a question.
What do you need most?
Companionship and supervision?
Hands-on daily help?
Medical care at home?
Caregiver relief or respite?
Serious illness or end-of-life care?
These phrases (or similar phrasing) have been placed in bold for each type of care to help you find your best match.
Questions to ask before choosing a type of care include:
Is my loved one’s need mainly social, physical, medical, or safety-related?
Is this care for a short-term recovery, long-term illness, or continued decline?
Do we sometimes need a few hours of help or daily help?
Does the need require licensed medical care?
Is the biggest problem my loved one’s needs, my availability/burnout, or both?
Will insurance likely cover the cost (or a portion of the cost), should we expect to pay out of pocket, or is there a volunteer-based option?
If we have to pay, what is our budget?
Can other family members help split the cost?
Quick Action Steps for This Week
Write down your loved one’s biggest current need.
Is this need mostly companionship, personal care, medical care, or respite (circle one)?
Circle the two types of care in this article that seem closest to your biggest current need.
Sometime within the next week, ask one trusted provider, agency, or caseworker which type of care they would recommend, based on your circles.
Ask how it is usually paid for before you assume anything.
Ask for recommendations, or if they can help you set up care.
Dear Caregiver,
You don’t have to memorize this list, especially since you don’t need every type of care at once. There are overlaps, but really, each is best at different points during your caregiving journey.
If you’re still a bit confused, that’s okay. It’s a lot to take in at once.
However, I have found that the more I understand the language, the better prepared I feel when having conversations with Dad’s doctors.
I’ve also found that when I know the language, they respect me more and are more willing to engage in conversation with me.
When it comes to in-home care, the right care matters. You’ll have better outcomes when using the right level of care with the right provider. Don’t be afraid to let someone go if they’re not the right fit. Connection matters.
Blessings,
Tina (Dad’s daughter)
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Disclaimer: This post is meant to help you understand caregiving options, not to give medical advice. I’m not diagnosing your loved one, recommending treatment, or telling you what kind of care they specifically need. Every situation is different, so please talk with your loved one’s doctor or a qualified medical professional before making medical or care decisions.
You’re not alone, dear caregiver.
This post breaks down the different kinds of care older people might need, from help with company to end-of-life care, in a simple way.
It shows how confusing the words doctors use can feel when families suddenly have to take care of someone.
The main idea is that knowing these options early helps people make better choices without feeling so overwhelmed.
At its core, it is about helping families understand what is going on so they feel more prepared and less lost.
Such an informative article—thank you for sharing it. I hadn’t even heard of palliative care until recently.
But as I was reading, one thing really stood out—and it’s where so many caregivers hit a wall. Honestly, it feels like a system issue that needs to be addressed.
The out-of-pocket cost.
Most caregivers simply don’t have the financial ability to bring in this kind of support.
And that’s the hard part… because on one side, you have caregivers burning out. On the other, you have people who truly need companionship and everyday assistance—and both are left trying to figure it out on their own.