What is Home Care?

Home care is a personalized service designed to help individuals remain safe, comfortable, and independent in their own homes when they are no longer able to fully care for themselves. Rather than relocating to a nursing home, assisted living facility, or hospital, the individual receives support in a familiar environment, where they feel most secure and dignified.

How Home Care Works?

In home care, a trained caregiver comes to the client’s home on a scheduled basis. Depending on the client’s needs, this support may be provided for a few hours a day, several days a week, or around the clock.

Caregivers may assist with:

• Personal care (such as bathing, dressing, and grooming)
• Mobility and fall prevention
• Meal preparation and light housekeeping
• Medication reminders
• Companionship and emotional support
• Transportation to appointments or errands

The goal is not to “take over” the client’s life, but to support them in doing as much as they safely can on their own.

Why Home Care Is Important

Many individuals strongly prefer to stay in their own homes. Home care makes this possible and it provides peace of mind to families who may live far away or be unable to provide daily care themselves.

Imagine an elderly man who lives alone in his home:

• He has difficulty walking safely and is at risk of falling
• He can no longer shower, cook meals, or manage household tasks on his own
• His family members live out of town and cannot check on him regularly

Without home care, this individual might be forced to move into a facility, even though he wants to remain at home. With home care, a caregiver can come to his house to assist with daily tasks, ensure his safety, provide companionship, and help him maintain his independence, while his family knows he is being cared for.

Who Can Receive Home Care? (General Criteria)

Home care is designed for individuals of all ages who have physical, cognitive, or medical limitations that make it difficult for them to safely manage daily activities on their own, but who do not require 24-hour medical supervision in a facility.

Home care may be appropriate for:

Seniors (60+): Many older adults receive home care to help them safely remain in their own homes as they age. This is often referred to as aging in place and may be supported through private pay or state-funded programs.

Adults with Physical or Mental Limitations: Home care supports adults who may have

• Limited mobility
• Cognitive impairment (such as dementia or memory loss)
• Developmental or intellectual disabilities
• Mental health conditions that affect daily functioning

These individuals may need help with personal care, daily routines, safety, or supervision but are still able to live at home with support.

Individuals Recovering from Illness, Injury, or Surgery: Home care can assist people who are recovering after hospitalization, surgery, or serious illness and need temporary support while regaining strength and independence.

Individuals with Chronic Conditions: People living with ongoing medical conditions such as diabetes, heart disease, COPD, or neurological conditions may benefit from home care to help manage daily needs and reduce the risk of complications.

Children and Home Care: In some states, children may also qualify for home care services, but eligibility is more specific. These services are typically provided to medically fragile children.

A medically fragile child is a child who:

• Has a serious medical condition
• May depend on medical equipment (such as oxygen, feeding tubes, or monitors)
• Requires frequent medical oversight, specialized care, or assistance with daily activities

When Home Care May Not Be Enough

Home care is not appropriate for everyone. In some situations, a person may require care that cannot be safely provided at home.

A nursing facility (nursing home) may be necessary when an individual:

• Requires 24-hour skilled nursing care
• Needs continuous medical monitoring
• Has complex medical needs that cannot be managed safely at home
• Is unable to perform basic activities of daily living even with caregiver support
• Is at high risk for medical emergencies without constant supervision

Unlike home care, nursing homes involve living in the facility full time and are typically used when a person’s medical or safety needs exceed what can be managed in the home.

 

Understanding Home Care Roles & Levels of Care
Home care services fall into two main categories: Skilled Home Care and Non-Skilled Home Care. The type of care a client receives depends on their medical needs, program eligibility, and the services offered by the specific agency providing care.

Important: Not all agencies within our organization provide skilled home care services. Service availability varies by agency.

1. Skilled Home Care Services

Skilled home care is provided by licensed healthcare professionals. It is for clients who need medical care, clinical oversight, or therapy. These services must be ordered by a physician and follow a formal Plan of Care.

These roles require state licensure, advanced education, and ongoing training.

Registered Nurses (RN) & Licensed Practical Nurses (LPN)

What They Do

• Perform medical assessments and provide clinical care in the home
• Administer medications and manage wound care
• Monitor health conditions and educate patients and families

RN vs. LPN

• RNs have a broader scope of practice and supervise LPNs and aides
• LPNs provide nursing care under the direction of an RN or physician

Therapy Services (PT, OT, ST)

When available, therapy services help clients recover and regain independence:

• Physical Therapy (PT): Improves movement, strength, balance, and fall prevention
• Occupational Therapy (OT): Helps clients safely perform daily activities
• Speech Therapy (ST): Supports speech, swallowing, and cognitive skills

2. Non-Skilled Home Care Services

Non-skilled home care focuses on personal care, daily support, and maintaining a safe home environment. These services do not include medical treatment or clinical decision-making.

Certified Caregivers (CNA & HHA)

These roles require state-approved training and certification, but they are not licensed medical professionals.

1. Certified Nursing Assistants (CNA) & Home Health Aides (HHA)

• Assist with Activities of Daily Living (ADLs), such as bathing and dressing
• May observe basic health changes and report concerns to a nurse
• Services depend on agency licensure and program rules

Non-Licensed Support Roles

These roles usually have simpler requirements and do not require state licensure. Training is typically provided by the agency.

1. Personal Care Assistants (PCA)

• Help with bathing, dressing, and hygiene
• Do not perform medical tasks
• Support daily independence

2. Homemakers (HMK)

• Help keep the home clean and organized
• Provide light housekeeping, laundry, grocery shopping, and meal preparation
• Do not provide personal care

3. Companions

• Provide social interaction, emotional support, and supervision
• Help reduce loneliness and promote safety
• Do not provide personal care

How Non-Skilled Home Care Is Provided in the U.S.

In addition to different caregiver roles and levels of care, home care services can also be delivered through different models. The type of home care a person can receive depends on their individual needs, the program they qualify for, and the state in which they live. Not all options are available in every state.

1. Agency-Provided Caregiver

In this model, a licensed home care agency assigns a caregiver to the client.

• The agency is responsible for recruiting, hiring, training, and supervising caregivers
• The agency manages scheduling, coverage, payroll, and compliance
• Caregivers are employed by the agency, not the client
• This is the most common home care model nationwide

This option is often preferred by families who want professional oversight and do not want to manage employment responsibilities.

2. Consumer-Directed Care (Choosing Your Own Caregiver)

In some states and programs, clients or their families are allowed to choose their own caregiver instead of being assigned one by an agency.

• The caregiver is often a family member, friend, or trusted individual
• The caregiver is paid through a state or insurance-funded program, not privately by the client
• Availability and rules vary by state and by program

⚠️ Not all states offer both options. Some only allow agency-assigned caregivers.

What a Caregiver’s Day Looks Like

A caregiver’s day is centered on providing safe, compassionate, and reliable support tailored to each patient’s individual needs. While no two days are exactly the same, caregivers follow a care plan designed to promote comfort, independence, and overall well-being.

Depending on the patient’s needs, a caregiver’s responsibilities may include:

• Assisting with personal care, such as bathing, dressing, grooming, and toileting
• Supporting safe mobility, including transfers, walking assistance, and fall prevention
• Preparing meals according to dietary needs and assisting with feeding when necessary
• Performing light housekeeping tasks to maintain a clean and safe environment
• Providing medication reminders as directed in the care plan
• Offering companionship, conversation, and emotional support
• Assisting with transportation to appointments or errands, when authorized

Caregivers are responsible for observing changes in a patient’s condition and ensuring a safe home environment. This includes following safety guidelines, using proper body mechanics, and encouraging patients to do as much as they can independently while providing assistance when needed.

Beyond physical tasks, caregivers play a critical role in supporting a patient’s emotional health. Many patients may be adjusting to illness, aging, or loss of independence. Caregivers provide reassurance by being a consistent, respectful, and dependable presence.

How Is Home Care Paid For?

Home care services must be funded by an approved payment source (also called a payer).

1. Medicaid (Most Common): Medicaid is a government-funded insurance program designed for individuals with limited income and resources. There is no age requirement to qualify for Medicaid, eligibility depends on the specific state program, and not all home care agencies or programs serve children.

• Income and asset limits must be met to qualify
• Program names may differ by state, but the coverage is still Medicaid
• Covers long-term home care services, including personal care and assistance with daily activities
• This is the primary payer for most home care agencies

2. Medicare: Medicare is a federally run health insurance program for:

• Individuals age 65 and older
• Individuals under 65 with a qualifying disability
• Covers limited, short-term home health services
• Typically related to medical recovery after hospitalization, illness, or surgery
• Requires a medical need and physician orders
• Does not cover long-term daily caregiving or personal care

3. Private Pay: Private pay means that home care services are paid directly by the individual or their family, without insurance or government assistance.

• Payment is made out of pocket (paying for services directly with your own money, rather than through insurance) 
• Services are billed at a private hourly or daily rate
• Often used when someone does not qualify for Medicaid or other programs
• May be used short-term, temporarily, or as a last resort due to cost

Private pay home care can be expensive, which is why it is less common for long-term care.

4. Other Programs (State-Specific): In addition to Medicaid and Medicare, some individuals may qualify for other state or federal programs that help cover home care services. Availability depends on location and eligibility criteria.

• Veterans Affairs (VA) Programs: VA home care benefits may be available to eligible veterans and, in some cases, their spouses.
• State Waiver Programs: These programs eliminate certain Medicaid rules to provide more flexible services. Some common Medicaid waiver programs include: 
  1. Home and Community-Based Services (HCBS) Waivers: Support seniors and adults with disabilities who need help with daily activities. 
  2. Disability Waivers: Serve adults or children with physical, developmental, or intellectual disabilities.
  3. Traumatic Brain Injury (TBI) Waivers: Provide services for individuals recovering from or living with a brain injury.
• Other State and Federal Programs: In addition to Medicaid waivers, some individuals may qualify for other assistance programs, depending on their state, age, or medical condition.

The Setup Process (Evaluation & Assessment)

Before home care services can begin, the individual must complete an evaluation or assessment. This is a required step to make sure the person truly needs home care and to determine what type of help is appropriate.

Who Performs the Evaluation?

The evaluation is completed by one of the following, depending on the program and state:

• State agency – A government department responsible for overseeing home care programs
• Third-party assessor – An independent organization hired by the state to perform evaluations
• Managed Care Organization (MCO) – An insurance or managed care plan that administers Medicaid or long-term care benefits

These organizations do not provide caregivers. Their role is to review eligibility and approve services.

What Are They Evaluating?

During the evaluation, the reviewer looks at:

• The individual’s ability to perform daily activities (such as bathing, dressing, and mobility)
• Medical or cognitive conditions that affect safety and independence
• The level of assistance the person requires

Their goal is to confirm that home care services are needed and to determine:

• Whether the person qualifies for services
• How many hours of care are approved
• What type of care is appropriate

How This Relates to Our Agencies

Home care agencies, like ours, do not decide eligibility and do not perform the initial approval. Instead:

• The state agency, third-party assessor, or managed care organization approves the services
• Our agencies provide the caregivers and delivers the approved care
• We work in coordination with these organizations to ensure services are provided correctly and according to the approved care plan

Service Approval Timeline

Home care does not begin overnight. The amount of time it takes to start services depends on the type of care needed, the program involved, and state or local approval processes.

General Timeline Expectations

• Short-term or skilled care: Approval is typically faster, especially when services are related to recovery after illness, injury, or hospitalization.
• Long-term home care services: Approval can take several weeks to several months, depending on the complexity of the case and program requirements.
• 24-hour or live-in care: These cases often take the longest to approve due to higher service needs, additional reviews, and caregiver availability.

The timeline may vary based on:

• The level of care and number of hours needed
• The program or payer (Medicaid, waiver program, etc.)
• State and local processes
• Completion of required evaluations and documentation

For new home care cases, patience is important. Delays are normal and expected.

Transfers of Care (Faster Process)

A transfer occurs when a patient is already receiving approved home care services but wants to change agencies.

This may happen when:

• The patient is unhappy with their current agency
• The agency cannot meet scheduling or care needs
• The patient wants to change caregivers or agencies

What to Expect With Transfers

• The patient contacts their case manager or care coordinator to request a transfer
• Since services are already approved, the process is much faster
• Transfers typically take 1–2 weeks, depending on the state and program

The patient may:

• Transfer with their current caregiver, if allowed by the program
• Or receive a new caregiver through the new agency

Service Authorization & Care Coordination

Before a home care agency can begin services, the individual’s care must be formally authorized.

Authorization is a formal approval issued by the state agency, managed care organization, or third-party administrator responsible for the individual’s case. It allows the home care agency to provide services and outlines what care is approved.

This authorization:

• Specifies how many hours of care are approved
• Defines the type of services that can be provided (such as personal care or support services)
• Establishes the time period for which services are authorized

Coordination and Start of Care

Care coordinators are responsible for organizing, overseeing, and managing home care services after authorization is received. They act as the main point of contact between the patient, caregivers, the home care agency, and the authorizing organization.

Coordinating the Start of Care: Once services are authorized, the care coordinator initiates the start of care by:

• Contacting the patient or family to confirm service details
• Identifying an appropriate caregiver based on care needs and availability
• Creating a schedule that aligns with the authorized hours and services
• Confirming the official start date for home care services

Ongoing Care Coordination: After care begins, the care coordinator continues to:

• Ensure services are delivered according to the authorized care plan
• Monitor approved hours, schedules, and care needs
• Address issues such as missed visits, scheduling changes, or caregiver concerns
• Communicate with the authorizing organization when updates, changes, or reauthorizations are needed
  Support continuity of care to prevent service interruptions

Electronic Visit Verification (EVV) 

Electronic Visit Verification (EVV) is a system used to electronically confirm that home care visits occur as scheduled. EVV records key details about each visit, including:

• Visit start and end times
• Location of the visit
• Caregiver and patient information

Caregivers typically use EVV through a mobile application on their smartphone to clock in and out of visits in real time. This allows visits to be recorded accurately at the time services are provided.

Why EVV Is Required

EVV is federally required for Medicaid-funded home care services. Home care agencies must use EVV to confirm that authorized services were actually provided.

While EVV systems and rules vary by state, the purpose is the same nationwide:

• To ensure services are delivered as approved
• To support accountability and compliance
• To prevent fraud and improper billing

EVV and Care Coordination

EVV plays an important role in day-to-day operations. Care coordinators and office staff use EVV to:

• Verify that visits match the authorized schedule and hours
• Identify missed visits, late clock-ins, or early clock-outs
• Address discrepancies promptly to avoid service interruptions

Other Care Partners in the Home Care Process

Home care does not operate in isolation. Several healthcare partners play an important role in monitoring the patient’s condition and supporting changes in care when needed.

Registered Nurses (RNs): RNs may be involved in assessments, care oversight, or follow-up visits. They help monitor the patient’s condition and identify changes that may require adjustments to services.

Case Managers: Case managers, often working for the state or managed care organization, oversee the patient’s overall care plan. They review ongoing needs, approve changes in services, and help ensure care remains appropriate over time.

Doctors’ Offices: Physicians and medical providers identify medical needs, document health conditions, and may recommend home care services or changes based on the patient’s health status.

Hospitals and Facilities: Hospitals often trigger home care referrals after discharges. They may communicate changes in condition, recent hospitalizations, or new care needs that impact home care services.

As a patient’s condition changes, these partners may recommend updates to the care plan. This can lead to new evaluations, adjusted authorizations, or changes in services, ensuring the patient continues to receive the right level of care.

Intake

Intake is the starting point of the home care process. This is where individuals, families, or referral sources first contact the agency to request services or ask for information about home care.

Home care does not begin immediately at intake. Instead, intake starts the process of determining whether services may be available and what steps are required next.

What the Intake Team Does

The Intake team is responsible for gathering basic information and guiding the individual through the early steps of care. This typically includes:

• Receiving calls, referrals, or online inquiries
• Collecting basic information such as:

• Patient name and contact details
• Location and living situation
• Insurance or program type (Medicaid, private pay, VA, etc.)
• General care needs and concerns
• Explaining available home care services at a high level
• Setting expectations about timelines and next steps

Depending on the state or service area, the Intake team may also support the authorization process or work closely with a dedicated Authorizations department. Regardless of structure, intake ensures cases are directed correctly so the next steps can move forward without delay.

Authorizations

The Authorizations team is responsible for reviewing, verifying, and managing service approvals issued by external organizations. Their role is to ensure that all authorizations are accurate, complete, and properly reflected in required systems before care begins.

The Authorization team is responsible for:

1. Reviewing authorization documents to confirm they include:

• Approved service type
• Authorized hours
• Start and end dates
• Any special conditions or limitations
• Verifying that authorizations are active and valid
• Confirming that authorization details match what was approved during the evaluation

2. Ensuring authorization information is correctly reflected in:

• Medicaid portals
• Managed care organization (MCO) systems
• VA portals or other program-specific platforms

Billing

The Billing team is responsible for requesting and processing payment for services that have already been provided. In home care, agencies deliver care first and are paid afterward through a process called reimbursement.

Reimbursement is the process of getting paid back for services that have already been delivered.

In home care:

• The caregiver provides services to the patient
• The agency submits a claim for those services
• The payer (such as Medicaid, an MCO, or the VA) reviews the claim
• Payment is issued if the services match the authorization and requirements
• Reimbursement is not immediate and depends on accurate documentation and compliance.

The Billing team is also responsible for:

• Reviewing and resolving denied or rejected claims
• Tracking payments, adjustments, and outstanding balances
• Maintaining compliance with state and payer billing regulations

HR & Recruitment

What the Recruitment Team Does

The Recruitment team is responsible for finding, screening, and onboarding qualified caregivers to meet the needs of patients across different programs and states. Because home care depends on having reliable caregivers available, recruitment plays a critical role in service continuity.

The Recruitment team is responsible for:

• Screening applicants based on role and program requirements
• Verifying credentials, certifications, and licenses when required
• Conducting background checks and compliance screenings
• Ensuring caregivers meet required qualifications prior to hire
• Coordinating onboarding and orientation with HR

What the HR Team Does

The Human Resources (HR) team is responsible for managing caregiver and staff employment after hire. HR ensures that employees are properly onboarded, supported, and maintained in compliance with company policies and regulatory requirements.

The HR team is responsible for: 

• Managing employment documentation and compliance requirements
• Tracking required trainings, certifications, and renewals
• Supporting employees with policies, procedures, and workplace concerns
• Managing disciplinary actions, performance issues, and terminations
• Ensuring compliance with labor laws and agency policies

Payroll

The Payroll team is responsible for ensuring caregivers and staff are paid accurately and on time for the work they perform. Payroll processes compensation based on verified work hours and approved pay rates.

The Payroll team is responsible for:

• Processing caregiver and staff wages
• Verifying worked hours using approved time records and EVV data when required
• Ensuring pay rates match role, program, and authorization requirements
• Managing overtime, differentials, and adjustments
• Issuing paychecks or direct deposits according to the payroll schedule
• Addressing payroll discrepancies and corrections

Marketing

The Marketing team is responsible for promoting the agency’s services and supporting growth across the communities it serves. Marketing focuses on increasing awareness of home care services, attracting caregivers, and reaching individuals who may need care.

Because the agency operates across multiple states, marketing strategies may be tailored to meet local program requirements and community needs.

The Marketing team is responsible for:

• Creating and managing caregiver recruitment campaigns
• Developing campaigns to reach patients and families with information about
• home care services, tailored by state or location
• Posting job advertisements across multiple platforms

They manage and mantain:

• Social media accounts
• Agency websites
• Online listings and directories
• Creating marketing materials such as flyers, digital ads, and informational content
• Supporting brand consistency across all agencies and locations