A daughter calls on a Tuesday afternoon and says her father has come home from hospital and needs home health care. What she wants, nearly every time, is someone at the house in the morning to help him wash and get dressed and eat something. Those are two different services. They are ordered differently, provided by different organizations, and paid for out of different pockets, and the fastest way to lose two weeks is to ask the wrong one for help.
Nobody is being careless when they mix the names up. The two share a word, they happen in the same room, and one of them can arrive with the other. Here is the difference, in the words of the two bodies that define it.
The difference in one table
| Home health care | Non-medical home care | |
|---|---|---|
| What it is | Clinical care at home after an illness, an operation or a fall | Help with the ordinary business of the day |
| Who decides you get it | A doctor or other health care provider, after a face-to-face assessment | You do |
| Who provides it | A Medicare-certified home health agency | A home care organization holding a state license |
| How long it lasts | As long as the episode lasts, then it stops | As long as you want it, from one visit a week to around the clock |
| Hours | Capped. Up to 8 hours a day, 28 hours a week combined | No cap. The schedule is whatever you arrange |
| What it costs you | Nothing, for services Medicare covers | Private pay, or a program such as Medi-Cal's IHSS or VA benefits |
| Regulator | Certified by Medicare in order to be paid by it | California Department of Social Services |
Left column from Medicare, home health services coverage, quoted in full below. Right column from the California Department of Social Services Home Care Services Branch, also quoted below. Both verified August 11, 2026.
What home health care actually is
Home health care is a medical service that happens to be delivered at home rather than in a building. It is prescribed. Medicare sets out the conditions plainly, and the first one surprises people:
A health care provider (like a nurse practitioner) must assess you face-to-face before certifying that you need home health services. A health care provider must order your care, and a Medicare-certified home health agency must provide it.
You cannot buy your way into it and you cannot decide for yourself that you qualify. There is a second gate as well. You have to be homebound, which Medicare defines strictly rather than loosely:
You must need part-time or intermittent skilled services and you're 'homebound,' which means you must meet both of these conditions:
And then there is the ceiling. This is the number families are least prepared for, because the phrase used to describe it sounds generous until it is converted into hours:
In most cases, 'part-time or intermittent' means you may be able to get skilled nursing care and home health aide services up to 8 hours a day (combined), for a maximum of 28 hours a week.
Four hours on a Monday and a Thursday is a normal home health week. It is not a person in the house. For someone who cannot safely be alone, home health is a visit, not cover.
The part that catches families out
Medicare will send an aide to help with washing and dressing. Read the condition attached to it, though, because it is the whole story:
Part-time or intermittent home health aide care (only if you're also getting skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy at the same time), like: Help with walking / Bathing or grooming / Changing bed linens / Feeding
The aide is attached to the clinical care, not to the person. When the therapy finishes and the nurse signs off, the aide stops too, on the same day. Nothing about the father's ability to get out of the bath has changed. What changed is that the episode closed. That single sentence is the origin of most of the calls this agency takes in a given week.
What non-medical home care is
Non-medical home care is the other half. It is help with the parts of the day that have become difficult: getting up, washing, dressing, cooking something worth eating, remembering the pills, getting to an appointment, having somebody in the house who notices when things are not right. No doctor orders it. Nobody has to certify that you are homebound. You decide you want it, you decide how often, and you can change your mind after a month.
It is not unregulated, which is the assumption that does families the most damage. California brought the whole category under state oversight a decade ago. The department that runs it describes its own job like this:
The Home Care Services Branch (HCSB) is responsible for licensing Home Care Organizations including processing applications, receiving and responding to complaints and conducting unannounced visits to ensure compliance. HCSB is also responsible for the Home Care Aide application process and maintenance of the Home Care Aide Registry.
And the law behind it, with the date it started, which matters if you are reading an older article:
California law established the Home Care Services Consumer Protection Act which, as of January 2016, requires Home Care Organizations to be licensed and creates a public online registry for Home Care Aides who have been background checked. This law is intended to promote consumer protection for elderly and disabled individuals who hire private aides to come into their homes and provide assistance with activities of daily living.
Two words that sound the same and are not
The organization holds the license. The individual caregiver is on the registry, having been background checked. Those are separate things and mixing them up is the most common error on home care websites in this state, including on pages written by agencies that hold a perfectly good license. If a website tells you its caregivers each hold a license, that is not a thing California does, and it is a small sign that nobody checked the page against the source.
Both facts are public. You can look up an organization on the state's own search, and the aide registry exists for the same reason. When you are trusting somebody with a key to your mother's house, the fifteen minutes it takes to check is the cheapest fifteen minutes in the whole process.
They are not alternatives, and plenty of people need both
This is the part that gets flattened into a versus. A man comes home after a hip replacement. For three weeks a nurse comes twice a week and a therapist works on the stairs with him. That is home health, and it is the right service, and it will end. Across the same three weeks somebody still has to be there at seven in the morning, because he cannot get himself out of bed and into the shower and he is not going to manage breakfast. That is home care, and it will still be needed in May.
The two run alongside each other perfectly well. A good non-medical caregiver makes the clinical side work better, because they are the one who notices that he has stopped using the frame properly or that the swelling looks worse than it did on Friday, and they are in the house on the four days nobody else is.
How to tell which one you are looking for
In practice the answer falls out of five questions, and you can answer all of them at the kitchen table without calling anybody:
- Did a doctor say this was needed, or did the family work it out between themselves? A doctor's order points at home health. Anything else points at home care.
- Is the task something a nurse has to do, or something a capable and kind person can do? Changing a dressing and getting somebody safely into a shower are not the same job.
- Does it have an end date? A recovery does. Needing help getting dressed usually does not.
- How many hours a week is it, really? If the honest answer is more than the eight hours a day and twenty-eight hours a week Medicare caps at, the gap is home care whatever else is going on.
- Can the person leave the house without considerable effort? If they can, they are unlikely to meet Medicare's homebound test, and home health is probably not available at all.
If four of those five point one way, that is your answer. If they split, call somebody and describe the week out loud. It takes ten minutes to work out on the phone and it is the sort of thing any decent agency will tell you straight, including when the answer is that you want the other kind.
What each one costs
The costs are not comparable, because the two services are not comparable. Covered home health is free to the patient at the point of use. Medicare states it in four words: you pay nothing for covered home health services. That is genuine, and it is also why home health is rationed by the eligibility rules rather than by price.
Non-medical home care is bought. The published median for this region is $40 an hour, which is a real, dated, primary survey figure rather than a guess, and at the hours most families actually start with it comes to far less than the monthly number the same survey prints. We take that apart properly, with the arithmetic shown, in the cost guide, and we go through every program that pays for some of it in the payment guide.
How to check any agency in California
Whoever you end up calling, including us, the state keeps a public search of the organizations it oversees, and the Home Care Services Branch takes complaints and makes unannounced visits, in its own words above. Ask any agency for its license number and look it up. An agency that hesitates over that question has told you something useful for free.
Ask two more while you are at it. Are the caregivers your employees or are they self-employed, which decides who carries the payroll taxes and the cover if somebody is hurt in the house. And what happens on the morning the regular caregiver is ill, because that morning arrives eventually and the answer is either a name or a shrug.
Where these numbers come from
Every figure on this page was read off one of these sources. Where a figure is our own arithmetic on a published rate, the table says so.
- Medicare, home health services coverageWhat Medicare covers and excludes at home, the homebound conditions, the certification requirement and the hour limits. No publication date printed, verified August 11, 2026.
https://www.medicare.gov/coverage/home-health-services - California Department of Social Services, Home Care Services BranchWho oversees home care organizations in California, the Home Care Services Consumer Protection Act and the Home Care Aide Registry. No publication date printed, verified August 11, 2026.
https://www.cdss.ca.gov/inforesources/Community-Care/Home-Care-Services - California Department of Social Services, Community Care Licensing facility searchThe state's public search for the organizations it oversees. Verified August 11, 2026.
https://www.ccld.dss.ca.gov/carefacilitysearch/ - CareScout Cost of Care Survey 2025The published hourly median for a non-medical caregiver in the Sacramento-Roseville-Folsom region. Data collected July through November 2025, published March 2026.
https://www.carescout.com/cost-of-care
