understanding the landscape

A practical guide for Pennsylvania families

If a nurse or therapist is coming to the house while a caregiver is also helping with everyday life, you're not doing anything wrong. You're probably dealing with two different systems at the same time. That's where it gets confusing. One person may be coming in to work on mobility after a hospitalization. Someone else may be helping with bathing, meals, laundry, transportation, or simply making sure your person isn't alone. The services overlap in location, but they don't work the same way — and they aren't paid for the same way.

The good news is that you usually don't have to choose between them. For many families, home health and non-medical home care serve different parts of the same week.

First, why this matters

Family caregiving is not a small or unusual situation. A 2025 AARP/National Alliance for Caregiving study found that 63 million Americans — nearly 1 in 4 adults — provided ongoing care for an adult or child with a complex medical condition or disability in the prior year. That's about 20 million more caregivers than in 2015. Families are carrying more responsibility at home, and many are trying to figure out the system while they're already tired.

The distinction matters because Medicare's rules are specific. Medicare covers certain home health services when eligibility requirements are met, including skilled nursing and therapy. It does not generally cover ongoing custodial or personal care when that is the only care someone needs.

A Medicare-covered nurse coming to your house does not automatically mean Medicare will pay for someone to come every morning to help your person get dressed.

Home health and home care are not the same thing

Home health is skilled care

• Nursing and skilled therapy such as physical, occupational, or speech therapy
• Ordered as part of a medical plan of care and provided by a Medicare-certified home health agency when Medicare coverage applies
• Often connected to a change in condition, hospitalization, surgery, or another specific medical need
• Usually part-time or intermittent rather than 24-hour care

Home care is the everyday support

• Bathing, dressing, grooming, toileting, and mobility support
• Meals, light housekeeping, laundry, errands, and transportation
• Companionship and respite for family caregivers
• Medication reminders, rather than medication administration
• Support that may continue for as long as the need exists

If you want the practical version of what non-medical home care can look like at different ages and stages of life, Gilgal's home care services page breaks down the two care models and the kinds of support families can arrange.

Why families often need both at the same time

Here's a common example. Someone comes home after a hospital stay and starts physical therapy three times a week. The therapist is working on a specific goal: getting stronger, walking more safely, or transferring from the bed to a chair.

But the hours in between still have to be covered. Someone may need help getting out of bed, getting dressed, preparing breakfast, doing laundry, or getting to an appointment. Physical therapy doesn't replace those hours of everyday support.

That's why the two services can work alongside each other. Home health addresses the skilled medical need. Home care can fill the day-to-day gaps around it.

This is also why families are often caught off guard when the physical therapist stops coming. The home health episode may have reached its goal, or it may no longer meet the requirements for continued skilled care. That doesn't necessarily mean the need for help has disappeared.

So, who pays for each one?

Home health: Medicare may cover it when the requirements are met

For people with Original Medicare, covered home health can include skilled nursing, physical therapy, occupational therapy, speech-language pathology, and limited home health aide services when the person is also receiving qualifying skilled care. Medicare sets specific eligibility conditions. The person must be under the care of a physician or other allowed provider, and must meet Medicare's homebound and skilled-care requirements. Coverage is not an unlimited daily-care benefit.

Medicare also says it does not pay for 24-hour care at home, homemaker services unrelated to the care plan, or custodial and personal care when that is the only care needed. See Medicare's current home health coverage rules.

Home care: the funding question is different

Non-medical home care is generally not covered by Original Medicare. Families may instead use private pay, Medicaid-funded home and community-based services when they qualify, VA benefits, long-term care insurance, or a combination of resources.

Pennsylvania has several Medicaid programs and waivers, and eligibility depends on the person, the program, and the level of care involved. That's why “Does Medicaid pay for home care?” rarely has a yes-or-no answer.

Our guide to paying for home care in Pennsylvania walks through private pay, Medicaid, VA benefits, long-term care insurance, and ways families sometimes combine funding sources.

One mistake to avoid: assuming one service sets up the other

A hospital discharge planner may help arrange home health. A physician may order therapy. A home health agency may send a nurse or therapist. None of that automatically means a non-medical caregiver has been arranged for the rest of the week.

If your family needs both, ask for both — and ask each provider to explain exactly what they are responsible for.

Four ways to keep the two systems from becoming a mess

1. Ask what is covered — and what is not. Don't rely on assumptions. Have each provider put the services, schedule, and limits in writing.
2. Expect home health to be reviewed. Skilled care is tied to medical necessity and a plan of care. It can end even when your person's broader need for assistance continues.
3. Build the home-care plan separately. If your person needs help before breakfast, on weekends, or after home health visits end, identify those hours directly.
4. Give one person the whole picture. That might be you, a sibling, another trusted family member, or a care-planning professional. Someone should know what both providers are doing.

And don't overlook the caregiver

The person coordinating all of this is often the same person who is working, raising children, driving to appointments, answering phone calls, and trying to sleep. That is why respite and non-medical support matter even when skilled care is already in place.

A few hours of help can be enough to make a week workable. It doesn't have to mean handing over the entire care plan.

If you're trying to build a care plan around your actual week, Gilgal also offers family care planning and coordination support.

What should you ask before you hire anyone?

• What exactly will your staff do — and what won't they do?
• Who is the caregiver's employer?
• What happens if the caregiver calls out?
• What is the minimum visit and the total hourly cost?
• Does the caregiver have experience with my person's specific needs?
• Who do I contact when something changes?

Gilgal is licensed in Pennsylvania as both a home care agency and a home care registry, so families can compare the two models rather than being pushed into whichever model a provider happens to offer. You can compare the agency and Family-Led Care models here.

If you're already dealing with this, you're not behind

Most families don't sit down one morning and decide, “Today we're going to become experts in home care.” Usually there was a fall, a diagnosis, a hospital stay, a change in mobility, or a caregiver who finally admitted, “I can't keep doing all of this by myself.”

Start with the gap. What's the hardest part of the week right now? What's already covered, and what isn't? Once you can answer those two questions, the rest of the conversation gets much easier.

Free virtual session

Want to learn this before you need it?

That's exactly why we created Home Care 101. It's a free virtual session for Pennsylvania families covering home care vs. home health, agency vs. registry, what care actually costs, how Medicaid and other funding sources fit in, and the questions worth asking before you hire a provider.

Register for Home Care 101

If you have a situation in front of you now and a general workshop isn't enough, you can also book a free 15-minute introductory call with Gilgal. There's no obligation to become a client. Sometimes the most helpful answer is simply knowing which direction to go next.

The bottom line

Home health and home care are not competing services. They solve different problems.

Home health is about skilled medical care delivered at home when the requirements are met. Home care is about the everyday support that helps someone actually live at home. For many families, the two belong in the same plan.

You don't have to figure out the entire future today. Start by identifying what is already covered, where the gaps are, and what would make the hardest part of the week easier.

Sources & further reading

• Medicare — Home Health Services
• AARP / National Alliance for Caregiving — Caregiving in the US 2025

Gilgal Home Care & Registry · Pennsylvania licensed home care agency and registry
Serving Montgomery, Chester, Delaware, Bucks & Philadelphia counties