Types of In-Home Care Explained 

Families choose it for a mix of reasons, comfort, safety, and support being some of the biggest, and those benefits of in-home care often become clearer once you understand the different types available. 

There are really two questions to answer when you’re looking at in-home care: 

• What kind of help is needed? Medical care, personal care, or something else 
• Who will provide that help and manage it day to day? 

For most families, the answer to that second question is an agency. With agency-based care, a home care or home health agency hires, trains, schedules, and supervises the caregiver. The agency handles the administrative side, and you work with whichever caregiver they assign. This is the most common way people receive in-home care, and it’s the model most people picture when they hear terms like personal care or home health care.

There’s also a different approach called self-directed care, where the person receiving care, or their representative, takes on the role of choosing and managing the caregiver themselves. We’ll get into how that works and who it’s for a bit further down.

Most people end up using more than one type of care, and the right mix depends on things like health condition, level of independence, and what kind of support is already available from family. Understanding the options ahead of time makes it easier to make decisions when you actually need to. 

Home health care is a broad category that covers many different kinds of medical support, all delivered in the home and ordered by a doctor. It’s usually tied to a specific health condition, a recovery from surgery, or an illness, and it can involve several types of care working together. 

Common types of home health care include: 

• Skilled nursing: Nurses manage things like wound care, medication, and monitoring for a chronic condition. 
• Physical therapy: Therapists help rebuild strength and mobility after an injury, surgery, or fall. 
• Occupational therapy: Therapists help someone relearn everyday tasks like dressing or cooking safely. 
• Speech therapy: Specialists support speech, language, or swallowing difficulties, often after a stroke. 
• Medical social services: Social workers connect patients and families with resources and help with long-term care planning. 
• Home health aide visits: Aides help with tasks like bathing or dressing under a nurse’s supervision. 

The amount of time involved can vary quite a bit. Some people only need a home health worker to stop by for an hour or two a day. Others need more frequent visits, or several of these services at once, depending on how serious the condition is and how much progress has been made. 

Because home health care is tied to a medical need, it tends to be short term overall, even if individual visits are brief. Coverage often comes through Medicare, Medicaid, or private insurance, though the specifics depend on the diagnosis and the plan. Once the underlying condition improves or stabilizes, this type of care usually winds down or stops altogether. 

Home health care is almost always arranged through an agency, since the caregivers involved are licensed medical professionals working under a doctor’s orders.

Our blog, “How to Find the Best Home Health Care Services for You or a Loved One” walks through what to look for and how to get started.

Personal care services cover the everyday support that helps someone stay independent at home. Unlike home health care, personal care does not require a doctor’s order, and it is not tied to treating a specific medical condition. It tends to be more flexible and more shaped by personal preference, which is part of why it looks so different from one household to the next. 

Personal care can include: 

• Help with bathing, dressing, and grooming 
• Support with meal preparation and light housekeeping 
• Assistance with mobility and getting around the house safely 
• Reminders or help with medication that does not require a licensed professional 

Most of these tasks fall into a category healthcare providers call activities of daily living, or ADLs. These are the basic things a person needs to do every day to take care of themselves. 

• ADLs: bathing, eating, dressing, and moving safely from room to room 
• IADLs (instrumental activities of daily living): managing money, preparing meals, and handling transportation 

The difference matters because it helps explain why two people can have very different personal care needs even without a medical diagnosis driving either one. Someone might be able to bathe and dress without any trouble but still need help managing bills or getting to appointments. Someone else might need hands-on help with basic daily tasks but have no trouble managing their finances. Cleveland Clinic’s overview of activities of daily living breaks down both categories in more detail, along with how healthcare providers assess them. 

Because personal care isn’t tied to a medical condition, it also tends to continue for as long as it’s needed, rather than winding down once a health issue resolves. Personal care plays a big role in how someone experiences daily life at home, beyond just physical health.  

Learn how in-home care enhances quality of life and how the right kind of support can shape someone’s routine, mood, and sense of independence.

The sections above describe types of care based on what kind of help is provided, medical treatment, personal care, and so on. Self-direction works differently. It isn’t a separate type of care, it’s a different way of arranging and managing the care described above, and it can apply to personal care, and in some cases, home health type services too, depending on the state and program. 

Again, with agency-based care, the agency chooses who comes into your home. With self-directed care, that decision belongs to the person receiving care, or to a representative acting on their behalf. Instead of an agency assigning a caregiver, the individual hires their own, sets the schedule, and manages the day-to-day relationship. 

One of the most common reasons families choose self-direction is the ability to hire someone they already know and trust, often a relative, neighbor, or close family friend, rather than a caregiver assigned by an agency. This can mean more consistency, more comfort, and a caregiver who already understands the person’s needs and routines. 

Self-direction is typically available through Medicaid Home and Community-Based Services (HCBS) programs. To qualify, a person generally needs to be eligible for Medicaid and meet their state’s requirements for the specific program, which often includes a functional need for support with daily activities. 

This approach is available to a wide range of people, including older adults, people with physical disabilities, and people with developmental disabilities, depending on the state and program. For many people with disabilities in particular, self-direction offers a level of control over daily support that agency-based care doesn’t always provide. Our article, “In-Home Care for Disabled Individuals and Their Families” looks at how this plays out for that population specifically.

Self-direction comes with rules about who can be hired, and those rules vary by state and by program. Many programs place restrictions on hiring a spouse, though the specifics differ depending on where you live and which program you’re enrolled in. Some states have expanded who can be paid as a caregiver in recent years, so it’s worth checking the rules for your specific program rather than assuming. 

Caregivers hired through self-direction typically still need to meet certain requirements before they can start working and getting paid. This usually includes passing a background check, and depending on the state and program, may also involve completing basic training or health screenings. These requirements exist to keep the participant safe while still allowing them to choose who provides their care, rather than being assigned a caregiver by an agency. 

Even though the participant is choosing and managing their caregiver, someone still has to handle payroll, tax withholding, and other employer responsibilities that come with paying a caregiver. This is where a fiscal intermediary comes in. A fiscal intermediary (FI), or financial management services (FMS) provider, manages the administrative and financial side of self-direction, so the participant can focus on choosing the right caregiver without having to become an employer in the technical sense on their own. 

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Companion care is the lightest level of in-home support. Unlike personal care or home health care, it isn’t built around hands-on physical assistance. Instead, it focuses on supervision, safety, and social connection. 

This can include help with light housekeeping, transportation to appointments or errands, and simply having someone present for company and conversation. Companion care is often a good fit for someone who is safe living independently but shouldn’t be left alone for long stretches of time, or whose biggest challenge is isolation rather than a physical or medical need. 

Because companion care doesn’t typically involve personal care tasks like bathing or dressing, it tends to cost less than other types of in-home support, though pricing varies by provider and location. It can also work well alongside other types of care as someone’s needs change over time, filling gaps that personal care or home health care don’t cover on their own. 

Isolation is one of the most common concerns for older adults living alone, which is part of why companion care comes up so often when families start looking into in-home elderly care options. 

Hospice and palliative care are different from the other types of care in this guide because they focus on comfort rather than recovery. Instead of treating a condition or helping someone regain independence, the goal is to manage pain and symptoms and support quality of life. 

Palliative care can happen at any stage of a serious illness, even while someone is still receiving treatment aimed at curing or managing that illness. It’s meant to ease symptoms like pain, nausea, or fatigue, and to support emotional wellbeing alongside medical treatment. 

Hospice care is specifically for people nearing the end of life, usually when a doctor determines that curative treatment is no longer the goal. It shifts the focus entirely to comfort, dignity, and support for both the patient and their family. 

In the home, this type of care can include: 

• Pain and symptom management from a nurse or hospice team 
• Emotional and spiritual support for the patient and family 
• Help with personal care tasks, similar to what a home health aide provides 
• Guidance and support for family members acting as caregivers 

Because hospice and palliative care involve licensed medical professionals and a coordinated care team, they’re arranged through a hospice agency or program rather than managed independently, and they aren’t something available through self-direction.

With so many types of in-home care available, it’s normal to feel unsure where to start. A few key questions can help narrow things down. 

• What kind of help is needed? Medical care calls for home health care, while daily tasks like bathing or meal prep point toward personal care. 
• How much support is needed, and how often? Some people need a few hours of help a week. Others need care every day or around the clock. 
• Who should be providing the care? Some families prefer the structure of an agency. Others want the flexibility of choosing their own caregiver through self-direction. 
• Is this short term or ongoing? Home health care and hospice tend to be tied to a specific timeline. Personal care and companion care often continue for as long as they’re needed. 

It’s also worth knowing that care needs aren’t set in stone. What works well today might look different in a year, and that’s completely normal. Checking in on the plan every so often helps make sure the right type and amount of support stays in place. 

You don’t have to sort through all of this alone. Many Medicaid programs and healthcare systems assign a case manager, sometimes called a care coordinator, to help figure out what kind of care makes sense, connect families with the right programs, and adjust the plan as needs change. A case manager can be a helpful starting point if you’re not sure which direction to go.

Cost is one of the biggest factors families weigh when choosing in-home care, and it’s also one of the hardest to pin down. What you pay depends on the type of care, how many hours are needed, where you live, and who’s providing it, so there’s no single answer that applies to everyone. 

A few things generally affect cost: 

• Type of care: Medical care like home health care is often covered in part by Medicare, Medicaid, or private insurance. Nonmedical care like personal care or companion care is less likely to be covered and may be paid out of pocket, depending on the program. 
• Hours needed: A few hours a week costs less than daily visits or around-the-clock support. 
• Who provides the care: Agency rates and self-direction can work differently financially, since self-direction often involves paying a caregiver directly through a program rather than paying an agency’s rate. 
• Location: Cost varies quite a bit from state to state and even between cities within the same state. 

For families relying on Medicaid, understanding what’s covered and what isn’t can make a real difference in what feels affordable. Learn more about affordable home care providers and what you need to know. 

Ready to get started? Get a full breakdown of how to find, understand, and pay for home care services near you.

Public Partnerships LLC, known as PPL, is a fiscal intermediary that supports self-directed care in many states across the country. If self-direction sounds like it could be a good fit, PPL may be one of the organizations that can help, depending on where you live. 

As a fiscal intermediary, PPL handles things like payroll and paperwork for self-direction, so participants and families can focus on choosing the right caregiver. PPL supports older adults, people with physical disabilities, and people with developmental disabilities through Medicaid programs in the states where it operates. 

Every state’s program works a little differently. The best next step is usually to see what’s available where you live. 

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