Understanding Home-Based Services
Written by Dr. Hao Huang
Updated at March 5th, 2026
| Type of Care | What it is | Who it’s for | Services may include | Who provides it | Paid by |
|---|---|---|---|---|---|
| Home Care (Non-Medical) | Support with everyday activities provided by trained caregivers (not nurses or doctors). | People who need help with daily tasks but do not need skilled medical care. |
-Bathing, dressing, grooming -Help with walking or transfers -Light housekeeping -Transportation to appointments or errands |
Personal care aides or home care aides from licensed home care agencies. |
-Private pay -Long-term care insurance -Medicaid (in some states) |
| Home Care (GUIDE) | Similar to Home Care above, it is non-medical support provided for patients with dementia. These caregivers may sometimes have additional specific training in dementia | Patients with dementia in a GUIDE program, such as HottoCare. This is usually intended to provide respite care to help caregivers. |
-Bathing, dressing, grooming -Meal preparation and feeding -Companionship -Help with walking or transfers -Light housekeeping and errands -Transportation to appointments or errands |
HottoCare provides these services through trusted, licensed home care agencies. | -Medicare pays up to $2,500 per year for this service, with no deductible or co-pay attached |
| Home Health Care (Medical) | Short-term medical care at home, prescribed by a doctor. A doctor must certify the patient is “homebound.” | People recovering from illness, surgery, or managing a chronic condition who need skilled care at home. |
-Nursing care (e.g., wound care, medication injections) -Physical therapy -Occupational therapy -Speech-language therapy -Monitoring of vital signs or chronic conditions |
Registered nurses (RNs), therapists, and home health aides from Medicare-certified home health agencies. |
-Medicare (if eligibility criteria are met) -Medicaid -Private insurance |
| Hospice Care (End-of-Life Care) | Comfort-focused care for people with a terminal illness who are no longer seeking curative treatment. | Patients with a life expectancy of 6 months or less, as certified by a doctor. |
-Pain and symptom management -Emotional and spiritual support -Help with daily activities -Counseling for patient and family -Bereavement support after death |
A team that may include hospice nurses, doctors, social workers, chaplains, home health aides, and volunteers. |
-Medicare Hospice Benefit -Medicaid -Most private insurance |
Sample list of home care services (adapted from Synergy Home Care):
Sample list of home health services (adapted from CenterWell Home Health):
- COPD care
- Diabetes care
- Dietary management
- Fall prevention
- Heart care
- Home health aides
- Injury rehabilitation
- Kidney care
- Medication management
- Memory care
- Occupational therapy
- Ostomy care
- Physical therapy
- Post-surgical care
- Skilled nursing
- Social work
- Speech therapy
- Stroke care
- Veterans care
- Wound care
How much in-home support does a client receive when on hospice?
The Medicare Hospice Benefit does not specify the amount of provision of aide/ADL support. Many hospices provide 1-2h, 1-2x/week, but it's at the organization’s discretion and (theoretically) tailored to the needs of the patient/family.
So the 2 home based frameworks family can choose from for someone with advanced stage dementia:
-
GUIDE + home health: 76 hours of in-home respite/year respite hours, utilization at the discretion of the family. generally limited to 4 hour blocks at a time. full range of homecare services that includes meal prep, transportation (there may be variation by homecare agency)
- Hospice: 52 - 208 hours of in-home respite/year if given weekly. respite is offered at the discretion of the hospice agency. generally limited to a 1-2hours/1-2x/week. narrow range of services (bathing, changing).