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PRIVATE DUTY CARE, HOME CARE, HOME HEALTH CARE-What is the Difference? - Old Dominion Home Care

Home Care Quiz—Test Your Knowledge

It has been my experience as a former visiting nurse and now aging life care manager, that families get confused by the terms home care, home health care, non-skilled and skilled care.  It is easy to do–the terms are frequently used incorrectly or interchangeably.  One of the biggest differences between the types of home care, i.e. care provided in the home–is who pays?  More often than not, families assume that Medicare pays for everything.  Unfortunately, this is not the case.  So, I hope to provide the answers to your frequently answered questions regarding “home care” through the following Home Care Quiz!

What is Home Care?

Can you name the two types of home care?

Answer:  Non-skilled home care, skilled home health care

What is the Difference Between Non-Skilled and Skilled Home Care?


  • Non-skilled home care provides personal care such as help with bathing, dressing, toileting, grooming and medication reminders. The care providers are certified nursing assistants (CNA),home health aides (HHA) or companions.
  • Skilled Home Care provides care from licensed nurses, physical, occupational or speech therapists with a doctor’s order.What Is the Difference Between the Three Types of “Personal Care Aides”?

What Is the Difference Between a CNA, HHA, or Companion?


  • A certified nursing assistant (CNA) in Virginia has 120 hours of training from an approved program and after passing a State exam for CNAs is licensed in Virginia.
  • A home health aide (HHA) is someone who has received the 120 hours of training but is not licensed.
  • Both CNAs and HHAs are qualified to provide personal care. Personal care includes help with bathing, dressing, grooming, toileting, assisting with transfers, meal preparation, medication reminders.
  • A companion is a person who has no formal training and provides “companionship” but no “hands on” care.
  • Medicare does not pay for ongoing personal care. The cost in the Washington Metro area varies from $20 to $25 per hour for HHAs or CNAs, and $18 to $22 per hour for a companion.
  • Sometimes families need someone to live-in and those rates vary from $180 to $200 per day.

Are All Home Care Agencies the Same?

Answer:  NO

  • There are home care agencies and nursing referral services.
  • A home care agency employs their own personal care aides and companions.
  • As an employer, the company screens each employee through a background check (SSN, driver’s license and citizenship status) and is responsible for paying social security and workman’s compensation for each employee. Home care agencies in Virginia are licensed by the Department of Health and are bonded.
  • The benefit of working with a licensed agency–the agency is responsible for finding a replacement if the caregiver is sick or on vacation AND the agency is responsible for payroll taxes and workman’s compensation.
  • A referral agency is another source for personal care aides. A referral agency does a background check and interviews applicants. Many are also bonded.  They provide a family with a list of potential caregivers.  The individual needing help then interviews and hires the personal care aide.  Once hired, the caregiver is your employee.  As the employer, you are responsible for payroll taxes and workman’s compensation for the caregiver.

What is Skilled Home Care or Home Health Care?


  • Skilled home care is also labeled home health care or medical home care.
  • Home health care provides skilled medical services by licensed nurses, physical, occupation or speech therapists. In addition, personal care is provided for up to six hours per week if there is skilled care involved.
  • Clinical services are provided wherever the individual resides.
  • Skilled home care requires a doctor’s order and the individual must be essentially homebound.
  • Medicare Part A and sometimes Medicare Part B covers in-home health care for services such as intermittent skilled nursing care, PT, OT, ST and home health aides. .

Requirements for eligibility

  • Must be under the care of a doctor and have a doctor’s written order for skilled care at home.
  • Doctor must certify that you need intermittent skilled nursing, PT, OT or ST.
  • Your condition must be expected to improve in a reasonable and predictable period of time.
  • Intermittent care is defined as skilled care that is provided 2-3x per week, not daily.
  • You must be essentially homebound (unable to leave the home without considerable effort and/or help).

In conclusion, care in the home setting can be either skilled and intermittent requiring a doctor’s order and supervision OR, non-skilled, hands-on personal care that can be short term or continuous.  Skilled home health care is covered by insurance, be it private insurance or Medicare; non-skilled home care is private pay and is available through licensed home care agencies or nursing referral services.  If this article has generated more questions or thoughts, please enter your comments or questions and I will be happy to reply.


About the Author: Judy Grumbly, Principal of AGE, LLC is a certified aging life care manager and registered nurse. She has been working with aging adults for over 30 years to help them achieve their goals as they age. Judy is currently President of the Mid-Atlantic Chapter of Aging Life Care Association and volunteers with the Arlington Neighborhood Village.