The terms "certified home health care" and "licensed home care" are often used in the context of healthcare services provided in the home, but they refer to different types of services and are subject to varying regulations.
Home health care involves skilled medical services provided by licensed healthcare professionals and is often associated with Medicare (or other insurance) reimbursement.
Home care provides non-medical assistance with daily activities and is subject to state regulations, with services often paid for out-of-pocket by individuals or their families. It's important to check the specific regulations in your state, as they can vary, and some home care agencies may also offer "private duty" skilled services (nursing and therapy).
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Certified home health (CHHA or HHA), in detail
Home health implies that your loved one has one or more conditions warranting medical care and therapy in the home. Home health requires:
a provider order
that your loved one meets certain criteria for receiving these services at home (for example, being what's called "homebound")
treatment by licensed healthcare professionals
Among the licensed healthcare professionals that may be involved, a registered nurse or a physical therapist is required and they are responsible for coordinating care, though treatment may also involve an occupational therapist, speech therapist, home health aide, and/or medical social worker.
These professionals follow a care plan developed specifically to meet your loved one's needs, which is reviewed and approved by the ordering provider. The care plan outlines treatment goals and the planned interventions to reach those goals. Everything the healthcare professionals do for and with your loved one is mapped directly to the care plan. Progress toward care plan goals is reviewed with every home health visit, as well as evaluated every 30 days or with any change in condition, and the order for home health must be renewed by the provider every 60 days.
Home health care stops when care plan goals are met, progress toward care plan goals has ceased (your loved one has achieved their best), or the provider does not renew the order. Therefore, there are limits to how long home health care is delivered. It is considered intermittent, short-term care.
Certified home health agency means that the agency is in good standing with and can bill CMS (Centers for Medicare and Medicaid), and follows CMS home health care guidelines.
Home health care is covered in part or in whole by all insurance plans.
Licensed home care (LHCSA or HCA), in detail
Home care typically implies in-home care delivered by non-licensed caregivers and does not require a provider order.
These caregivers adhere to a service plan customized to meet your loved one's level and frequency of care needs, whether companion care, homemaking (IADLs), personal care (ADLs), or all three. Transportation may be made available with these services, as well, though not guaranteed.
There are home care agencies that do offer skilled care, which is considered "private duty" nursing or therapy. Availability of these skilled services varies by state (regulations) and agency.
Licensed home care is subject to state regulations, and licensing requirements may vary from state to state. These regulations require registration with the state, affect contracting and agency operations, and determine the training requirements and scope of care of the agency employees (what they can and cannot do in their roles). Three states remain that do not require home care agencies to be licensed by the state - Iowa, Massachusetts, and Michigan (as Ohio recently passed legislation requiring home care agencies to be licensed).
Services provided by licensed home care agencies are often private-pay, meaning they are not typically covered by health insurance or Medicare. Rather they are paid out of pocket by individuals and their families. That said, some managed long-term care and Medicaid plans do cover home care services and private-duty nursing.
