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Home Health Care Services?

In-Home Support, Dementia Care, Alzheimer’s Care, Personal Care, Companionship and Light Housekeeping

What are Professional In-Home Care Services?

Professional in-home care is a form of non-medical, personal care services provided to the elderly, medically fragile, or who have disabilities – and who prefer to remain at home rather than be relocated to a hospital or facility. This professional caregiver support enables individuals to live safely in familiar surroundings and offers increased independence and autonomy. In-home care support includes senior companionship, light housekeeping, and assistance with activities of daily living.

Families find many benefits in in-home care. In-home care can help combat the loneliness seniors or those often isolated experience. At the same time, in-home care services can give family members peace of mind knowing their loved one is under safe, professional care. This helps to reduce the stress associated with caregiving and enables family members to be family, not personal care aides, and spend quality time with their loved ones.

As in-home care provides flexible solutions tailored to individual needs, it is often preferred to the alternative of long-term care in a residential facility.

In Home Care

In-Home Care Services vs. Home Health Care Services

Home Health Care Services as defined by

Home health care services are a wide range of services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient, and more effective than the care you get in a hospital or skilled nursing facility (SNF).

Examples of skilled home health services include:

  • Wound care for pressure sores or a surgical wound
  • Patient and caregiver education
  • Intravenous or nutrition therapy
  • Injections
  • Monitoring serious illness and unstable health status

Home health care services generally aim to treat an illness or injury.

Home health care services help you:

  • Get better
  • Regain your independence
  • Become as self-sufficient as possible
  • Maintain your current condition or level of function
  • Slow decline
If you get your Medicare benefits through a Medicare health plan, check with your plan to find out how it gives you Medicare-covered home health benefits.

If you have a Medicare Supplement Insurance (Medigap) policy or other health insurance coverage, tell your doctor or other health care provider so your bills get paid correctly.

If your doctor or referring health care provider decides you need home health care, they should give you a list of agencies that serve your area. They must tell you whether their organization has a financial interest in any agency listed.

What should I expect from my home health care?

  • Doctor’s orders are needed to start care. Once your doctor refers you for home health services, the home health agency will schedule an appointment and come to your home to talk to you about your needs and ask you some questions about your health.
  • The home health agency staff will also talk to your doctor about your care and keep your doctor updated about your progress.
  • It’s important that home health staff see you as often as the doctor ordered.

Examples of what the home health staff should do:

  • Check what you’re eating and drinking
  • Check your blood pressure, temperature, heart rate, and breathing
  • Check that you’re taking your prescription and other drugs and any treatments correctly
  • Ask if you’re having pain
  • Check your safety in the home
  • Teach you about your care so you can take care of yourself
  • Coordinate your care -- this means they must communicate regularly with you, your doctor, and anyone else who gives you care

In-Home Care

Professional in-home care is a form of non-medical, personal care services that are provided to people who are elderly, medically fragile, or who have disabilities – and who prefer to remain at home rather than be relocated to a hospital or facility. This type of professional caregiver support enables individuals to continue to live safely in familiar surroundings and offers an increased level of independence and autonomy. In-home care services include companionship, light housekeeping and assistance with activities of daily living.

Families find many benefits in in-home care. In-home care can help combat the loneliness that seniors or those isolated often experience. At the same time, in-home care services can give family members peace of mind knowing that their loved one is under safe, professional care. This helps to reduce the stress associated with caregiving and enables family members to be family, not personal care aides, and spend quality time with their loved ones.

As in-home care provides flexible solutions tailored to individual needs, it is often preferred to the alternative of long-term care in a residential facility.

In Home Care 1

Companion Caregiver Duties

A companion caregiver is a professional service provider who offers companionship and assistive care to seniors or persons with disabilities. This type of care can involve aiding in activities of daily living (ADLs) such as eating, drinking, walking, showering, bathing, grooming, dressing, toileting, as well as providing the social interaction critical to help stave off cognitive decline. Companion caregivers may also offer transportation and light housekeeping services. As an in-home caregiver with a personal assistance service (PAS), all services are non-medical, even though the caregiver may have certifications as a certified nurse assistant (CNA), home health aid (HHA), or patient care assistant (PCA), medication technician (MT), etc. Professional in-home caregivers are trained to recognize changes in their clients’ conditions that could require further medical attention.
They act as the “eyes and ears” of the family, ensuring peace of mind. A companion caregiver can significantly improve the quality of life for individuals needing care and support by providing a consistent source of companionship, assistance with household tasks, assistance with personal care, socialization opportunities, and more.

Companion caregivers are an extremely important form of support for those who are elderly, disabled, or ill and need assistance with their everyday tasks. They often act as something between a friend and a nurse. Professional companion caregivers can be critical in helping those in need maintain as much personal independence as possible, for as long as possible.

Companion Caregiver Duties

Personal Care Services

Personal care services is a broad category with a multitude of real-world definitions. The most referenced definition includes a wide range of activities that promote good personal hygiene while promoting better mental health. Encompassing a broad category of tasks called activities of daily living, (ADLs), personal care services can include assistance with walking, eating, drinking, showering, bathing, grooming, dressing and toileting. Recipients of personal care are typically unable to do these activities themselves. The care allows a loved one to remain in their own home in safety and comfort, enjoying as independent a lifestyle as possible.

Personal care services are often interpreted to include other duties of an in-home caregiver such as companionship and light housekeeping.

Personal Care Services

Personal Care Aide Duties

The primary ways in which a personal care aide can assist someone in their home are as follows:


Reading, reminiscing, going on walks, just going – period – as appropriate to the client’s condition. Pre-COVID, we’d hear, “Let’s go to the Hill Country and look at the flowers.” We did that. We went to wedding rehearsals and family reunions and theaters, restaurants and museums. COVID has kicked us in the knee a bit. Now, our caregivers mostly transport clients to doctors’ appointments, pharmacies, grocery stores, etc., but the field is expanding. We can drive the client in their car or in our car. In addition, our caregivers are helping clients with hobbies that they can’t do alone anymore, or they don’t want to do alone anymore. This provides the crucial social interaction sorely lacking in so many seniors’ lives – the social interaction often key to slowing cognitive decline.

Light Housekeeping

The State of Texas allows caregivers to do 20% of their work as light housekeeping. Basically, we keep clean, sanitary and organized the areas where the client predominantly lives: bedroom, bathroom, kitchen, living room. Can we change bed linens? Do laundry? Clean the bathroom? Vacuum? Dust? Make light meals and snacks? Yes, we are doing that throughout the Houston Metro Area every day. Examples of what we won’t do: pick up grandchildren’s toys, clean a guest room, rake leaves, clean windows, pressure wash the garage. We focus on client care.

Assistance with ADLs (Activities of Daily Living):

This is a massive category, one that includes functions that most of us take for granted – walking, eating, drinking, showering, bathing, grooming, dressing, toileting and more.
The benefits of having professional care available in the comfort of a senior’s own home cannot be understated – overall quality of life increases as clients are provided with personalized care unique to their needs. With solid training and experience, a caring heart and an eye for detail, these dedicated professionals make a significant, positive impact in their clients’ lives – every day.

Home Health Aide Duties

The term, “home health aide” confuses many, many people who are trying to understand healthcare industry jargon. With multiple meanings and interpretations, it is a real puzzle. Is a personal assistance service (PAS) a medical service? The answer is, “no”, a PAS is a non-medical service. Why then does the state of Texas Department of Health and Human Services (the PAS licensing governmental body) refer to personal assistance services’ employees as “home health aides?” A home health service is very different from a PAS, providing medical care, at a residence, for an illness or injury. Their staffs support medical services given by a doctor or nurse supervisor. In the world of non-medical personal assistance services, a home health aid is an employee of a licensed, in-home care agency who takes care of clients in their residences by offering companionship, light housekeeping and personal care.

Home Health Aide Duties

Signs Your Aging Parents Need Help at Home

It’s natural for aging parents to wish to remain independent. But when daily activities such as eating, bathing and keeping track of medication become too difficult to manage alone, it may be time for your parents to seek assistance at home. The National Institute of Health shares a list of the signs of self-neglect that are apparent, even during a short visit by the family:
  • Hoarding
  • Failure to take essential medications or refusal to seek medical treatment for serious illness
  • Leaving a burning stove unattended
  • Poor hygiene
  • Not wearing suitable clothing for the weather
  • Confusion
  • Inability to attend to housekeeping
  • Dehydration
Those signs point to the need to consider additional care. Fostering a safe environment in which elderly parents can age gracefully and healthfully can be as easy as hiring a local home caregiver. These caregivers provide personal assistance and emotional companionship which can help stave off cognitive decline. Local caregivers promote independence and reduce the need for institutional living, offering flexibility in scheduling and promoting socializing with friends and relatives in a familiar home environment.
Personalized attention, assisting with medication administration, making light meals and snacks, monitoring safety conditions of the home and running errands are just some of the valuable services provided by caregivers. Additionally, hiring a good, local caregiver increases the family’s peace of mind, knowing that their loved one is receiving professional care in their own home, where the senior so often wishes to remain.
Activities Of Daily Living Adls

Activities of Daily Living (ADLs)

Activities of Daily Living (ADLs) are a set of basic activities people perform during everyday life. These include activities such as: eating, drinking, showering, bathing, grooming, dressing, toileting, etc. ADLs form the basis for assessing an individual’s functional ability and independence for performing these daily tasks.

Healthcare providers use ADLs to evaluate an individual’s overall health and to determine appropriate nursing home placements or levels of care needed in assisted living facilities. Moreover, information from an ADL assessment is also important when determining long-term care or home health services eligibility. The ability to perform these routine tasks is essential for maintaining independence at home and is considered by insurance companies when making decisions about reimbursement of care costs.

Senior Needs Assessment

A senior needs assessment is a process of evaluating the needs of an adult aged 65 plus. It can be as encompassing as assessing cognitive, social, physical and psychological health to identify areas in which the individual may require assistance. A comprehensive senior needs assessment can help uncover concerns that may not have been previously identified that could require medical treatments or lifestyle modifications. It can help to provide the necessary information needed to create plans to maintain and enhance the quality of life for the individual. Conducting a comprehensive assessment early on can provide more effective interventions if any difficulties arise late in life. As a result, seniors can enjoy longer periods of wellbeing. At Encore Caregivers, a nurse’s assessment takes place before service begins. Our nurse will come out and complete a 45-minute assessment, required by the state and free of charge.
She focuses on the client’s health, safety, physical and mental challenges and their general personality. It is that attention that helps build a caregiver/client relationship. When it is right, when the skill level, proximity of the caregiver and personality of our caregiver matches that of the client – the results are heart-warming and the relationships are solid. It is a beautiful thing to behold – and we have fostered those relationships throughout the Houston Metro Area for 14 years.

It is so very professional and demonstrates our commitment to you.

Senior Needs Assessment

How to Pay for In-Home Care

The main payment options for in-home care are as follows:

Private Pay

Long-term Care Insurance

Medicaid covers a sliver of the cost of in-home care

Texas Medicaid Eligibility: 2023 Income & Assets Limits (

Veterans Benefits cover a sliver of the cost of in-home care

VA Aid And Attendance Benefits And Housebound Allowance | Veterans Affairs

Encore Caregivers is private pay and long-term care insurance accepting in-home care agencies. No contract, no pre-pay, or downpayment. Our manager, and office administration, bills each Tuesday by looking back at the previous week and invoicing for services we have already provided. 

Self-Pay/Private Pay Options

Self-pay (also called private pay) is the dominant method for payment for in-home care services. It allows the senior much more freedom of choice in their selection of the in-home care agency best equipped to serve.
Some red flags in private pay:

  • Contracts – this locks the senior into a set number of hours or days of service. At Encore Caregivers, we have no contracts – you tell us when to begin and end services.
  • Down Payments or Pre-Pays – this is money up front to pay in advance of services. At Encore Caregivers, we have no down payments or pre-pays. We bill only after service has been provided.
At Encore Caregivers, our Manager, Office Administration bills every Tuesday for service we have already provided the previous week. We also offer several billing options for our clients:
  • Recommended and preferred, and a secure method of payment is The Automated Clearing House (ACH). ACH provides a service in which a client requests the bank to withdraw funds from their account weekly after giving Encore Caregivers authorization to bill directly to their account. Encore Caregivers, of course, delivers the complete invoice directly to the client as well. The bank charges a small fee for that service, but Encore Caregivers covers that fee.
  • We can also email a link and the family can click the link and pay on-line.
  • We can keep a credit card on file and it will be billed weekly, with an additional 2.7% processing fee.
  • We can bill by a weekly, mailed invoice and clients pay us by check. Check-writing is increasingly rare, but we do continue to offer that option as a service to our clients.

Long Term Care Insurance

Taken directly from
Unlike traditional health insurance, long-term care insurance is designed to cover long-term services and supports, including personal and custodial care in a variety of settings such as your home, a community organization, or other facility.

Long-term care insurance policies reimburse policyholders a daily amount (up to a pre-selected limit) for services to assist them with activities of daily living such as bathing, dressing, or eating. You can select a range of care options and benefits that allow you to get the services you need, where you need them. The cost of your long-term care policy is based on:

  • How old you are when you buy the policy
  • The maximum amount that a policy will pay per day
  • The maximum number of days (years) that a policy will pay
  • The maximum amount per day times the number of days determines the lifetime maximum amount that the policy will pay.
  • Any optional benefits you choose, such as benefits that increase with inflation

If you are in poor health or already receiving long-term care services, you may not qualify for long-term care insurance as most individual policies require medical underwriting. In some cases, you may be able to buy a limited amount of coverage, or coverage at a higher “non-standard” rate. Some group policies do not require underwriting.

Good to Know
Many long-term care insurance policies have limits on how long or how much they will pay. Some policies will pay the costs of your long-term care for two to five years, while other insurance companies offer policies that will pay your long-term care costs for as long as you live—no matter how much it costs. But there are very few that have no such limits.

Bright Idea
Before you buy a policy, be aware that the insurance company may raise the premium on your policy. It is a good idea to request information on the company’s premium rate history.


Taken directly from

Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.

Will Medicaid Pay for In-Home Care?
Taken directly from

Yes, Medicaid will pay for in-home care, and does so in one form or another, in all 50 states. Traditionally, Medicaid has, and still continues to, pay for nursing home care for persons who demonstrate a functional and financial need. However, in-home care provides an alternative for seniors who require assistance to remain living at home, but prefer not to relocate to nursing home residences. In-home care via Medicaid not only helps elderly persons to maintain their independence and age at home, but is also a more cost-efficient option for the state than is paying for institutionalization.

Many states allow Medicaid recipients to direct their own in-home care. This model of receiving services is called consumer directed care, participant directed care, cash and counseling, and self-directed care. It often allows care recipients to hire relatives as paid caregivers. Commonly, adult children can be hired and paid to provide care for their aging parents. Several states even allow one’s spouse to be hired.

“Home care” may extend to a variety of settings outside of one’s own personal home. This may include the home of a friend or relative, an adult foster care home, or an assisted living residence. The exact settings in which one can receive services depends on the state and the Medicaid program.

Eligibility Requirements for Medicaid Home Care
To be eligible for Medicaid, and hence, in-home care, specific eligibility criteria must be met. In addition to being a resident in the state in which one applies, there are also financial and functional requirements.
Financial Criteria
While both income and assets are considered for Medicaid eligibility purposes, the limits vary based on the state in which one resides and the program for which one is applying. To be eligible for the regular state Medicaid program, one must meet the criteria set forth for their specific eligibility group. For the purposes of this article, the eligibility group is “aged, blind and disabled”. Generally speaking, most states limit one’s monthly income to either 100% of the Federal Poverty Level (FPL) or 100% of Supplemental Security Income (SSI) / Federal Benefit Rate (FBR). In 2023, a state that utilizes 100% of the FPL as the income limit allows a single applicant up to $1,215 / month in income. States that utilize 100% of SSI, limit an individual’s income to $914 / month. Assets are generally limited to $2,000 for an individual.

For more information:


This article is based on information posted on the Medicare website:

Medicare is the federal health insurance program for:

  • People who are 65 or older
  • Certain younger people with disabilities
  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant)
The different parts of Medicare help cover specific services:
Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care (not to be confused with in-home care).
Medicare Part B (Medical Insurance)

Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.

Note:  Medicare Part B covers only:

  • Medically necessary services – services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice
  • Preventive services – health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best

Note:  The website, lists more than 150 tests, items and services covered by Medicare.  In-home care, considered custodial care, is not on the list.

On the website is this statement:

“Some of the items and services Medicare doesn’t cover include:  Long-Term Care [also called custodial care].”

Medicare Part D (prescription drug coverage)
Helps cover the cost of prescription drugs (including many recommended shots or vaccines).

Often families confuse in-home care (personal assistance services) with home health care, in which medical professionals visit the residence, providing needed medical services. Much of home health care is covered by Medicare.

The companionship, light-housekeeping and assistance with activities of daily living (personal care) services, provided by an in-home care agency are not covered.

Do Medicare Advantage plans pick up the slack and cover in-home care? Of course, you need to check with your individual plan advisor, but the answer our clients have received time and time again is “NO”. Who should you listen to with regard to coverage?
Medicare Advantage plan advisor

Veterans’ Benefits

Taken directly from website

VA Aid and Attendance benefits and Housebound Allowance
VA Aid and Attendance of Housebound benefits provide monthly payments added to the amount of a monthly VA pension for qualified Veterans and survivors. If you need help with daily activities, or you’re housebound, find out if you qualify.

Am I Eligible for VA Aid and Attendance or Housebound Benefits as a Veteran or Survivor?

VA Aid and Attendance Eligibility
You may be eligible for this benefit if you get a VA pension and you meet at least one of the following requirements.

At least one of these must be true:

  • You need another person to help you perform daily activities, like bathing, feeding, and dressing, or
  • You have to stay in bed – or spend a large portion of the day in bed – because of illness, or
  • You are a patient in a nursing home due to the loss of mental or physical abilities related to a disability, or
  • Your eyesight is limited (even with glasses or contact lenses you have only 5/200 or less in both eyes; or concentric contraction of the visual field to 5 degrees or less)

Housebound Benefits Eligibility
You may be eligible for this benefit if you get a VA pension and you spend most of your time in your home because of a permanent disability (a disability that doesn’t go away).

Note: You can’t get Aid and Attendance benefits and Housebound benefits at the same time.

How Do I Get This Benefit?
You can apply for VA Aid and Attendance or Housebound benefits in one of these ways:

Through the Mail

Send a completed VA form to your pension management center (PMC) – Fill out VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance) and mail it to the PMC for your state.  You can have your doctor fill out the examination information section.

Get VA Form 21-2680 to download
Find your PMC

You can also include with your VA form:

  • Other evidence, like a doctor’s report, that shows you need Aid and Attendance of Housebound care
  • Details about what you normally do during the day and how you get to places
  • Details that help show what kind of illness, injury or mental or physical disability affects your ability to do things, like take a bath on your own
  • Details that help show what kind of illness, injury, or mental or physical disability affects your ability to do things, like take a bath, on your own

Learn about the evidence you’ll need to support your claim

If you are in a nursing home, you will also need to fill out a Request for Nursing Home Information in Connection with Claim for Aid and Attendance (VA form 21-0779).

Get VA Form 21-0779 to download

Apply in Person

You can bring your information to a VA regional office near you. 

Find your nearest VA regional office

Using veterans’ benefits, seniors can receive assistance needed to continue living in their homes while enjoying independence in familiar surroundings.  

The above information was provided as a service to any veteran who needs in-home care and may be eligible for Aid and Attendance benefits.  We thank you for your service and want you to enjoy any benefit made available to you. 

Note:  Encore Caregivers accepts private pay and long term care insurance only.  

As always, the definitive source for veterans’ benefits is: