A complete family guide to understanding two very different types of in-home care — what each includes, who needs each, and how to choose.
Private duty care (also called non-medical home care) provides assistance with daily activities — bathing, dressing, meal preparation, housekeeping, transportation, and companionship. It is not covered by Medicare and can be arranged for any number of hours, including 24/7. Home health care provides skilled medical services at home — nursing visits, physical therapy, wound care, and medication management — ordered by a physician and often covered by Medicare for eligible patients. The key difference: private duty care supports daily living; home health care supports medical recovery. Many families use both simultaneously.
When a parent needs help at home, families often encounter two terms that sound similar but describe very different services: private duty care and home health care. The confusion is understandable — both involve care provided at home, both may involve aides or nurses, and both are designed to help seniors remain in their homes longer.
But choosing the wrong type of care — or not knowing both options exist — can leave critical needs unmet. A family that arranges only private duty care for a parent recovering from hip replacement surgery may not realize Medicare-covered physical therapy is available. Conversely, a family that assumes home health care will provide daily personal care may be surprised when the nurse's visits end after a few weeks.
This guide explains exactly what each service includes, who typically needs each, how costs and insurance coverage differ, and how families can use both services together to create a comprehensive care plan.
Private duty care — also called non-medical home care, personal care, or companion care — provides assistance with the activities of daily living (ADLs) and instrumental activities of daily living (IADLs) that a senior can no longer safely or comfortably manage alone. It is provided by home care aides, companions, or personal care assistants, not by licensed nurses or therapists.
The goal of private duty care is to support aging in place — helping seniors remain in their own homes safely and comfortably for as long as possible. Care can be arranged for as few as a few hours per week or as many as 24 hours per day, 7 days per week.
Private duty care does not require a physician's order and is not covered by Medicare. Families typically pay out of pocket, or may use long-term care insurance, Medicaid waiver programs (in some states), or VA benefits to help cover costs.
For a complete breakdown of what home care includes and doesn't include, see our guide: What Does Home Care Actually Include?
Home health care provides skilled medical services at home, ordered by a physician and delivered by licensed clinicians — registered nurses, licensed practical nurses, physical therapists, occupational therapists, and speech therapists. It is designed to support recovery from illness, surgery, or injury, or to manage ongoing medical conditions that require professional monitoring.
Home health care is typically short-term and visit-based — a nurse or therapist visits the patient's home 1–3 times per week to provide skilled services, then leaves. It does not provide continuous daily personal care or companionship.
When eligibility criteria are met, Medicare Part A and Part B cover home health care at no cost to the patient. Eligibility requires a physician's order, homebound status, and a need for skilled nursing or therapy services.
| Factor | Private Duty Care | Home Health Care |
|---|---|---|
| Medical services | None (non-medical only) | Skilled nursing, therapy, wound care |
| Personal care (bathing, dressing) | Yes | Limited (home health aide only) |
| Housekeeping / meal prep | Yes | No |
| Companionship | Yes | No |
| Medication support | Reminders only (no administration) | Full medication management |
| Transportation | Yes | No |
| Medicare coverage | Not covered | Covered when eligible |
| Medicaid coverage | Some states (waiver programs) | Yes |
| Typical scheduling | Flexible — hourly to 24/7 | Periodic visits (1–3x/week) |
| Typical duration | Ongoing (months to years) | Short-term (weeks to months) |
| Who provides care | Home care aides, companions | Licensed nurses, therapists |
| Physician order required | No | Yes |
Medicare coverage is one of the most important — and most misunderstood — differences between these two services.
Medicare does not cover non-medical home care, including:
Payment sources: out-of-pocket, long-term care insurance, Medicaid waiver (some states), VA benefits
Medicare covers home health care when ALL criteria are met:
Covered services: skilled nursing, PT, OT, speech therapy, medical social work, home health aide (under supervision)
For more on Medicare and assisted living costs, see: Does Medicare Pay for Assisted Living?
| Cost Factor | Private Duty Care | Home Health Care |
|---|---|---|
| Hourly rate | $25–$40/hour | $150–$250/nursing visit (if not covered) |
| Monthly (part-time, 4 hrs/day) | $3,000–$4,800/month | N/A (visit-based) |
| Monthly (full-time, 24/7) | $12,000–$20,000/month | N/A (visit-based) |
| Medicare coverage | None | $0 when eligible |
| Long-term care insurance | Usually covered | Usually covered |
| Medicaid | Some states (waiver programs) | Yes |
For a detailed cost comparison of home care vs assisted living, see: Home Care vs Assisted Living Costs: Which Is More Affordable in 2026?
Yes — and for many families, using both simultaneously is the most effective approach. The two services are designed to complement each other, not compete.
After hip replacement surgery, Medicare-covered home health provides physical therapy 3x/week. Private duty care fills the remaining hours with personal care, meal prep, and companionship.
A home health nurse monitors a diabetic wound and adjusts medications. A private duty aide provides daily personal care, transportation, and meal preparation between nursing visits.
As home health coverage ends after recovery, private duty care continues to provide ongoing daily support, allowing the senior to remain at home long-term.
The key is coordination: inform both providers about each other's involvement, share care plans, and designate a family member or care manager to oversee the combined arrangement.
Both private duty care and home health care have limits. As a senior's needs escalate — particularly with advancing dementia, frequent falls, complex medical needs, or the need for 24/7 supervision — home-based care may no longer be sufficient to ensure safety and quality of life.
Dementia creates unique challenges for both types of home-based care. Private duty caregivers can provide meaningful support in the early and middle stages — maintaining routine, providing personal care, and offering supervision during the day. However, as dementia progresses, the limitations of home-based care become more apparent.
Margaret lives alone and is physically capable but increasingly isolated after her husband's death. Her daughter arranged 4 hours of private duty companion care daily — a caregiver who drives her to appointments, prepares lunch, and engages her in activities. No medical services are needed. Cost: approximately $3,200/month out of pocket.
Robert was discharged after knee replacement surgery. His physician ordered home health care: a physical therapist visits 3x/week for 6 weeks, and a nurse visits weekly to monitor his wound and pain management. Medicare covers all services at no cost. His wife manages his personal care; no private duty care is needed.
Eleanor had a stroke and was discharged home with Medicare-covered home health care: PT, OT, and speech therapy 3x/week. Her family also arranged private duty care for 8 hours daily to assist with bathing, dressing, and meal preparation — services home health doesn't cover. As home health coverage ends after 8 weeks, they plan to continue private duty care long-term.
Harold's family started with 4 hours of private duty care daily for personal care and companionship. As his Parkinson's progressed, they increased to 12 hours, then 24/7 live-in care. When the cost exceeded $18,000/month and his safety needs exceeded what home care could provide, they transitioned him to an assisted living community with specialized Parkinson's care at $6,500/month.
Check all that apply to your parent's current situation:
Our senior care advisors can help you understand your options and connect you with the right services for your family's situation — at no cost.
Get a Free Care ConsultationWondering whether assisted living is the right next step?
Take our free Assisted Living Readiness Assessment and receive personalized recommendations for your family's situation.
What Should I Do Next?
Signs It May Be Time for Assisted Living
15 indicators that a higher level of care may be needed
How to Choose an Assisted Living Community
Evaluation framework, questions to ask, and red flags
How to Talk to Your Parent About Assisted Living
Communication strategies and sample dialogue
How to Pay for Assisted Living
Medicare, Medicaid, VA benefits, and private pay options
Care Transitions Resource Center
Every resource organized by care stage
Private duty care and home health care serve different but complementary purposes. Private duty care supports daily living — the personal care, companionship, and household tasks that allow a senior to remain at home comfortably. Home health care supports medical recovery — the skilled nursing and therapy services that help a senior regain function after illness or surgery.
Many families find that using both services together provides the most comprehensive support — particularly during the transition from hospital to home, when skilled medical needs and daily personal care needs both require attention.
If you're unsure which services your parent needs, start with a conversation with their primary care physician and a consultation with a senior care advisor. Understanding the options clearly is the first step toward building a care plan that truly meets your parent's needs.