Home Health vs Home Care: What's the Difference (and Which One Are You?)

If you ever sit in a room with a home health director and a home care director and listen to them describe their work, you can usually tell within sixty seconds that they are not running the same business. They use overlapping vocabulary — "visits," "schedules," "caregivers," "compliance" — but the meaning of those words is almost completely different.

I've worked in home health as an occupational therapist for years. I now build software for both verticals, and I can tell you the most common question I get from new operators is: which one am I? Sometimes they have been running for two years before they realize they have been calling themselves the wrong thing on their website.

This piece exists to settle it.

The one-sentence version

Home health is medical, time-limited, and ordered by a physician. It is paid by Medicare, Medicaid, or commercial insurance under a clinical benefit, and it follows CMS Conditions of Participation.

Home care is non-medical, ongoing, and ordered by the family or a case manager. It is paid privately, by long-term care insurance, by Medicaid waivers, by VA benefits, or by IHSS programs — and the regulations come from your state, not CMS.

If you are sending an RN to do an OASIS assessment, you are running home health. If you are sending a CNA or HHA to help someone bathe and make breakfast, you are running home care.

The detailed version

Here is how the two compare across the dimensions that actually matter when you are running an agency.

| Dimension | Home Health | Home Care | |---|---|---| | Who delivers care | RN, PT, OT, SLP, MSW, HHA (under supervision) | CNA, HHA, caregiver, companion | | Who orders it | Physician (signed plan of care required) | Family, case manager, or self-pay client | | Primary payer | Medicare, Medicaid, commercial insurance | Private pay, LTC insurance, Medicaid waivers, VA, IHSS | | Episode model | 60-day certification periods, recertified | Open-ended, often years | | Documentation | OASIS, plan of care, visit notes, 485, 487 | ADL logs, care plan, shift notes | | Federal regulator | CMS (Conditions of Participation) | None directly — state DOH or DHS | | Visit length | 30–90 minutes typical | 2–24 hours per shift | | Required tracking | PECOS, NPI, OASIS submission, claims | EVV (for Medicaid), state-required ratios, payroll | | Software needs | OASIS, route optimization, cert period tracking, claims | Shift scheduling, EVV, ADL log, authorization tracking, payroll |

Why the confusion exists

Two reasons.

The first is regulatory drift. In some states the same agency can hold a home health license and a home care license — and a few large national chains run both arms under the same roof. From the outside they look identical. Inside, they are run by completely different teams with different software, different supervisors, and different payroll cycles.

The second is consumer-facing language. Families calling around asking about "home care for mom" usually do not know whether they want a nurse or a caregiver, and they often do not know that the difference will determine whether Medicare pays or whether they pay out of pocket. Sales teams from both industries are happy to take the call.

The financial difference

This is the part most operators don't realize until they have already picked a lane.

Home health gets reimbursed in 30-day payment periods under PDGM, with case-mix weights that reward complex patients and penalize visits that fall short of the LUPA threshold. The math is unforgiving — a single missed recertification window can cost an agency a full episode of revenue, and a wrongly-coded OASIS item can flip a clinical group and shave thousands off a payment.

Home care, by contrast, is hourly. You bill against an authorization (Medicaid waiver, IHSS, LTC policy) or a private-pay rate, and the math is closer to staffing-agency economics: every hour you fill is revenue, every shift you can't cover is loss. The pressure isn't case-mix — it's recruiting and retention.

That difference cascades into everything. Home health agencies obsess over OASIS accuracy and cert-period management. Home care agencies obsess over caregiver retention and shift-fill rates. The dashboards do not even live in the same neighborhood.

What this means for your software

Here is the part I learned the hard way: software that was built for home health cannot run a home care agency, and software built for home care cannot run home health. I've seen agencies try both directions, and both directions fail.

Home health software treats the patient as the primary unit. Home care software treats the shift as the primary unit. That single architectural choice changes everything downstream — the data model, the schedule view, the documentation flow, the way you pay people, the way you bill people.

This is also why we ship two separate products under one company. Home Health Scheduling is built around 60-day cert periods, OASIS, and visit episodes. Home Care Scheduling is built around recurring shifts, EVV, and ADL logs. Same logic engine underneath. Two completely different surfaces.

So which one are you?

Three questions usually settle it:

Does a physician sign the plan of care? If yes, you are home health. If no, you are home care.
Are you billing Medicare Part A? If yes, home health. If no, almost certainly home care.
Do your clinicians do OASIS, or do your caregivers do ADL logs? This is the cleanest tell, because the documentation is so structurally different that no agency does both for the same client.

If your answers are split — some clients are home health, others are home care — you are running two agencies in one office. That's allowed in many states, but it requires two licenses, two billing flows, and (in our experience) two pieces of software.

The takeaway

Home health and home care are sister industries, not the same industry. They share a name, a delivery setting, and a piece of the patient population — but the regulations, the economics, the software, and the daily rhythm are different in almost every dimension that matters.

If you are evaluating software, license types, or even just trying to figure out which conferences to go to: pick a lane first. The wrong lane is more expensive than the right one.

Running home health? Take a look at Home Health Scheduling — built around OASIS, cert periods, and route optimization.

Running home care? Home Care Scheduling handles shifts, EVV, ADL logs, and authorization tracking.