Types of Home Care Services: What’s Available and Who Pays

“Home care” is an umbrella term that covers several distinct service types. Understanding the differences matters because the type of care your loved one needs determines which programs fund it, who provides it, and how you access it. Here’s the breakdown.

Personal Care Services

Personal care is hands-on assistance with activities of daily living: bathing, dressing, grooming, toileting, eating, and mobility. This is the most common type of home care and the one most Medicaid programs cover.

Personal care is what most families mean when they say “my mom needs help at home.” It’s also the service type that qualifies for paid family caregiving
in Pennsylvania, Michigan, and Texas —a family member can be hired and paid to provide personal care through Medicaid.

Who pays:  Medicaid (through CHC in PA, Home Help in MI, STAR+PLUS in TX), VA programs, private pay, some long-term care insurance.

Homemaker Services

Homemaker services cover the non-personal household tasks: meal preparation, light housekeeping, laundry, grocery shopping, and maintaining a clean, safe living environment.  These services don’t involve hands-on physical assistance with the person — they focus on the home.

In our experience, homemaker services are often authorized alongside personal care, not instead of it. A care plan might include 20 hours of personal care and 5 hours of homemaker services per week, reflecting both the person’s physical needs and their household management needs.

Who pays:  Medicaid, private pay.

Companion Care

Companion care provides social engagement, supervision, and safety monitoring. The companion spends time with your loved one — talking, playing games, going for walks, watching television — and ensures they’re safe and not isolated. Companion care doesn’t typically include hands-on personal care.

This service type is particularly relevant for individuals with early-stage dementia who don’t yet need intensive personal care but shouldn’t be left alone for extended periods.

Who pays:  Private pay (primarily). Some Medicaid programs include companion services in certain waiver packages.

Respite Care

Respite care provides temporary relief for the primary caregiver. A substitute caregiver steps in for a defined period — a few hours, a full day, or occasionally overnight — so the regular caregiver can rest, run errands, attend to their own health, or simply take a break.

In our experience, respite is the most underused home care service. Family caregivers resist it out of guilt, but it’s the service most strongly associated with caregiver sustainability. Caregivers who use respite regularly provide better care and stay in the role longer.

Who pays:  Medicaid (included in CHC, MI Choice, and STAR+PLUS care plans), VA programs, some community organizations.

Skilled Home Health Care

This is the medical category — distinct from everything above. Skilled home health includes nursing visits, physical therapy, occupational therapy, speech therapy, and wound care. It’s ordered by a physician, provided by licensed clinicians, and typically time-limited (until recovery or stabilization).

Home health and home care are different services with different funding. Home health is covered by Medicare; home care is covered by Medicaid. Many families need both — home health for post-surgical recovery, home care for ongoing daily support.

Who pays:  Medicare, Medicaid, private insurance.

How to Know Which Type You Need

If your loved one needs help with bathing, dressing, eating, or getting around, they need personal care— and that’s where paid family caregiving comes in.

If they mainly need help keeping the house clean and meals prepared, homemaker services may suffice.

If they need someone to be with them for safety and social engagement but don’t need hands-on physical help, companion care is the fit.

If the primary caregiver needs a break, respite care fills the gap.

If they need medical treatment at home (nursing, therapy), that’s home health— talk to their doctor.

Most families need a combination. CareChoice helps families figure out which services apply and how to access them through Medicaid.

Talk to CareChoice → Contact us

Written by Jailah Johnson, Community Engagement Coordinator | CareChoice