Medicare Home Health vs. Private-Duty Care: What Central Ohio Families Need to Know

Medicare will send a nurse and a therapist for a few weeks. It will not stay the night. Knowing where the benefit ends keeps a hospital discharge from becoming a second crisis.

By Ray Kessler, Certified Senior Advisor · Published October 16, 2026

Two Very Different Things Called “Home Care”

A daughter in Westerville gets a call from the hospital: her father is being discharged Friday after a hip fracture, and the discharge planner says home health will “start within a day or two.” Her first reaction is relief. Her second, a week later, is confusion, because the nurse who comes to the house stays forty-five minutes, a physical therapist comes twice a week, and nobody is there at night when her father tries to get to the bathroom alone. She assumed Medicare had arranged someone to help him. Medicare had arranged something much narrower.

In everyday speech, “home care” covers two separate services that happen to share a front door. Medicare home health is a short-term, doctor-directed benefit for skilled nursing and therapy. Private-duty home care is the hands-on, hour-by-hour help with bathing, meals, toileting and supervision that most families picture when they say a parent “needs someone at home.” Original Medicare pays for the first and, with narrow exceptions, does not pay for the second. Central Ohio families who learn that difference in the hospital hallway make better decisions than those who learn it three weeks into a crisis.

What the Medicare Home Health Benefit Actually Covers

Medicare home health is built around a physician’s plan of care. A doctor or other allowed practitioner must certify that your parent needs intermittent skilled care, meaning skilled nursing that is part-time rather than continuous, or physical therapy, speech-language pathology, or continuing occupational therapy. A face-to-face visit with the practitioner related to the reason for home health must happen within a window around the start of care. The agency must be Medicare-certified, and the plan of care is reviewed at regular intervals, generally every 60 days, with the doctor re-certifying that the services are still needed.

Covered services include skilled nursing (wound care, injections, teaching a family member to manage a new medication or a feeding tube), therapy to rebuild strength and safety after a fall or surgery, medical social services, and certain medical supplies. Medicare may also cover a home health aide for personal care such as bathing and dressing, but only part-time and only while your parent is also receiving skilled nursing or therapy. Medicare’s own materials define “part-time or intermittent” as fewer than eight hours a day and no more than twenty-eight hours a week, combined, with limited exceptions. In practice, aide visits are often an hour or less, a few times a week. Under Original Medicare there is generally no charge for covered home health services themselves, though durable medical equipment such as a walker or hospital bed typically carries a coinsurance. Details differ for Medicare Advantage plans, which must cover the same basic benefit but can add networks and prior-authorization rules, so call the plan before assuming an agency is covered.

The Homebound Rule, Explained Without the Jargon

To qualify, your parent must be considered “homebound.” That does not mean bedridden or never leaving the house. Medicare describes it roughly as follows: leaving home takes a considerable and taxing effort, usually needing a cane, walker, wheelchair or another person’s help, or the person’s condition makes leaving medically inadvisable, and absences from home are infrequent or short, or for medical care. Attending an adult day program or a religious service does not by itself disqualify someone, and neither does an occasional trip such as a haircut or a family event.

This is where central Ohio’s geography matters. A widower in a ranch home in rural Pickaway County who can walk to the mailbox but cannot get down the porch steps or into a car without help may qualify, while a parent in a Dublin condominium who still drives to the grocery store three times a week will probably not. The test looks at the effort and the condition, not the zip code, but families in the outer counties often discover that the homebound question is the first gate, and the agency’s intake nurse will assess it. If your parent was just in the hospital or a rehab stay, you can find more on how those transitions work in our guide to the Medicare 100-day rehab benefit.

What Medicare Home Health Does Not Cover

The gap between the benefit and the need is where families get hurt. Medicare home health does not cover around-the-clock care at home, full-time or even daily long-hours aide help, meal delivery, or “homemaker” services such as housekeeping and errands when those are the only help required. It also does not pay for companion visits or overnight supervision for a parent with dementia who is up and wandering at 3 a.m. Medicare does not pay for custodial care just because a parent cannot safely manage alone.

One common myth deserves correcting. Many families are told, or assume, that Medicare stops paying once a parent “plateaus.” Under the settlement in Jimmo v. Sebelius, coverage of skilled nursing and therapy does not depend on whether the patient is improving; it depends on whether skilled care is needed to maintain function or slow decline. If an agency tells you your parent is being discharged solely because progress has stalled, you are entitled to ask the agency for the written reason and to ask the physician whether skilled care is still needed. Agencies must give written notice before ending services, and there is an appeal process described in that notice.

Choosing a Medicare-Certified Agency in Central Ohio

When a hospital arranges home health, it is supposed to hand your parent a list of local home health agencies that serve the address and let the patient choose. In reality, a hurried discharge can turn that into “this is who we use.” You are allowed to ask for the list. Our guide to the hospital discharge planner conversation in Columbus walks through the questions to ask before the paperwork is signed, including how quickly the first visit will happen. Pay attention to how fast an agency can start care: a gap of several days between discharge and the first nurse visit is the period when most avoidable readmissions begin.

Medicare publishes quality information on certified agencies, including patient-survey results and star ratings, on its Care Compare tool at medicare.gov. Use it to compare two or three agencies that serve your parent’s address, and then ask each directly whether they serve your county. Coverage areas matter: an agency that reliably reaches Hilliard and Grove City may not travel to Madison County farm roads or the eastern edge of Licking County, and weekend and evening visits are harder to schedule everywhere. Ask how they staff therapy, whether the same nurse usually returns, and who to call at night. We do not rank or recommend individual agencies, and we do not report any agency’s ratings, because those change; confirm every detail with the agency and with Medicare.

Where Private-Duty Home Care Takes Over

Private-duty care is the personal care, companionship and supervision paid for out of pocket, through long-term care insurance, or through a public program. Agencies in the Columbus area typically set a minimum visit length and bill by the hour; independent caregivers hired directly are a separate path with different legal obligations, which we cover in agency versus private hire. For overall pricing context, see our Ohio cost of care hub, which reports state-level CareScout figures; we do not publish a Columbus-only hourly rate, and families should get written quotes from several local agencies.

Not every family has to pay privately. Ohio’s Medicaid-funded PASSPORT waiver can pay for personal care and other in-home supports for eligible older adults who would otherwise need a nursing facility, and we explain that program in our Medicaid and PASSPORT guide. In Franklin County and several neighboring counties, senior-services levies fund additional in-home help through the local area agency on aging; see how county senior levies fund in-home help and what the area agency on aging does. These programs have eligibility rules and waitlists, so start the conversation before the crisis, not after.

A Sensible Way to Layer the Two

The families who get through a recovery best treat the two kinds of care as layers, not alternatives. During the weeks when Medicare home health is active, the nurse and therapist handle the skilled needs, and the family fills the remaining hours with a combination of relatives, neighbors and, if budget allows, a few private-duty shifts concentrated on the hardest times of day: morning routine, meals, and the evening to bedtime window. When the plan of care ends, the private or program-funded help stays, and the home safety work that the physical therapist recommended becomes the family’s long-term to-do list. Our guide to fall prevention in central Ohio homes picks up from there.

It also helps to be honest about the endpoint. If the pattern keeps repeating, with a short Medicare episode, a few good weeks, another fall, another episode, and an exhausted adult child driving in every evening, that is information. A parent who needs hands-on help every day, including nights, may be better served in a licensed setting where staff are on site. Ohio’s licensing framework for assisted living is explained on our licensing page, and how we verify what communities tell us is on our editorial standards page. There is no right answer for every household; the point is to decide on purpose rather than by default.

Questions to Ask Before You Sign Anything

Before the first home health visit, ask the agency five things. What exactly will Medicare cover, and what will it not? How many visits per week are in the plan of care, and for how long? Who is the clinical contact, and what is the after-hours number? What will you tell us if you believe services should end, and how much written notice do we get? And if we need additional hours that Medicare will not pay for, can you provide them privately, or can you recommend someone who does? Write the answers down. A clear, specific response is a good sign; a vague one is worth noting.

Disclosure: we are a free advisory service, not a medical provider, Medicare representative or law firm. Coverage rules and plan details change, and your parent’s eligibility depends on the physician’s certification and the plan. Confirm coverage with Medicare (1-800-MEDICARE), your parent’s Medicare Advantage plan if applicable, or Ohio’s OSHIIP counselors before you rely on it.

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