Different Types of Home Care Services: A Practical Guide

Different Types of Home Care Services: A Practical Guide

Choosing the right type of care can feel overwhelming, especially when terms like home health, private duty, PAS, VA services, hospice, and respite are used interchangeably. Each service plays a different role, serves different needs, and follows different regulations. As an RN with decades of experience in home‑based care, I’ve seen firsthand how clarity helps families make confident decisions.

This guide breaks down the major types of home care in plain language — what they are, who qualifies, and what they actually provide.

1. Personal Assistance Services (PAS) / Non‑Medical Home Care

PAS services provide non‑medical support to help individuals remain safely at home. These agencies are not clinical and do not provide nursing or therapy.

What PAS includes

• Bathing, dressing, grooming
• Meal preparation
• Light housekeeping
• Medication reminders (not administration)
• Companionship
• Assistance with errands and appointments

Who qualifies

• Individuals needing help with daily tasks
• People with disabilities
• Older adults who want to remain independent

Key points

• PAS is non‑skilled care
• No physician order required
• Not covered by Medicare; may be covered by Medicaid waiver programs or paid out-of-pocket

Note – To find PAS services, search your state’s licensed home‑care provider directory and select ‘Personal Assistance Services’ or ‘Non‑Medical Home Care.’

2. Home Health (Skilled Care)

Home health is clinical, skilled care delivered in the home. It is regulated by CMS and requires a physician order.

What Home Health includes

• Skilled nursing
• Physical therapy
• Occupational therapy
• Speech therapy
• Medical social work
• Home health aide (limited, intermittent)

Who qualifies

• Must be homebound
• Must need skilled services
• Must have a physician order
• Often following hospitalization, surgery, or a new diagnosis

Key points

• May be covered by Medicare, Medicaid, or private insurance
• Medicare‑certified agencies must complete OASIS assessments
• Care is intermittent, not 24/7
• Focus is on recovery, stabilization, and education

Note – To find Home Health Agencies, use CMS’s Care Compare website for Medicare‑certified HHAs, or your state’s licensed provider directory for non‑Medicare agencies.

3. Private Duty Nursing / Private Pay Care

Private duty services are paid out‑of‑pocket or through long‑term care insurance.

What Private Duty includes

• Hourly nursing (RN or LVN)
• Medication administration
• Chronic condition monitoring
• Ventilator or trach care
• Extended personal care
• Overnight or 24‑hour support

Who qualifies

• Individuals needing ongoing medical or personal support
• Families wanting more care than home health provides

Key points

• Paid out-of-pocket
• No homebound requirement
• No OASIS
• Flexible scheduling

Note – to find Private‑pay home health agencies search your state’s licensed provider directory or  look up ‘private duty nursing’ or ‘private pay home care’ near you.

4. VA Home‑Based Services

The Department of Veterans Affairs offers several home‑based programs for eligible veterans.

Common VA programs

• HBPC (Home‑Based Primary Care): RN‑driven chronic disease management
• VA‑contracted home health: Skilled care through Medicare‑certified agencies
• VA personal care assistants: Non‑medical support
• VA respite services: Short‑term relief for caregivers

Key points

• HBPC does not use OASIS
• VA‑contracted home health does use OASIS if the agency is Medicare‑certified
• Eligibility varies by service‑connected status and clinical need

Note – Veterans should contact their VA Medical Center’s Community Care Office about home health benefits, or speak with their VA social worker for personal care, homemaker, or respite services.

5. Hospice Care

Hospice is specialized care for individuals with a terminal diagnosis and a life expectancy of six months or less if the disease follows its normal course.

What Hospice includes

• RN case management
• CNA personal care
• Social Worker and Chaplain services
• Medication and supplies related to the terminal diagnosis
• 24/7 on‑call support

Key points

• Focus is comfort, not cure
• Provided wherever the patient lives
• Hospice uses Hospice Item Set, not OASIS
• Levels of care include
  • Routine Care — regular home visits
  • General Inpatient Care — short‑term symptom crisis
  • Continuous Care — extended in‑home nursing
  • Respite Care — caregiver relief stay

Note – To find hospice services, use CMS’s Care Compare website for Medicare‑certified agencies, or search your state’s licensed provider directory for private‑pay or non‑Medicare hospice providers.

Additional resource – BHealthyRN » Hospice Care in America: Compassion, Compliance, and the Business Behind It

6. Respite Care

Respite care is a short‑term inpatient stay for hospice patients to give family caregivers a temporary break while the patient continues receiving routine hospice support.

What Respite includes

• Up to five consecutive days of care
• Provided in a contracted facility
• Patient receives routine hospice support during the stay

Key points

• Part of the hospice benefit
• Helps prevent caregiver burnout
• Must be arranged through the hospice agency

Why Understanding These Services Matters

Each type of care serves a different purpose:

• PAS helps with activities of daily living and companionship
• Home health helps with recovery and clinical stability
• Private duty fills gaps with extended support
• VA programs support eligible veterans
• Hospice focuses on comfort and dignity
• Respite supports caregivers of hospice patients

Knowing the difference will help you choose the right service at the right time — and helps clinicians guide patients more effectively.

To see more articles — BHealthyRN.com

This article is for educational purposes only and not medical advice. Please consult a healthcare professional for any medical concerns.

About the Author — Rhonda McElvany, RN, CRC, with over 30 years of experience in hospital inpatient, outpatient, data validation, and risk-adjustment coding, now enjoys writing about today’s healthcare issues and concerns.