Skilled Home Health Care – Who, What, and Why

An RN‑written overview for patients, families, and agency owners

7/23/2026     Rhonda McElvany, RN, CRC     BHealthyRN

Skilled home health care is one of the most effective ways to deliver clinical care to patients where they feel safest — at home. This overview explains who qualifies, what services are included, and why home health matters. It also sets the stage for deeper articles on OASIS, PDGM, HHVBP, and CMS oversight, which will be linked here as they’re published.

List of Home Health Agencies with Owner Information as of 4.1.2026

WHO Skilled Home Health Care Serves

Home health is designed for patients who need intermittent skilled care and meet specific criteria. A patient qualifies when all of the following are true:

1. They have a skilled need

The patient requires RN, PT, or ST services that are medically necessary. Common qualifying needs include:

• Wound care
• New diagnoses
• Medication changes
• Mobility decline
• Post‑hospital or post‑surgical recovery
• Safety concerns or fall risk

2. Care is intermittent

Visits are part‑time — typically 1–3 times per week for an average of 45 to 60 minutes each.

3. They meet homebound criteria

Leaving home requires considerable taxing effort due to illness, injury, or medical restrictions.

4. They are under a physician’s plan of care

A provider must sign and oversee the home health plan of care.

5. They have a documented face‑to‑face encounter

A provider confirms the need for home health during a face-to-face encounter within the required timeframe.

Who pays for home health?

• Medicare (primary payer)
• Medicare Advantage plans
• Medicaid (varies by state)
• Commercial insurance
• VA programs
• Private pay (rare for skilled care)

Home health is not long‑term custodial care.  For more information, review personal care or private duty services.

WHAT Skilled Home Health Care Provides

Home health delivers clinical, goal‑oriented care through a team of licensed professionals. Services include:

Skilled Nursing (RN/LVN)

Assessments, wound care, medication management, disease teaching, safety monitoring.

Physical Therapy

Strength, gait, balance, mobility, fall prevention.

Occupational Therapy

ADLs, home safety, adaptive equipment, energy conservation.

Speech Therapy

Swallowing, communication, cognitive rehabilitation.

Medical Social Work

Resources, counseling, long‑term planning.

Home Health Aide

Personal care under RN supervision.

Telehealth / Remote Monitoring

Growing in popularity – Agency‑dependent.

WHAT Happens at Admission: Start of Care & OASIS

The Start of Care (SOC) visit sets the foundation for the entire episode. During SOC, the clinician completes:

• Full head‑to‑toe assessment
• Medication review
• Safety evaluation
• Disease teaching
• Care planning
• OASIS‑E2 assessment

WHAT Home Health Aims to Achieve

Home health is goal‑driven, not indefinite. Common goals include:

• Improved mobility
• Wound healing
• Medication stabilization
• Disease self‑management
• Fall reduction
• Safe discharge to independence or long‑term support

Patients are discharged when goals are met, skilled need ends or is no longer effective, or the condition stabilizes.

WHY Skilled Home Health Care Matters

Home health is one of the most patient‑centered models of care available. It helps patients:

• Stay safe at home
• Transition safely after hospitalization or surgery
• Recover in familiar surroundings
• Avoid unnecessary hospitalizations
• Improve outcomes through personalized care

Home health is regulated—quality measure reporting, compliance with Medicare/Medicaid specifications, discharge outcomes, and consumer satisfaction can all directly impact both the agency’s reputation and reimbursement received.

Important Factors affecting Home Health Agencies

List of Home Health Agencies with Owner Information as of 4.1.2026

HHVBP

Home Health Value‑Based Purchasing adjusts payments based on quality outcomes, OASIS accuracy, patient satisfaction survey results, and hospitalization rates.

PDGM

Home Health agencies receive reimbursement from Medicare based on the patient’s diagnoses, functional status, additional chronic conditions and complications, and admission source — not visit volume.

CMS Oversight & Quality Monitoring

Agencies must meet certain Conditions of Participation (CoPs), which include reporting annual quality measures, meeting satisfaction scores reported through consumer surveys (HHCAHPS), and maintaining required Star Ratings by reporting quality measures.

This article is for educational purposes only and not medical advice. Please consult a healthcare professional for any medical concerns.  This article may contain links to products where there may be a charge for the information.

To see more articles — BHealthyRN.com

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.