The nurse came on Tuesday for about an hour. She'll be back Friday. The physical therapist comes three times a week. And somewhere in that first week, a son or daughter asks me the question I hear more than any other: "So who's here the rest of the time?"
I'm an occupational therapist, and I work in home health. This is what I tell families on day one, as plainly as I can. Home health is a set of visits, not a shift. The rules below are Medicare's. Where something is my experience or my suggestion, I say so.
This article is about Original Medicare. If your parent has a Medicare Advantage plan, ask the plan what it covers. If you're still working out whether you need home health, home care or hospice, start with our comparison of the three.
What Medicare's Booklet Says It Won't Pay For
Medicare's own booklet for families, Medicare & Home Health Care, has a short list under "What isn’t covered." Medicare doesn't pay for:
- "24-hour-a-day care at home"
- "Meals delivered to your home"
- "Services like shopping, cleaning, and laundry"
- "Custodial or personal care like bathing, dressing, and using the bathroom (when this is the only care you need)"
The federal rule for the home health benefit says the same thing about housework. Services whose only purpose is to let someone keep living at home, "for example, cooking, shopping, Meals on Wheels, cleaning, laundry", are excluded (42 CFR §409.49(d)). Two more exclusions in that rule surprise families: drugs (§409.49(a)), and transportation, "whether to receive covered care or for other purposes" (§409.49(b)). Home health doesn't cover the ride to the cardiologist.
That doesn't mean medicines and equipment go unpaid. The booklet says other medical services and equipment "are generally still covered as part of your other Medicare benefits." A walker is paid for separately, and prescriptions go through whatever drug coverage your parent has, not through the home health agency.
"Part-Time or Intermittent," in Medicare's Words
Medicare's home health manual defines the limit. Nursing and aide care are covered "any number of days per week as long as they are furnished (combined) less than 8 hours each day and 28 or fewer hours each week (or, subject to review on a case-by-case basis as to the need for care, less than 8 hours each day and 35 or fewer hours each week)" (Medicare Benefit Policy Manual, ch. 7, §50.7).
There's a second limit just for nursing. To qualify, your parent's need for a nurse must be "intermittent": care needed "on fewer than 7 days each week, or less than 8 hours each day for periods of 21 days or less (with extensions in exceptional circumstances when the need for additional care is finite and predictable.)" (MBPM ch. 7, §40.1.3). The same section says someone expected to need "more or less full-time skilled nursing care over an extended period of time" would usually not qualify.
In plain words:
- Nurse and aide hours are added together. Under 8 hours in a day, and 28 hours or less in a week. Up to 35 hours only in limited cases, reviewed one by one.
- Daily nursing is allowed only for a short stretch. Medicare's booklet puts it as "Daily for less than 8 hours each day for up to 21 days", with longer only in exceptional circumstances.
- 28 hours is a ceiling, not an amount you're owed. The visits are the ones ordered in the plan of care (42 CFR §484.60(a)(2)(iv)), and each one has to be reasonable and necessary. In my experience, most patients get far fewer hours than that.
An example
This is an example, not a real patient, and not the plan your parent will get. Say a parent comes home after a hip replacement. The doctor orders nursing twice a week, physical therapy three times a week, and an aide twice a week for bathing. In my experience most visits run about an hour, sometimes less.
| Visits a week | Rough hours | |
|---|---|---|
| Nurse | 2 | 2 |
| Aide | 2 | 2 |
| Physical therapist | 3 | 3 |
| Total | 7 | About 7, out of 168 in a week |
Nursing and aide time here is about 4 hours, far under the 28-hour cap. The other 161 hours belong to your parent and whoever is around them.
The Aide Comes With Skilled Care, Not Instead of It
This one catches the most families. Medicare's booklet says: "Medicare only covers home health aide services if you’re also getting skilled care," meaning nursing, physical therapy, speech therapy, or continuing occupational therapy (OT that carries on after nursing, physical or speech therapy qualified your parent).
When the nurse and therapists are done, the aide is done too. The rule says "dependent services furnished after the final qualifying skilled service are not covered" (42 CFR §409.45(a)). Under Original Medicare, the bathing visits can't carry on alone.
The aide also isn't a housekeeper. The manual says an aide may do some "light cleaning, preparation of a meal, taking out the trash, shopping" during a visit. But "the purpose of a home health aide visit may not be to provide these incidental services" (MBPM ch. 7, §50.2). An aide visit ordered only for housework can't be covered, "notwithstanding their importance to the patient" (§50.2, Example 2).
What Falls to the Family
The rules expect the agency to ask about you. The comprehensive assessment must cover the patient's "primary caregiver(s), if any, and other available supports," including their willingness and ability to provide care, and their availability and schedules (42 CFR §484.55(c)(6)).
That question isn't a test of whether your parent qualifies. The manual is clear that a patient who qualifies gets covered care "without regard to whether there is someone available to furnish the services" (MBPM ch. 7, §20.2). Having no family nearby doesn't cancel home health. It just doesn't create more hours. (The same section says that if a family member is or will be doing a task well, the agency wouldn't also do it.)
What the agency owes you is teaching. The plan of care must "specify the patient and caregiver education and training" (42 CFR §484.60, opening paragraph), including training "to facilitate timely discharge" (§484.60(a)(2)(xiii)). The agency must also give you written instructions with the visit schedule and the medicine schedule, including "which medications will be administered by HHA personnel" (§484.60(e)(2)). In practice, the medicines not on that part of the list are the family's to manage between visits.
In my experience, the in-between work usually looks like this:
- Meals and groceries.
- Medicines between visits, the way the nurse taught you.
- Rides to appointments, since transportation is excluded.
- Nights and weekends. Most visits happen on weekday daytimes.
- Watching someone who can't safely be alone, if your parent has memory problems or falls.
- Practicing what the therapist taught. The exercises, the safe way to get off the toilet. As an OT, this is where I see the biggest difference in how fast people get better.
My suggestion: be honest at the first visit about what you can and can't do. If you work days, say so. If you can't lift your father, say so. The nurse will be asking about it anyway. Our article on what happens at the first home health visit walks through that visit.
If the Family Can't Cover It
These are the options I point families to. Each one has its own rules, and none of them is a sure thing.
- The agency's medical social worker. Medicare's booklet says medical social services, when a doctor orders them, "might include counseling or help finding resources in your community." Ask the nurse whether a social work visit makes sense. Our guide to the home health care team explains who does what.
- Your local Agency on Aging. Your parent has the right to be given the names, addresses and phone numbers of the local Agency on Aging, Center for Independent Living, and Aging and Disability Resource Center (42 CFR §484.50(c)(10)). The Administration for Community Living says area agencies on aging offer "services such as home-delivered meals, homemaker assistance," among others. The Eldercare Locator, 1-800-677-1116 (eldercare.acl.gov), connects you to services for older adults and their families.
- Private-pay home care. A home care company bills you directly for hours of personal care and companionship. Medicare's manual allows care beyond the part-time limits to be "purchased by other payers" without affecting Medicare coverage (MBPM ch. 7, §50.7.1).
- Medicaid. Medicare's booklet says "Medicaid programs vary from state to state". If your parent might qualify, call your state Medicaid office and ask about help at home.
- The VA, for veterans. The VA's Homemaker and Home Health Aide program "is for Veterans who need personal care services and help with activities of daily living." The VA says it depends on eligibility for community care, the clinical criteria and whether the service is available, and there may be a copay.
- Long-term care insurance. If your parent has a policy, call the insurer and ask what it pays for at home.
Sometimes none of it adds up, and your parent can't safely be alone for the hours nobody can cover. That isn't a failure. In my experience, it's the moment to talk with the doctor and the agency about whether home is still the right place for now.
Homebound Doesn't Mean Never Leaving
Families sometimes think home health means their parent can't leave the house at all. That's not the rule. The manual says absences for health care don't count against being homebound, including adult day programs that provide treatment. It says "any absence for the purpose of attending a religious service shall be deemed to be an absence of infrequent or short duration", and lists examples like "an occasional trip to the barber, a walk around the block or a drive" (MBPM ch. 7, §30.1.1). Medicare's booklet puts it simply: "You can still get home health care if you attend adult day care or religious services." Who qualifies for home health care covers the full rule.
What "Not Covered" Doesn't Mean
"Medicare won't pay for it" doesn't mean nobody can provide it. In my experience, some home health agencies also offer private-pay services, and the manual's own example has an agency billing Medicare for the covered hours and billing "the beneficiary (or another payer) for the remainder of the care" (MBPM ch. 7, §50.7.1). The rule is about money, and about telling you first.
Your parent has the right to be told, out loud and in writing, the "charges for services that may not be covered by Medicare" (42 CFR §484.50(c)(7)(ii)), and to get written notice before a specific service the agency believes "may be non-covered care" (§484.50(c)(8)). Medicare's booklet says the agency must give you a written notice called an "Advance Beneficiary Notice of Noncoverage" (ABN) "before giving you a home health service or supply that Medicare probably won’t cover". CMS's ABN instructions name "Home health agencies (HHAs) providing care under Medicare Part A or Part B" among those who must use it. Your parent's other rights are in our guide to home health patient rights.
Frequently Asked Questions
Does Medicare cover 24-hour care at home?
No. Medicare's home health booklet lists 24-hour-a-day care at home as something Medicare doesn't pay for. Home health is visits. Medicare covers nursing and aide time combined of under 8 hours a day and 28 or fewer hours a week, or up to 35 in some limited situations.
How many hours of home health aide care does Medicare pay for?
There is no set number. Aide visits are written into the plan of care and must be reasonable and necessary for the illness or injury. Nursing and aide time combined must be under 8 hours a day and 28 or fewer hours a week, or up to 35 in limited situations. In my experience, most aide visits last about an hour, a few times a week.
Will Medicare pay for an aide if my parent only needs help bathing?
No. Under Original Medicare, aide visits are covered only while your parent also gets skilled care: nursing, physical therapy, speech therapy, or continuing occupational therapy. Personal care like bathing and dressing is not covered when it is the only care needed.
Who helps if the family can't cover the rest of the day?
The home health agency must give you the names and phone numbers of your local Agency on Aging and Aging and Disability Resource Center. The Eldercare Locator, 1-800-677-1116, can connect you too. Private-pay home care, Medicaid in your state, a VA program for some veterans, or long-term care insurance may pay for more hours.
Sources
- Medicare & Home Health Care, CMS Product No. 10969, July 2025 (Medicare.gov)
- Medicare Benefit Policy Manual, Chapter 7, Home Health Services, §§20.2, 30.1.1, 40.1.3, 50.2, 50.7 (CMS)
- 42 CFR §409.49, Excluded services (Cornell LII)
- 42 CFR §484.55, Comprehensive assessment of patients (Cornell LII)
- 42 CFR §484.60, Care planning, coordination of services, and quality of care (Cornell LII)
- 42 CFR §484.50, Home health patient rights (Cornell LII)
- FFS Advance Beneficiary Notice of Non-coverage (ABN) and form instructions (CMS)
- Area Agencies on Aging (Administration for Community Living)
- Eldercare Locator (Administration for Community Living)
- Homemaker and Home Health Aide Care (U.S. Department of Veterans Affairs)
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