If you're reading this because Mom is being discharged from the hospital tomorrow, Dad had another fall, or someone just mentioned hospice, you may suddenly be hearing terms you never expected to have to understand.
Home Care. Home Health. Palliative Care. Hospice.
They are not the same thing.
I talk with Central Texas families who understandably think home health means someone will stay with Mom throughout the day. Others aren't sure whether palliative care and hospice are the same thing, or assume hospice means someone will now be at Dad's bedside around the clock.
Those misunderstandings matter, especially when a family is trying to put together a safe plan quickly.
Here's the simplest way I explain the difference:
Home Care = Helps with every day daily living
Home Health = Skilled healthcare where you live
Palliative Care = Relief from symptoms and stress of a serious illness
Hospice = Comfort-focused care for someone who meets hospice eligibility requirements
And here's the part families often don't realize:
You may need more than one.
A senior can have home care and home health at the same time. Someone in Independent Living may bring in home care. An Assisted Living resident may receive home health after a hospitalization. Someone living in Memory Care may receive hospice.
These aren't always competing choices.
Sometimes they're different layers of the same care plan.
What Is Home Care?
Home care generally provides non-medical assistance with everyday activities.
Depending on the senior's needs and the provider, that may include:
- Bathing and dressing
- Toileting and personal care
- Walking and transfers
- Meal preparation
- Light housekeeping
- Medication reminders
- Transportation and errands
- Companionship
- Safety supervision
- Respite for family caregivers
If Mom needs someone to help her get out of bed, shower, get dressed and prepare breakfast, you're probably talking about home care.
Does Medicare pay for home care?
Traditional Medicare generally does not cover ongoing custodial or personal care when that is the only care someone needs.
Families often pay privately for home care. Depending on the individual situation and eligibility, long-term care insurance, VA benefits, Medicaid programs or other resources may help with costs.
This distinction becomes particularly important after a hospital discharge.
Being told:
“We're sending Mom home with home health.”
doesn't mean Medicare is sending someone to stay with her throughout the day.
What Is Home Health?
Home health provides skilled healthcare where someone lives.
It is commonly used after a hospitalization, rehabilitation stay, surgery, illness or significant change in health. Depending on the patient's medical needs, eligibility, orders and plan of care, home health services may include:
- Skilled nursing assessments and monitoring
- Wound care and dressing changes
- Catheter care and education
- Ostomy/colostomy care and education
- Medication review, reconciliation and education
- Monitoring changes in certain medical conditions
- Physical therapy
- Occupational therapy
- Speech-language pathology
- Other medically necessary skilled services
Home health is generally provided through scheduled skilled visits—not continuous caregiving.
A nurse might visit to assess a wound, change a dressing, provide catheter or ostomy care, review medications or monitor a medical condition. A physical or occupational therapist may visit separately.
In my experience working with Central Texas families, these visits are often around an hour or less and may occur a few times during the week, depending entirely on the individual's needs and plan of care.
This is where understanding the difference between home health and home care becomes especially important.
Home health may address Dad's wound, provide physical therapy and monitor his medical progress—but he may still need help getting dressed, preparing meals, getting safely to the bathroom or simply being alone for long periods of time.
That's the bigger care-plan conversation.
A senior advisor can help the family look at what happens between the skilled visits: What can Mom or Dad still do safely? What can the family realistically provide? Where are the gaps?
Sometimes those gaps can be addressed with home care, family support, transportation, technology or other services.
Sometimes the amount of assistance needed means it's worth considering Independent Living with support, Assisted Living, Memory Care or a residential care home.
Home health addresses skilled healthcare needs. A senior advisor can help the family understand how the rest of the care plan fits together.
Home Health vs. Home Care: A Real-Life Example
Imagine Dad is discharged from a hospital in Round Rock after a fall.
His healthcare provider orders home health. A physical therapist works with him on strength and balance, and skilled nursing may address qualifying medical needs.
That's home health.
But Dad still can't safely shower alone. Getting dressed is difficult. He can't prepare breakfast, and his daughter can't be there every morning before work.
The family hires someone to help with those daily activities.
That's home care.
Dad can have both:
Home Health + Home Care + Family Support
They're not duplicating each other.
They're solving different problems.
What Is Palliative Care?
Palliative care focuses on improving quality of life and relieving symptoms and stress associated with a serious illness.
Depending on the patient's condition and program, palliative care may help address symptoms such as pain, shortness of breath, fatigue, nausea or anxiety while also helping the patient and family understand goals and treatment choices.
Here's the important distinction:
Palliative care does not necessarily mean someone is dying, and it can be provided alongside treatment intended to cure or control an illness.
Someone receiving treatment for cancer, heart disease, lung disease or another serious condition may also receive palliative care.
Palliative care may be available in hospitals, clinics, at home or in other settings depending on the provider and program. Coverage and availability can vary, so families should ask the healthcare provider and insurance plan what services are available.
Palliative Care vs. Hospice
Both focus heavily on comfort, symptoms and quality of life, but they're not interchangeable.
Palliative care can begin much earlier in a serious illness and can accompany disease-directed treatment.
Hospice has specific eligibility requirements. Under the Medicare hospice benefit, the patient elect’s hospice care rather than Medicare-covered treatment intended to cure the terminal illness.
A simple way to remember:
Palliative care can accompany treatment. Hospice represents a shift toward comfort-focused care for someone who meets hospice eligibility requirements.
What Is Hospice?
Hospice provides specialized care focused on comfort and quality of life for someone with a terminal illness.
For Medicare hospice eligibility, physicians certify that the individual has a life expectancy of six months or less if the illness follows its normal course, and the individual elects the hospice benefit.
That doesn't mean hospice automatically stops after six months. Medicare allows hospice to continue when someone remains eligible and is appropriately recertified.
Hospice services may include:
- Nursing and physician services
- Pain and symptom management
- Hospice aide services
- Medical social services
- Counseling and spiritual support
- Certain medications, medical equipment and supplies related to the terminal illness
- Support for family caregivers
- Bereavement services
According to the Centers for Medicare & Medicaid Services, approximately 1.84 million Medicare beneficiaries received hospice services in fiscal year 2024, with Medicare hospice payments exceeding $27 billion.
Does hospice provide someone 24 hours a day?
Routine hospice does not mean a hospice employee stays at the bedside around the clock.
Medicare recognizes different levels of hospice care, including more intensive care during certain qualifying crises, but families shouldn't assume routine hospice replaces ongoing caregiving.
A family may therefore have:
Hospice + Home Care + Family Support
The hospice team addresses hospice-related clinical and comfort needs while home care and family members provide additional everyday assistance.
Can Home Care, Home Health, Palliative Care and Hospice Be Used in Senior Living?
Yes, depending on the service, the senior's eligibility, the provider and the senior living community.
This is something many families don't realize.
When we say care is provided “at home,” home doesn't necessarily mean the house someone has lived in for 30 years.
Home might now be an apartment in Independent Living, an Assisted Living community, Memory Care or a residential care home.
Independent Living + Home Care
This can be a very useful combination.
Maybe Mom lives in Independent Living in Lakeway. She enjoys her apartment, eats dinner with friends and participates in activities, but mornings are becoming difficult.
She needs some help bathing and dressing, medication reminders or transportation to appointments.
Depending on the community's policies, private home care may provide additional assistance.
For some seniors, adding home care can help them remain successfully in Independent Living longer.
Senior Living + Home Health
An eligible senior may also receive qualifying home health services while living in a senior living community.
For example, Dad may return to Assisted Living in New Braunfels after a hospitalization. The community continues providing the services included in his care plan while home health provides qualifying physical therapy or skilled nursing.
The two aren't doing the same job.
Assisted Living or Memory Care + Hospice
Hospice may also be provided where an eligible senior lives.
Medicare specifically recognizes that hospice can generally be provided in someone's home or another place where the person lives, including an Assisted Living facility or nursing home.
Imagine Mom has advanced dementia and has lived in the same Memory Care community in Georgetown for several years.
The staff knows her. Her room is familiar. Her family knows the caregivers.
If Mom becomes eligible for hospice, she may be able to remain in that familiar environment while the Memory Care community continues providing dementia care and supervision and the hospice team provides hospice services.
That's:
Memory Care + Hospice
Different responsibilities. One senior.
Central Texas Families Have Options
Across Austin and Central Texas, there are hundreds of senior-care providers overall and many homecare, home health, palliative-care and hospice professionals doing important work every day.
I don't believe there is one company that's automatically right for every family.
The right provider for Mom in Georgetown may be different from the right provider for Dad in Kyle. Availability may differ in Lakeway, Cedar Park, Temple, New Braunfels, Marble Falls or Waco.
When comparing providers, ask about:
- Whether they serve your ZIP code
- How quickly services can begin
- Current staffing and availability
- Medicare or advantage plan participation
- Any Private-pay costs when applicable
- Minimum hours or shifts for home care
- Experience with your loved one's particular diagnosis or care needs
- Weekend and after-hours support
- How they communicate with families
- How they coordinate with other healthcare providers
The name matters. The fit matters more.
Families can also explore local services through the Senior Industry Services Senior-AI Directory, which connects Central Texas seniors and families with senior-care resources throughout the area.
If Mom Is Being Discharged Tomorrow, Ask These 7 Questions
If you're sitting at St. David's, Ascension Seton, Baylor Scott & White or another Central Texas hospital and someone tells you Mom is medically ready for discharge, here's where I would start:
1. What services have actually been ordered?
Don't settle for “home health.” Ask whether that means nursing, physical therapy, occupational therapy or something else.
2. When will the first visit actually happen?
A referral and someone physically arriving at the house aren't the same thing.
3. Can Mom safely get to the bathroom and transfer?
Think about what happens at 2:00 a.m., not just while everyone is standing beside her in the hospital.
4. Can she manage medications, food and hydration safely?
5. Is dementia, confusion or poor judgment part of the problem?
Someone can physically walk and still be unsafe alone.
6. Who will be there between professional visits—and overnight?
A spouse? Son or daughter? Paid caregiver? Nobody?
Be realistic.
7. What's Plan B if going home doesn't work?
Have that conversation before the next fall or 911 call.
Our Hospital-to-Home resources provide additional information for Central Texas families navigating hospital and rehabilitation transitions.
When Is Home No Longer Enough?
There's no single answer.
I look at the whole picture.
Repeated falls. Wandering. Medication mistakes. Unsafe transfers. Frequent emergency room visits. Needing supervision overnight. Family caregiver exhaustion.
Sometimes adding home care is enough.
Sometimes Independent Living + Home Care works beautifully.
Sometimes Assisted Living + Home Health is the right combination.
Sometimes Memory Care + Hospice allows someone to remain in familiar surroundings with additional comfort-focused support.
And sometimes the amount of care needed at home makes it worth comparing the cost and practicality of home care with Assisted Living, Memory Care or a residential care home.
I don't start with:
“How do we move Mom?”
I start with:
“What does Mom need to be safe?”
Then we work backward from there.
Frequently Asked Questions
What is the difference between home care and home health?
Home care generally helps with everyday activities such as bathing, dressing, meals, transportation and supervision. Home health provides qualifying skilled healthcare such as nursing or physical, occupational or speech therapy.
Can someone have home care and home health at the same time?
Yes. A senior might receive physical therapy through home health while a home care caregiver assists with bathing, meals and supervision.
What's the difference between palliative care and hospice?
Both focus on comfort and quality of life. Palliative care can be provided alongside treatment for a serious illness. Hospice has specific eligibility requirements and focuses on comfort rather than treatment intended to cure the terminal illness.
Does Medicare pay for home care?
Medicare generally does not cover ongoing custodial care when personal assistance is the only care someone needs. Medicare may cover qualifying skilled home health services when its requirements are met.
Does hospice provide 24-hour caregiving?
Routine hospice does not mean a caregiver remains with someone 24 hours a day. Medicare recognizes higher levels of hospice care for qualifying circumstances, but families may still need family support or privately paid home care.
Can someone in Independent Living have home care?
Often, yes, depending on the community's policies. Outside home care may provide personal assistance that helps some seniors remain in Independent Living longer.
Can someone in Assisted Living receive home health?
An eligible resident can receive qualifying home health services while living in Assisted Living. The home health agency and Assisted Living community provide different services.
Can someone receive hospice in Assisted Living or Memory Care?
Yes. Eligible seniors can receive hospice services in senior living settings. The senior living community continues providing its services while hospice provides care under the hospice plan of care.
Finding the Right Help in Austin and Central Texas
Families shouldn't have to become senior-care experts overnight.
Whether you're in Austin, Round Rock, Georgetown, Cedar Park, Leander, Pflugerville, Lakeway, West Lake Hills, Dripping Springs, Buda, Kyle, San Marcos, New Braunfels, Marble Falls, Temple, Belton, Killeen, Waco or elsewhere in Central Texas, start with what Mom or Dad actually needs.
The Senior Industry Services Senior-AI Directory can help families explore local home care, home health, hospice and other senior-care resources.
If you're navigating a hospital or rehabilitation discharge, our Hospital-to-Home resources can help you better understand the transition and the questions to ask.
And if the question has become:
“Can Mom still safely live at home?”
Oasis Senior Advisors Austin & Central Texas helps families understand and compare Independent Living, Assisted Living, Memory Care and residential care homes throughout Central Texas at no cost to the family.
The goal isn't automatically keeping Mom at home.
And it isn't automatically moving her.
The goal is finding the right combination of care, safety, independence, dignity and quality of life for Mom or Dad.
Sometimes that's one service.
Often, it's a combination.
And you don't have to figure it all out alone.
About the Author
John Brown, CSA
CEO, Oasis Senior Advisors Austin & Central Texas
Founder, Senior Industry Services (SIS)
Hospital-to-Home | One Call. Many Solutions.
John works with Central Texas seniors, families, healthcare professionals and senior-living providers to navigate changing care needs, hospital and rehabilitation transitions, assisted living, memory care, residential care homes and other senior-care solutions.
Sources & Resources
Medicare — Home Health Services: Medicare's current guidance explains eligibility requirements, covered skilled services and part-time/intermittent home health care.
https://www.medicare.gov/coverage/home-health-services
Medicare — Hospice Care: Medicare explains hospice eligibility, covered services, benefit periods and where hospice care may be provided.
https://www.medicare.gov/coverage/hospice-care
Medicare — Long-Term Care: Medicare explains the distinction between covered medical services and custodial long-term care.
https://www.medicare.gov/coverage/long-term-care
Centers for Medicare & Medicaid Services — Hospice Fast Facts: CMS data on Medicare hospice utilization and expenditures.
https://www.cms.gov/files/document/cpi-hospice-fast-facts.pdf
Senior Industry Services — Senior-AI Directory:
https://seniorindustryservices.com/senior-care-directory/
Senior Industry Services — Hospital-to-Home:
https://seniorindustryservices.com/hospitaltohome/