Choosing a home health care provider for a parent, spouse, or loved one can feel overwhelming—especially when the decision follows a hospitalization, rehabilitation stay, fall, surgery, or sudden change in health.
Families may hear terms such as home health, home care, skilled nursing, private-duty care, personal assistance services, physical therapy, and caregiver services used in the same conversation. But these services are not interchangeable, and understanding the difference is an important first step.
For families across Central Texas—from San Marcos and Kyle to Austin, Round Rock, Georgetown, Temple, Belton, and Waco—the right question is not simply:
“Which home health company should we choose?”
It is:
“What kind of help does my loved one actually need, and which provider is qualified to provide it?”
This guide explains how to identify those needs, verify a provider, compare quality information, ask better questions, understand Medicare coverage, and recognize warning signs before making a decision.
Table of Contents
- Understand Home Health vs. Home Care
- Assess Your Care Needs and Service Requirements
- Verify Medicare-Certified Home Health Agencies
- Check Texas Licensing and Compliance
- Ask Home Health Care Interview Questions That Matter
- Evaluate Home Health Agency Quality Ratings
- Plan for the Hospital-to-Home Transition
- Review Care Plans, Communication, and Technology
- Know the Red Flags
- Understand Medicare, Medicaid, Insurance, and Private Pay
- Know When Home May No Longer Be the Right Setting
- Frequently Asked Questions
Understand Home Health vs. Home Care
Before comparing providers, make sure you are comparing the right type of provider.
Home Health
Home health generally involves medical or clinical services delivered in someone's residence.
Texas defines licensed home health services to include services such as nursing, physical therapy, occupational therapy, speech therapy, medical social services, IV therapy, certain services performed under professional supervision, and other health-related services.
For qualifying Medicare beneficiaries, covered home health services can include:
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech-language pathology
- Medical social services
- Certain medical supplies and equipment
- Part-time or intermittent home health aide services when the beneficiary is also receiving qualifying skilled services
Medicare generally requires that a qualifying patient need part-time or intermittent skilled services, meet Medicare's homebound requirements, have care ordered by an appropriate healthcare provider, and receive services through a Medicare-certified home health agency.
Home Care or Personal Assistance
Non-medical home care is different.
In Texas, Personal Assistance Services (PAS) can include routine ongoing assistance that helps someone perform activities of daily living or remain independent. This may include bathing, dressing, grooming, feeding, toileting, transferring, ambulation, respite services, and certain assistance with medications.
A person can therefore need both home health and home care.
For example, after a hospitalization, a senior might receive physical therapy and skilled nursing through a home health agency while a separate home care provider helps with bathing, meals, supervision, transportation, or other daily needs.
Important Medicare Distinction
Medicare does not generally pay for:
- 24-hour-a-day care at home
- Meal delivery
- Homemaker services unrelated to the medical plan of care
- Custodial or personal care when that is the only care someone needs
That distinction can prevent families from assuming Medicare will pay for ongoing caregiving at home when it may not.
Assess Your Care Needs and Service Requirements
Before calling providers, write down what your loved one actually needs.
Consider these areas:
Activities of Daily Living
Can your loved one safely:
- Bathe?
- Dress?
- Use the bathroom?
- Transfer from a bed or chair?
- Walk safely?
- Prepare meals?
- Eat independently?
- Manage medications?
Medical Needs
Do they require:
- Skilled nursing?
- Wound care?
- Physical therapy?
- Occupational therapy?
- Speech therapy?
- Medication education?
- Monitoring following surgery or hospitalization?
Cognitive and Safety Needs
Consider whether there is:
- Alzheimer's disease or another dementia
- Wandering risk
- Frequent falls
- Confusion with medications
- Difficulty using a phone
- Unsafe cooking or driving
- Nighttime confusion
- A need for ongoing supervision
Frequency
Does the person need someone visiting periodically for skilled services, several hours of daily assistance, overnight supervision, or continuous support?
That distinction matters.
Someone who needs a nurse or therapist several times each week has very different needs from someone who cannot safely be left alone.
Duration
Ask whether the need is likely to be:
- Short-term recovery after hospitalization or surgery
- Temporary assistance during rehabilitation
- Long-term help with daily activities
- Progressive support related to dementia or another chronic condition
Writing these needs down gives families a much better starting point when comparing providers.
Verify Medicare-Certified Home Health Agencies
If Medicare will be used to pay for home health services, verify that the agency is Medicare-certified.
The official Medicare Care Compare tool allows families to search Medicare-certified home health agencies and review publicly reported information.
CMS publishes home health quality information through Care Compare, including quality measures and patient-experience information.
When talking with an agency, ask:
- Are you Medicare-certified?
- Do you serve my ZIP code?
- Can you accept the hospital or physician's order?
- How quickly can you begin care?
- Do you provide the specific nursing or therapy services prescribed?
- Will you verify Medicare or insurance coverage before services begin?
Do not assume that every company using the words “home health” or “senior home care” is a Medicare-certified home health agency.
Check Texas Licensing and Compliance
Texas home health and personal assistance agencies are regulated through the Texas Health and Human Services Commission (HHSC) under the state's Home and Community Support Services Agency, or HCSSA, framework.
Texas HCSSA licensing categories include:
- Personal Assistance Services
- Licensed Home Health Services
- Licensed and Certified Home Health Services
- Hospice
- Certain home dialysis categories
The specific license category matters because it determines which services the agency is authorized to provide.
Texas HHSC states that a person or organization generally may not provide home health, hospice, or personal assistance services for pay without the appropriate HCSSA license unless a statutory exemption applies.
Families should ask:
- What type of Texas HCSSA license do you hold?
- What services are you licensed to provide?
- Are you Medicare-certified if we need Medicare home health?
- Can I verify your license?
- How are complaints handled?
- Who supervises the care being provided?
Texas Health and Human Services Long-Term Care Resources
Ask Home Health Care Interview Questions That Matter
Once you've identified the correct type of care, interview potential providers.
Specific answers are more valuable than broad promises.
About Staffing
Ask:
- Who will actually provide the care?
- What credentials or training do staff members have?
- How are employees screened?
- Are background checks completed?
- How often are staff members supervised?
- How frequently do staff assignments change?
- What happens when the regular nurse, therapist, aide, or caregiver is unavailable?
For non-medical home care, ask specifically about caregiver consistency.
A revolving door of caregivers can be particularly difficult for someone living with dementia.
About the Care Plan
Ask:
- How is the initial assessment completed?
- Who develops the care plan?
- How often is it reassessed?
- How are changes communicated to the family?
- Who should we call if something changes?
- How quickly can the plan be adjusted?
About Your Loved One's Specific Needs
Ask about experience supporting people with:
- Alzheimer's disease or dementia
- Parkinson's disease
- Diabetes
- Stroke recovery
- Fall risk
- Mobility limitations
- Wounds
- Recent surgery
- Heart or pulmonary conditions
Avoid assuming that an agency experienced with one condition is automatically equipped for another.
About Emergencies
Ask:
- What happens if my parent falls?
- Who does the caregiver call?
- Is someone available after regular business hours?
- What happens if a caregiver does not arrive?
- How are medication concerns handled?
- When is 911 called?
- How will the family be notified?
Good providers should be able to explain their procedures clearly.
Evaluate Home Health Agency Quality Ratings
For Medicare-certified home health agencies, Care Compare provides more than a simple directory.
CMS publishes Quality of Patient Care Star Ratings and Patient Survey Star Ratings for eligible agencies. The quality ratings incorporate measures related to patient care and outcomes, while patient-survey information reflects experiences reported through the Home Health Care CAHPS program.
Look beyond the overall number.
Review information involving:
- Timely initiation of care
- Improvement in mobility
- Improvement in transferring
- Improvement in bathing
- Medication management
- Preventable hospitalization measures
- Communication
- Overall patient experience
CMS recommends using star ratings together with other available quality information rather than relying on a single number.
Also ask the provider:
- How quickly can you start care?
- How do you communicate missed or changed visits?
- Who handles concerns?
- How do you measure patient outcomes?
- How do you coordinate with physicians?
Plan for the Hospital-to-Home Transition
Choosing care becomes even more important when someone is leaving a hospital, inpatient rehabilitation facility, or skilled nursing facility.
The first few days at home can expose needs that were not obvious in the hospital.
Before discharge, make sure you understand:
- What medications should be taken and when
- What medications were changed or discontinued
- Whether durable medical equipment is needed
- Whether home health has actually been ordered
- Which agency accepted the referral
- When the first visit is expected
- Whether therapy has been ordered
- Upcoming physician appointments
- Mobility and fall precautions
- Dietary instructions
- Wound-care instructions, if applicable
- Who to call if something changes
Ask the Home Health Agency
If skilled home health has been ordered, ask:
- Have you received the hospital's orders?
- When will the first visit occur?
- Which disciplines were ordered—nursing, PT, OT, speech therapy or another service?
- Who should we call if the patient's condition changes before the first visit?
- How will information be communicated back to the physician?
Ask About the Help Between Visits
This is an often-overlooked question.
A home health nurse or therapist may visit periodically. That does not mean someone will remain in the home throughout the day.
If your loved one cannot safely:
- Get to the bathroom
- Prepare food
- Transfer independently
- Remember medications
- Avoid falls
- Remain alone
you may need additional home care or another care setting.
Review Care Plans, Communication, and Technology
Technology can improve communication, but technology alone does not make an agency a good provider.
Ask whether the agency offers:
- Electronic care documentation
- Family communication portals
- Visit notifications
- Electronic scheduling
- Medication documentation
- Secure communication
- Remote monitoring when clinically appropriate
More importantly, ask:
Who is responsible when something changes?
Families should know exactly whom to contact when a new symptom, missed visit, fall, medication concern, or change in behavior occurs.
A portal is useful.
A responsive person is better.
Red Flags to Watch For
Be cautious when a provider:
- Cannot clearly explain whether it provides home health, personal assistance, or both
- Cannot explain its Texas license category
- Claims Medicare will pay for unlimited caregiving or 24-hour home care
- Provides vague or confusing pricing
- Pressures the family into a long-term agreement immediately
- Cannot explain its employee screening process
- Avoids questions about supervision
- Has no clear procedure for missed visits
- Cannot explain emergency procedures
- Will not discuss caregiver or staff consistency
- Cannot explain how concerns or complaints are handled
- Makes promises that sound substantially broader than the written care plan or insurance coverage
Trust matters, but so does documentation.
Ask questions until the answers make sense.
Understand Medicare, Medicaid, Insurance, and Private Pay
How care is paid for depends heavily on what kind of care is being provided.
Medicare
Medicare may cover qualifying home health services when eligibility requirements are met, including the need for part-time or intermittent skilled care and Medicare's homebound criteria.
Medicare does not generally pay for ongoing custodial care simply because someone needs help bathing, dressing, cooking, or remaining safe at home.
Medicaid
Texas Medicaid programs may provide certain home and community-based services for eligible individuals, but eligibility, programs, benefits, provider participation, and availability vary.
Long-Term Care Insurance
Some long-term care insurance policies may cover qualifying home care or personal assistance services.
Review:
- Elimination periods
- Daily or monthly benefit amounts
- Benefit duration
- Eligibility triggers
- Approved provider requirements
- Reimbursement versus indemnity provisions
Private Pay
Many families pay privately for non-medical home care.
Before starting services, request written information about:
- Hourly rates
- Minimum shift requirements
- Weekend or holiday rates
- Overnight rates
- Cancellation policies
- Transportation charges
- Deposits
- Rate-change policies
Compare the total expected monthly cost, not just the advertised hourly rate.
Know When Home May No Longer Be the Right Setting
Sometimes the question changes from:
“Which home care company should we hire?”
to:
“Is staying at home still the safest and most sustainable option?”
That does not automatically mean someone needs to move.
But families should reconsider the overall care plan when there are:
- Repeated falls
- Frequent hospitalizations
- Significant nighttime needs
- Wandering
- Increasing dementia-related behaviors
- Unsafe medication management
- Extensive hands-on assistance needs
- Caregiver exhaustion
- Increasing isolation
- A need for supervision throughout most or all of the day
- Home-care costs approaching the cost of a residential care option
At that point, it can be useful to compare staying home with other possibilities such as independent living with added support, assisted living, residential care homes, memory care, skilled nursing, hospice, or other community resources.
The goal is not to push a particular type of care.
The goal is to understand the options before a crisis makes the decision for you.
Finding the Right Care in Central Texas
Central Texas families have many choices, but more choices do not always make the decision easier.
A family in South Austin recovering from a hospital stay may need short-term skilled home health.
Someone living alone in Georgetown may primarily need personal assistance and transportation.
A family in San Marcos or Kyle caring for a parent with dementia may discover that a few hours of home care is no longer enough.
A senior returning home in Temple or Belton after rehabilitation may need a combination of home health, durable medical equipment, family assistance, and private-duty care.
The right solution depends on the person's medical needs, functional abilities, cognitive status, finances, home environment, family support, and long-term goals.
Senior Industry Services (SIS) provides Central Texas seniors, families, caregivers, and healthcare professionals with educational resources and connections to local senior-care services and providers.
The objective is simple:
Understand what you need. Know what questions to ask. Verify the provider. Then make an informed decision.
Frequently Asked Questions
What is the difference between home health and home care?
Home health generally involves skilled or clinical services such as nursing, physical therapy, occupational therapy, speech therapy, and other health services delivered in the home.
Home care or personal assistance generally focuses on daily activities such as bathing, dressing, meal preparation, mobility, supervision, companionship, and other non-medical support.
Some people need both.
How do I verify whether a home health agency is Medicare-certified?
Use the official Medicare Care Compare tool to search for Medicare-certified home health agencies and review available quality information.
Does Medicare pay for home caregivers 24 hours a day?
Generally, no. Medicare specifically states that it does not pay for 24-hour-a-day care at home. It also does not cover custodial or personal care when that is the only care a person needs.
Who regulates home health agencies in Texas?
Texas Health and Human Services Commission regulates Home and Community Support Services Agencies under Texas law. HCSSA categories include Personal Assistance Services, Licensed Home Health Services, Licensed and Certified Home Health Services, hospice, and certain other services.
What questions should I ask a home health or home care provider?
Ask about licensing, Medicare certification when applicable, employee screening, training, supervision, caregiver consistency, emergency procedures, communication, pricing, insurance coverage, start-of-care timing, and experience with your loved one's specific needs.
What if my parent needs more help than home health provides?
Consider whether additional private-duty home care, family caregiving, respite services, adult day programs, assisted living, a residential care home, memory care, skilled nursing, hospice, or another form of support may be appropriate.
The important thing is to compare the actual amount of care needed with what each option provides and what it will cost.
Sources & Resources
Medicare — Home Health Services Coverage
Official information explaining Medicare home health eligibility, covered services, and services Medicare does not cover.
Medicare Home Health Services
Medicare — Care Compare
Search and compare Medicare-certified home health agencies and publicly reported quality information.
Medicare Care Compare
Centers for Medicare & Medicaid Services — Home Health Quality & Star Ratings
Information about quality measures, Quality of Patient Care ratings, and patient-experience ratings used to compare Medicare-certified home health agencies.
CMS Home Health Quality Reporting
Texas Health and Human Services — Home and Community Support Services Agencies
Texas licensing and regulatory information for home health, personal assistance services, hospice, and related HCSSA service categories.
Texas Health and Human Services
Reviewed by John Brown, CSA®
Senior Industry Services (SIS)
Central Texas Senior-Care Resources & Professional Network
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