Charleston Senior AdvisorWhat does in-home care provide, and what does home health provide?
In-home care providers send aides for non-medical help such as bathing, dressing, meals, housekeeping, errands and companionship, while home health agencies send nurses and therapists for skilled visits under a doctor's plan of care.
Both are licensed by DPH under separate license types. In the tri-county area DPH's data shows 15 licensed home health agencies, 10 hospice programs, 1 inpatient hospice house and 136 licensed in-home care providers with local offices. In-home care is usually measured in shifts of hours; home health is measured in visits, often an hour or less, a few times a week.
Who pays for each?
Medicare pays for home health when the patient is homebound and needs intermittent skilled care, at no cost to the patient; in-home care is paid privately, through long-term care insurance or VA pension, or by the Community Choices waiver for eligible Medicaid members.
At CareScout's 2025 South Carolina median, in-home care runs about $31 an hour. Many families combine the two: Medicare-covered home health for a few weeks after a hospital stay, plus privately paid aide hours for the daily tasks the nurse does not cover.
How do I choose an agency of either type?
Confirm the DPH license, then ask how quickly the agency can start, who supervises aides or nurses, how calls after hours are handled, and how missed visits are covered; for home health, also confirm Medicare certification for the services ordered.
For in-home care, ask about minimum shift lengths, whether caregivers are employees or contractors, and whether rates differ on weekends, holidays and overnight. Our in-home care roster and home health roster list every licensed office in the three counties.
When is neither enough?
When help is needed around the clock, when a parent cannot be left alone at all, or when paid hours pass about 40 a week, a CRCF, memory care unit or nursing home is usually safer and less expensive than stacking home services.
Keep a two-week log of incidents and unmet needs before deciding; it makes the conversation with a parent, and with siblings, far easier.
Can the same family use both kinds of help at once?
Yes, and many do after a hospital stay: Medicare-covered home health visits handle wound care, therapy and medication teaching for a few weeks, while privately paid in-home aides cover bathing, meals and the hours between visits.
Tell each agency about the other so schedules do not overlap and so the home health nurse can see how the aide is helping. When home health ends, the aide hours often continue, sometimes funded by the Community Choices waiver if the person qualifies.
Side by side
| In-home care provider | Home health agency | |
|---|---|---|
| Help given | Aides for daily living and companionship | Nurses and therapists for skilled care |
| Order needed | No doctor's order | A doctor's plan of care |
| Medicare | Does not pay | Pays for homebound patients |
| Unit of care | Shifts of hours | Visits |
Sources: S.C. Code Regs. 60-84, DPH Healthcare Quality, SCDHHS bulletins and charts, CareScout, CMS and VA rate tables, as cited in each answer. See our editorial standards.
