Columbia Senior AdvisorWhat is the difference between home health and in-home care?
Home health is skilled, short-term medical care at home (nursing, physical, occupational or speech therapy) ordered by a doctor for a homebound patient; in-home care is non-medical help with bathing, dressing, meals, housekeeping and companionship, arranged by the family for as long as needed.
DPH licenses home health agencies and in-home care providers under separate licenses, and a home health license usually lists the counties the agency may serve. DPH's data counts 290 licensed in-home care providers with Midlands offices, 220 of them in Richland County and 47 in Lexington County.
Which one does Medicare pay for?
Medicare pays for home health visits, including part-time aide help tied to the skilled plan, when a doctor certifies the patient is homebound; it does not pay for in-home care agencies' hourly aides, which are paid privately, by long-term care insurance, VA benefits or the Community Choices waiver.
Home health visits are short and scheduled, often a few per week, and end when goals are met. Families who need someone present for hours each day almost always need an in-home care agency as well.
What does each cost in the Columbia area?
Medicare-covered home health costs an eligible patient nothing; private-duty in-home care follows the market, and CareScout's 2025 South Carolina median for a home care worker is about $31 an hour.
Ask agencies about minimum shift lengths, which are often three or four hours, plus higher weekend, holiday and overnight rates. Get rates in writing and ask whether aides are employees or independent contractors.
How do families combine the two after a hospital stay?
Commonly, a home health nurse and therapist visit a few times a week for the medical recovery, while an in-home care aide covers mornings or evenings for bathing, meals and safety until the parent is steady.
Tell each agency about the other so schedules do not overlap and aides know what the therapist is working on. When home health discharges your parent, review whether the private hours can drop or need to rise.
Side by side
| Home health agency | In-home care agency | |
|---|---|---|
| Care | Skilled nursing and therapy | Personal care, homemaking, companionship |
| Who orders it | A physician, for a homebound patient | The family, any time |
| Payer | Usually Medicare | Private pay, LTC insurance, VA, Community Choices |
| Length | Short visits until goals are met | Hourly shifts, as long as needed |
Drawn from S.C. Code Regs. 60-84, DPH Healthcare Quality and SCDHHS publications, CareScout, CMS, the VA and the regional aging agencies cited in the text; our editorial standards explain how we check them.
