"Home care" and "home health" sound interchangeable but are licensed differently, paid for differently, and serve different needs — here's how San Diego families tell them apart.
By Marcus Reyes, LSW · August 18, 2026
Home care (sometimes called non-medical or personal care) covers help with the tasks of daily living — bathing, dressing, meal prep, light housekeeping, transportation, medication reminders, and companionship. In California, agencies that provide this kind of paid caregiving in a private home must be licensed as a Home Care Organization (HCO) by the California Department of Social Services, and every caregiver they employ must be registered with the state's Home Care Aide registry.
Home health, by contrast, is a medical service ordered by a physician: skilled nursing visits, physical or occupational therapy, wound care, IV therapy, and health monitoring after a hospitalization or for a chronic condition. Home health agencies are licensed by the California Department of Public Health and, if they bill Medicare, must be Medicare-certified. A home health aide can also assist with some personal care tasks, but only as part of a broader skilled plan of care.
This is where the confusion usually turns into real money. Medicare and most Medi-Cal managed care plans can cover home health when a doctor certifies it's medically necessary and the senior is largely homebound — but coverage is time-limited and tied to a specific care plan, not ongoing custodial help. Home care, on the other hand, is almost always private-pay in San Diego, running roughly $28–$42 an hour through a licensed HCO, though IHSS (In-Home Supportive Services) can cover it for qualifying low-income Medi-Cal recipients, and VA Aid & Attendance can help eligible veterans and surviving spouses offset the cost.
A common pattern after a Sharp, Scripps, or UCSD hospital discharge: home health covers the first weeks of nursing and therapy visits under Medicare, and once that skilled episode ends, the family transitions to private-pay or IHSS-funded home care for ongoing daily support — the two services often follow each other rather than compete.
If the core issue is a medical recovery — a recent surgery, a new diagnosis, a wound that needs monitoring — start with a referral for home health through the hospital discharge planner or the senior's physician. If the core issue is that daily tasks have become unsafe or unmanageable but there's no active medical need, a licensed HCO providing home care is the right fit.
Many San Diego seniors eventually need both, at different points or even simultaneously — home health nurses for a wound check twice a week, home care aides for the other five days. Confirming a provider's actual license type (HCO vs. home health agency) before signing anything matters, since some companies use "home care" and "home health" loosely in their marketing regardless of what they're actually licensed to do.
Home Care Organizations are listed in the CDSS Home Care Services Bureau registry; home health agencies that bill Medicare appear in Medicare's Care Compare tool, which also shows quality-of-care ratings drawn from patient outcomes. Either way, ask for the license number directly and verify it before care starts — not after.
A free local senior care advisor can help a family sort out which service actually fits the situation, and flag which local home care and home health providers are properly licensed and have a clean track record.
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