Adjacent Care Settings
Reviewed by Zach Newman · Last reviewed July 2026
Home health rarely operates alone. Patients move between hospice, skilled nursing facilities, palliative care, and personal care services, and knowing where home health ends and another setting begins affects eligibility and referrals. This glossary of post-acute care terms defines the settings that surround home health, from hospice and PACE to the difference between home health and home care.
12 termsDual Eligibles
Dual eligibles are people enrolled in both Medicare and Medicaid, a population of more than 12 million Americans who are disproportionately low-income, chronically ill, and heavy users of home-based care. For home health agencies, duals are a core patient segment: Medicare pays first for the skilled episode while Medicaid wraps around with cost-sharing protection and long-term services and supports.
HCBS Waivers
Home and community-based services (HCBS) waivers, authorized mainly under Section 1915(c) of the Social Security Act, let state Medicaid programs pay for long-term services and supports in a person's home or community instead of an institution. Waivers fund services like personal care, respite, home modifications, and case management for people who meet an institutional level of care. For home health agencies, waivers are the main funding stream keeping long-term patients stable at home after skilled episodes end.
Home Health vs. Home Care
Home health and home care are distinct services that are constantly confused by patients, families, and even referral sources. Home health is skilled, intermittent medical care (nursing, therapy) ordered by a practitioner and covered by Medicare for homebound patients. Home care, sometimes called non-medical or private duty home care, is help with bathing, dressing, meals, and companionship, typically paid out of pocket, through Medicaid programs, or by long-term care insurance.
Hospice
Hospice is a Medicare benefit providing comfort-focused care for patients with a terminal prognosis of six months or less, as certified by two physicians. Electing hospice means the patient waives curative treatment for the terminal condition in exchange for an interdisciplinary comfort care model, usually delivered at home. For home health agencies, hospice is the most important adjacent setting: it is where many patients should transition when they stop improving.
Inpatient Rehabilitation Facility (IRF)
An inpatient rehabilitation facility (IRF) is a hospital or hospital unit that provides intensive, physician-supervised rehabilitation, typically at least three hours of therapy per day, five days a week. IRFs serve patients recovering from events like stroke, brain injury, and major trauma who can tolerate and benefit from intensive rehab. For home health agencies, IRF discharges are high-value, therapy-heavy referrals with an institutional admission source under PDGM.
LTACH (Long-Term Acute Care Hospital)
A long-term acute care hospital (LTACH, also written LTCH) is a hospital certified to treat medically complex patients who need extended hospital-level care, with an average length of stay above 25 days. Typical LTACH patients include ventilator weaning cases, complex wounds, and multi-system failures. For home health agencies, LTACH discharges are low-volume but very high-acuity referrals that test an agency's clinical depth.
Medicaid Home Health
Medicaid home health is a mandatory benefit that every state Medicaid program must cover, including part-time nursing, home health aide services, and medical supplies and equipment, with therapies as a common optional addition. Unlike Medicare home health, Medicaid home health cannot be restricted to homebound beneficiaries, and payment is typically per-visit fee-for-service or negotiated managed care rates rather than 30-day episodes.
PACE (Program of All-Inclusive Care for the Elderly)
The Program of All-Inclusive Care for the Elderly (PACE) is a capitated Medicare and Medicaid program that provides complete medical and social care to adults 55 and older who meet a nursing facility level of care but can live safely in the community. A PACE organization takes full financial risk and delivers care through an interdisciplinary team, typically anchored to an adult day health center. For home health agencies, PACE is both a competitor for frail seniors and a potential contracting partner.
Palliative Care
Palliative care is specialized medical care focused on relieving symptoms, pain, and stress for people with serious illness, at any stage and alongside curative treatment. Unlike hospice, it has no prognosis requirement and no requirement to forgo disease-directed therapy. For home health agencies, community-based palliative care is both a valuable clinical partner and an increasingly common adjacent service line.
Personal Care Services
Personal care services (PCS) are non-medical, hands-on assistance with activities of daily living such as bathing, dressing, toileting, transfers, and meal preparation, delivered by aides or personal care attendants. They are funded primarily by Medicaid state plans and HCBS waivers, private pay, and long-term care insurance. Traditional Medicare does not cover standalone personal care, which makes PCS the biggest coverage gap conversation in home health intake.
Private Duty Nursing
Private duty nursing (PDN) is continuous, shift-based skilled nursing delivered in the home, typically in blocks of 4 to 24 hours, for patients who need ongoing licensed nursing care. It is paid hourly by Medicaid programs, some commercial insurance, workers' compensation, or families directly. It is a fundamentally different service from Medicare home health, which covers only intermittent skilled visits.
Skilled Nursing Facility (SNF)
A skilled nursing facility (SNF) provides short-term skilled nursing and rehabilitation in an institutional setting, typically after a hospital stay, under the Medicare Part A SNF benefit. For home health agencies, SNFs are simultaneously an upstream referral source, a downstream discharge destination, and the setting home health increasingly competes against for post-acute referrals.
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