The five main types of home care services are companion care (non-medical, social), homemaker services (housekeeping, meals), personal care (hands-on ADL help), skilled home health (clinical, physician-ordered), and hospice (end-of-life). Each is defined by what kind of help is delivered — not by how many hours or what time of day. Most families need a mix; the framework that decides what mix is the ADL / IADL assessment.
This guide explains the ADL/IADL framework, walks through what each home care type covers, and helps you match your parent’s needs to the right services. For the broader picture, read our pillar what are elder care services.
The ADL / IADL framework
Used by Medicare, Medicaid, and virtually every long-term care insurance policy. Two categories of daily-life activities define what kind of care a senior needs.
ADLs — Activities of Daily Living
The six basic self-care activities:
- Bathing — showering, sponge bathing, hair washing
- Dressing — choosing and putting on clothes, including buttons, zippers, shoes
- Toileting and continence — getting to and using the toilet, hygiene afterward
- Transferring — moving from bed to chair, chair to toilet, lying to sitting
- Eating — feeding oneself once food is prepared
- Walking and mobility — getting around the home safely
Difficulty with 2 or more ADLs typically triggers long-term care insurance benefits and indicates need for personal care services.
IADLs — Instrumental Activities of Daily Living
The eight more complex tasks that maintain independent living:
- Meal preparation and cooking
- Housekeeping and laundry
- Shopping and errands
- Medication management
- Transportation
- Finances and bill paying
- Using the phone or technology
- Managing health and medical appointments
Difficulty with IADLs alone often indicates need for companion or homemaker services — non-medical, hands-off support.
1. Companion care
Covers: companionship and conversation, medication reminders, transportation, errands, hobby support, social engagement, light meal preparation, walks and exercise companionship, light housekeeping.
Doesn’t cover: bathing, dressing, toileting, transfers, hands-on body care, medication administration, clinical care.
Best for: seniors with IADL needs but no ADL needs. Provided by trained but non-certified caregivers. Cost: $25 to $40 per hour.
2. Homemaker services
Covers: housekeeping, laundry, linens, meal planning and cooking, errands, grocery and pharmacy runs, light home maintenance.
Doesn’t cover: any hands-on body care, medication management, clinical work.
Best for: seniors who can self-direct but need help with the household tasks. Often combined with companion care. Cost: $25 to $35 per hour.
3. Personal care
Covers: ADL support — bathing, dressing, toileting, transfers, eating assistance, mobility help. Plus IADL support where needed.
Doesn’t cover: clinical care, wound care, IV medications, complex medical tasks.
Best for: seniors with 2 or more ADL needs. Provided by Certified Home Health Aides (CHHAs) or Certified Nursing Assistants (CNAs). Cost: $28 to $45 per hour.
4. Skilled home health
Covers: RN visits, physical therapy, occupational therapy, speech therapy, medical social work, wound care, infusion therapy, medication management, vital signs monitoring, post-hospital recovery, chronic disease management.
Doesn’t cover: ongoing daily-living support (that’s companion or personal care).
Best for: short-term recovery (4 to 8 weeks typical) after hospitalization or for specific clinical episodes. Requires a physician’s order. Often Medicare-covered.
5. Hospice
Covers: comprehensive end-of-life care including RN visits, hospice aide, social worker, chaplain, medical equipment, pain management, bereavement support, and short-term continuous care during symptom crises.
Doesn’t cover: aggressive curative treatment for the terminal diagnosis (though Medicare allows concurrent treatment in some cases).
Best for: terminally ill seniors with 6-month or less prognosis. Medicare-covered for eligible patients.
How to figure out what your parent needs
Three steps:
- List the ADL and IADL items your parent currently needs help with. Be honest. Help “only a little” still counts.
- Schedule a geriatric assessment ($300 to $500). The Geriatric Care Manager will validate your list and add observations you haven’t seen — they’re trained to spot the patterns families miss.
- Map needs to services: ADL needs → personal care; IADL needs → companion or homemaker; clinical recovery → home health; end-of-life → hospice. Most plans combine 2 or more service types.
Read more in our how to choose elder care services guide.
What’s the next step?
If you’re not sure which type your parent needs, a geriatric assessment will sort it out in 90 minutes. Talk to an ElderCareServicesNearMe advisor to schedule one.
