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Eldercare Review | Monday, August 31, 2026
In-home care services are gaining stronger relevance as older adults and families look for support that allows people to remain at home instead of moving into institutional settings. The category is no longer limited to basic personal assistance. It is becoming a care-access model shaped by aging demographics, family caregiving strain, payer policy and local service availability.
Medicare’s home health coverage includes part-time or intermittent skilled nursing, therapy and home health aide care when eligibility requirements are met. Medicare also states that combined skilled nursing and aide services are generally limited to up to eight hours a day and a maximum of 28 hours a week in most cases.
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That limitation is relevant as there are times when some families need assistance outside the scope of covered skilled services. Care management, companionship, meal assistance and supervision may not be covered by Medicare in some cases. This leads to a greater private and Medicaid-related market for non-medical in-home care providers.
In January 2026, Richmond Fed pointed out that home health care and aging in place are affected by Medicare and Medicaid financing, informal caregiving and neighborhood factors affecting their ability to stay at home. It is equally relevant for agencies, as it affects demand for services depending on the community.
For home-care agencies, there is a business setting in which clinical and activities-of-daily-living demands intersect. Client may need assistance with activities like bathing and ambulating, medication reminder services and safety. Others will require short visits, so that a family member who is acting as the caregiver can continue their work. It is important for the agencies to craft plans that address various kinds of needs without offering medical services for which they are not licensed.
There is an element of trust in the business model, too. Caregivers are being allowed to enter a private household in which the client may be particularly vulnerable. Agencies must show careful hiring, background checks, training, supervision and responsive scheduling. A missed shift can quickly become a safety problem.
The issue of payment still poses a realistic challenge. In-home care provided on private terms may be quite costly for people requiring extended care or nighttime assistance. Medicaid home- and community-based services could assist some qualified clients, though their availability and payment schedule will depend on each state.
On the policy side, the situation is getting tighter as well. CMS finalized the CY 2026 Home Health Prospective Payment System final rule, which includes new payment rules, quality measures and revised HHCAHPS survey, which will start in April 2026. Even if agencies providing non-medical assistance do not get payments from the Medicare home health program, there are still some quality requirements that apply to the market.
The next phase of in-home care will likely favor providers that can explain their service boundaries clearly and coordinate with families, physicians and community resources. Demand is growing, but trust will decide which agencies retain clients.
In-home care services are becoming aging-in-place infrastructure. Their value will be measured by whether they help older adults remain safer at home while reducing avoidable stress for families.
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