Des Moines Senior AdvisorWhat is the difference between home health and private-duty home care?
Home health is skilled, intermittent nursing and therapy ordered by a doctor for a homebound patient and delivered by a DIAL-licensed home health agency; private-duty home care is hourly non-medical help such as bathing, meals, housekeeping and companionship.
DIAL lists 20 home health agencies, 11 hospices and 3 inpatient hospice houses with offices in the six metro counties. Many families use both at once after a hospital stay: home health nurses and therapists visit a few times a week, while a private-duty aide fills the hours in between.
Does Medicare pay for private-duty aides in Iowa?
No. Medicare pays for home health visits, including part-time aide help while skilled care is also being provided, but not for hourly, overnight or companion care, which families pay for privately or through the Elderly Waiver or PACE.
Iowa's 2025 median for non-medical home care is about $41 an hour. The Elderly Waiver can cover homemaker, home health aide and consumer-directed attendant care for eligible members 65 and older, and its Consumer Choices Option lets a member hire their own workers.
How do we choose a home health agency in the Des Moines area?
Choose a Medicare-certified agency that can start promptly, staffs the therapies your parent needs, and answers after-hours calls; you can ask the hospital or doctor for a specific agency rather than accepting the first assigned.
Ask how soon the first visit will happen after discharge, which days therapists come, and who to call at night. An agency that already knows your parent's doctors makes the first weeks smoother.
What should we ask a private-duty home care agency?
Whether aides are employees who are background-checked, trained and supervised, what the minimum shift is, how the agency covers a sick call, and how billing works for holidays and overnight shifts.
Ask for a written service agreement. If you hire an aide directly instead of through an agency, you take on payroll, taxes and backup coverage yourself; the Elderly Waiver's Consumer Choices Option formalizes that arrangement with a financial management service.
Side by side
| Medicare home health | Private-duty home care | |
|---|---|---|
| Who orders it | A doctor's plan of care | The family |
| What it does | Skilled nursing and therapy, part-time aide help | Hourly personal care, homemaking, companionship |
| Who pays | Medicare, for homebound patients | Private funds, Elderly Waiver or PACE |
| How long | While skilled needs continue | As long as needed and affordable |
Drawn from Iowa Code chapter 231C, 481 IAC chapters 67 and 69, Iowa HHS and DIAL publications, CareScout, CMS, the VA and the aging agencies cited in the text; our editorial standards explain how we check them.
