NHS Community Health Care vs Home Care: The Difference

If you search for "home health vs home care", most of what you find is written for the United States. There, "home health" means medical care at home and "home care" means everyday help. The UK has the same split, but different names and very different rules about who pays.

In the UK, the "home health" side is NHS community health services, such as district nurses and community therapists. The "home care" side is social care at home, often called homecare or domiciliary care, provided by care agencies. This guide explains the difference, who arranges each one, and how each is paid for. It describes the system in England. Rules differ in Scotland, Wales and Northern Ireland.

The difference at a glance

	NHS community health services	Home care (social care at home)
What it is	Health care at home, such as district nursing, community physiotherapy and occupational therapy, and community palliative care	Help from a paid carer with daily life, such as washing, dressing, meals and medicine reminders
Who provides it	Community nurses, district nurses, therapists and other NHS staff	Homecare agencies or a carer you employ yourself
How you get it	Usually arranged by your GP or the hospital	Through a council needs assessment, or arranged privately
Who pays	The NHS. It is free to you	Means-tested council funding, or you pay yourself
Who checks quality	The Care Quality Commission (CQC)	The Care Quality Commission (CQC). All homecare agencies must register with it

What are NHS community health services?

NHS England describes community health services as care for people from birth to the end of life. Community teams help people with complex health and care needs to live independently at home for as long as possible. Most of this care happens in people's homes, including care homes.

Community health services include:

• district nursing
• community occupational therapy and physiotherapy
• community speech and language therapy
• specialist nurses, for example for diabetes, heart failure, COPD or continence
• falls prevention services
• intermediate care, and urgent community response services
• community end of life and palliative care
• wheelchair services

NHS services are free of charge, apart from a few exceptions set by Parliament. So if a district nurse visits to dress a wound or manage medicines, you do not pay for it.

Your GP can arrange for community nurses to visit you at home. If you are in hospital, staff can arrange short-term support at home before you leave, where a service exists in your area.

Short-term care after hospital or a fall

If you need help to recover after a hospital stay, or after a fall, injury or illness at home, you may be offered intermediate care. This is also called reablement, rehabilitation or recovery services. A team from the NHS and adult social care helps you regain independence. That might mean practising getting dressed, preparing a meal or using the stairs.

This care is free. It lasts as long as you need it, usually for up to 6 weeks. It is not yet available in all areas. Ask hospital staff, your GP surgery or your local council about it.

What is home care?

Home care means a paid carer visits you at home to help with daily life. The NHS says it is also known as domiciliary care or home help. It can be short term, for example while you recover from an illness, or long term. You might need a carer for an hour a week, several hours a day, at night, or a live-in carer.

A paid carer can help with things like:

• getting out of bed in the morning, and getting ready for bed at night
• washing, dressing and using the toilet
• preparing meals and drinks
• remembering to take medicines
• shopping and collecting prescriptions
• getting out, for example to a lunch club

Home care also helps with company and routine. That matters a lot to people who live alone. You can search home care agencies near you on AskBart, or read our home care guides.

Who pays for each?

This is the biggest difference between the two.

NHS community health care: free

District nursing, community therapy and intermediate care are NHS services, so they are free to you.

Home care: means-tested or self-funded

To get help from the council, start by asking for a care needs assessment. If you are eligible, the council may arrange home care for you. How much you pay depends on your income and savings. The council works this out in a financial assessment, often called a means test.

If the council pays for some or all of your care, it must give you a care and support plan and a personal budget. You can choose to take this as a direct payment and arrange your own care. Read more about direct payments for home care.

If you are not eligible for council help, you pay for home care yourself. Prices vary a lot by area. See our guide to UK home care costs to compare.

Some benefits, such as Attendance Allowance and Personal Independence Payment, are not means-tested. They can help towards the cost of home care.

NHS Continuing Healthcare: when the NHS pays for everything

Some people with long-term, complex health needs qualify for NHS Continuing Healthcare. It is arranged and funded by the NHS and is free to the person. It covers the full cost of care, including personal care such as help getting washed and dressed, in your own home or in a care home.

Eligibility depends on your assessed needs, not on a particular diagnosis. If someone's health is getting worse quickly and they are nearing the end of life, they should be considered for the fast-track route. This usually puts care in place within 48 hours. Read our guide to NHS Continuing Healthcare.

Who is each one for?

NHS community health services suit people with a health need that can be met at home. Examples are wound care, injections, managing a long-term condition, or therapy to get moving again after a fall.

Home care suits people who find daily routines hard, such as washing, dressing and getting out and about, and who want to stay at home rather than move into a care home.

Many people need both. For example, a district nurse may visit to manage someone's medicines, while care workers help them wash and dress each morning.

Using both together

NHS and social care staff often work side by side. District or community nurses coordinate a range of services. These can include healthcare assistants, social care workers and home care agencies. After talking with you, the nurse prepares a care plan and refers you to services that may help.

Intermediate care is also a joint NHS and council service. When it ends, your team should agree with you what happens next. This could include longer-term home care, which the council may assess you for.

Training and checks for care workers

In England, all homecare agencies must register with the Care Quality Commission (CQC). The CQC inspects them and publishes reports and ratings.

Under CQC rules, providers must only employ "fit and proper" staff. They must run robust recruitment checks and check that staff have the skills and experience for the role. Where a role needs a professional registration, such as a nurse, they must check it is current.

Many new care workers are trained to the Care Certificate standards. These set out the knowledge, skills and behaviours expected of people new to health and social care. They were updated in March 2025.

Questions to ask a homecare agency

The NHS suggests asking:

• What will I be charged, and what counts as an extra?
• Have your carers looked after someone with needs like mine?
• How will you choose the right carer for me?
• Will carers visit in a set time slot, and tell me if they are running late?
• What training do your carers get?
• Can I read your standard contract before I sign?
• How do I contact you in an emergency or out of hours?

Our home care agency checklist has more questions, and you can check any agency's latest CQC report before you decide.

What each service does not do

Home care

• Care workers are not nurses. Clinical tasks such as wound care are usually done by community nurses. Some live-in care organisations do provide carers who can give specialist nursing care.
• Most councils do not provide home help with things like cleaning, laundry and gardening. A charity such as your local Age UK may be able to help, but it may not be free.
• Visits are usually booked for set times, so ask the agency how flexible it can be.

NHS community health services

• They cover health needs. They do not include cleaning, shopping or general help around the house.
• Intermediate care is short-term, usually up to 6 weeks.

If someone needs care around the clock, it may be time to look at live-in care or a care home. Our guides on care homes vs home care and when home care is not enough can help.

How to decide what you need

1. Health needs. If the person needs nursing, wound care, injections or therapy, talk to the GP about NHS community services.
2. Daily living needs. If the main problem is washing, dressing, meals or loneliness, ask the council for a care needs assessment. This helps even if you plan to pay privately, because it shows what help is needed.
3. How long help is needed. After a hospital stay or a fall, ask about free intermediate care first.
4. Complex or worsening health. Ask whether the person should be assessed for NHS Continuing Healthcare.
5. Benefits. Check Attendance Allowance or Personal Independence Payment, which are not means-tested.
6. The family carer. If you look after someone, you can ask the council for a free carer's assessment of your own needs.
7. Quality. Read the CQC report for any agency you are considering.

If the person has a terminal illness, hospice teams can also provide care at home. See how to qualify for hospice care, how hospice referral and assessment work and our guide to end of life care at home.

Frequently asked questions

What is the difference between home health and home care in the UK?

"Home health" is a US term. The nearest UK equivalent is NHS community health services, such as district nurses and community therapists. These are free and usually arranged by your GP or hospital. "Home care" in the UK means help from a paid carer with daily life, such as washing, dressing and meals. It is arranged by the council after a needs assessment, or privately, and is means-tested or self-funded.

Do I have to pay for a district nurse?

No. District nursing is an NHS service, and NHS services are free of charge apart from a few exceptions set by Parliament.

Is home care free in the UK?

Not usually. The council may pay some or all of the cost, depending on a needs assessment and a means test. Short-term intermediate care after a hospital stay is free for up to about 6 weeks. People who qualify for NHS Continuing Healthcare have their care paid for in full by the NHS.

Who regulates home care agencies?

In England, all homecare agencies must register with the Care Quality Commission (CQC), which inspects them and publishes reports.

Can someone have NHS nursing and home care at the same time?

Yes. It is common for a district nurse to visit for health needs while care workers help with personal care. District nurses often coordinate these services.

Sources

• What are community health services (NHS England)
• The NHS Constitution for England (GOV.UK)
• Help at home from a paid carer (NHS)
• Care to support recovery after leaving hospital, or after a fall, injury or illness (NHS)
• Care and support you can get for free (NHS)
• NHS continuing healthcare (NHS)
• End of life care at home (NHS)
• Carer's assessments (NHS)
• Apply for a needs assessment by social services (GOV.UK)
• Services we regulate (Care Quality Commission)
• Regulation 19: Fit and proper persons employed (Care Quality Commission)
• Care Certificate standards (Skills for Care)
• Palliative care team (Marie Curie)