Personal Care at Home: What a Caregiver Does and Doesn’t Do

Personal care at home is the hands-on half of home care: help with bathing, dressing, getting from bed to chair, using the toilet, eating and remembering medications. Pennsylvania defines it in its home care regulations, and the definition draws a clear line between what a caregiver does and what needs a nurse. This guide walks through that line task by task, explains how the need is measured, and covers the two situations families ask about most: dignity in the bathroom and what changes when dementia is involved.

What “personal care at home” means under Pennsylvania law

Home care agencies and registries in Pennsylvania are licensed by the Department of Health under Chapter 611, which lists personal care as one of five home care services. The regulation defines it as assistance “with self-administered medications, feeding, oral, skin and mouth care, shaving, assistance with ambulation, bathing, hair care and grooming, dressing, toileting and transfer activities” (28 Pa. Code § 611.5).

The worker who provides it is a direct care worker. Before she is assigned to your home, the agency must confirm she passed a competency exam or training, and if she will provide personal care, that training must cover six additional subjects: “bathing, shaving, grooming and dressing,” “hair, skin and mouth care,” “assistance with ambulation and transferring,” “meal preparation and feeding,” “toileting” and “assistance with self-administered medications” (28 Pa. Code § 611.55(c)). Competency is reviewed at least once a year.

Two things follow. Personal care is a defined skill set, not “whatever the family needs.” And the same rule marks what is out of bounds: the Department of Health describes home care agencies as providers of “non-skilled services” (PA Department of Health, Home Care). Our personal care service page shows how this looks in practice; companionship, the other half of home care, is on the companionship service page.

What a personal care aide does, task by task

Bathing and grooming

The caregiver sets up the bathroom, checks the water temperature, helps the person in and out of the tub or shower, washes what the person cannot reach, and dries thoroughly, including between folds of skin. When a full shower is too much, a bed bath or a sponge bath at the sink does the job. Grooming means hair, shaving with an electric razor, basic nail care and mouth care, including dentures.

Dressing

Helping choose clothes for the weather and the day, laying them out in order, and helping with the parts that need two steady hands: socks, shoes, buttons, bras, compression stockings. A good caregiver lets the person do every step she still can.

Transfers and mobility

Bed to chair, chair to toilet, toilet to walker: this is where injuries happen, to the older adult and to the caregiver. A trained aide uses a gait belt, positions the walker correctly, and knows when a task needs two people or a mechanical lift. Walking beside someone unsteady is part of the job.

Toileting and incontinence

Help getting to the toilet on time, with clothing, with cleaning up afterward, and with briefs and pads when needed. A caregiver also notices what families miss: skin redness, a change in urine, constipation, a urinary tract infection showing up as sudden confusion.

Eating

Setting up the meal, cutting food, cueing, and hand-over-hand help when needed. Feeding someone with swallowing problems follows instructions from a speech therapist or nurse.

Medication reminders, not administration

Pennsylvania’s definition says “assistance with self-administered medications.” The aide can bring the pill organizer, open it, remind the person it is 8:00 am, and write down that the dose was taken. The person takes the medication. The aide does not decide doses, crush pills into food without instructions, give injections or handle anything through a tube. Our guide to medication safety for seniors at home explains how families set up a system a caregiver can follow.

What a personal care aide does not do, and who does

The line is between non-skilled and skilled. Skilled care requires a nurse or therapist under a physician’s order, and it is home health, not home care. Medicare covers “medically necessary part-time or intermittent skilled nursing care” at home, and covers a home health aide “only if you’re also getting skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy at the same time” (Medicare.gov, home health services). It does not cover personal care “when this is the only care you need.”

Task	Personal care aide	Who does it if not the aide
Bathing, showering, bed bath, grooming, mouth care	Yes
Dressing, compression stockings, shoes	Yes
Transfers with gait belt, walking assistance	Yes	Physical therapist sets the plan when needed
Toileting, incontinence care, skin checks	Yes
Meal setup and feeding	Yes	Speech therapist evaluates swallowing problems
Reminding and recording self-administered medications	Yes
Deciding doses, giving medications, injections, insulin	No	Nurse (RN or LPN) under a doctor’s order, or a trained family member
Wound care, dressing changes on open wounds	No	Home health nurse
Catheter insertion or changes, ostomy care beyond emptying	No	Home health nurse
Feeding tubes, oxygen adjustments, ventilators	No	Home health nurse or respiratory therapist
Assessing a change in condition and deciding what to do	No; the aide reports it	Nurse, physician

One clarification: a family member can do many skilled tasks at home after a nurse teaches them. The rule limits what an agency employee does, not what a daughter does.

How the need for personal care is assessed: the six ADLs

Care plans, Medicaid assessments and long-term care insurance policies all measure the same six activities of daily living. The standard tool is the Katz Index of Independence in Activities of Daily Living, which “ranks adequacy of performance in the six functions of bathing, dressing, toileting, transferring, continence, and feeding,” scoring each 1 for independent or 0 for dependent. “A score of 6 indicates full function, 4 indicates moderate impairment, and 2 or less indicates severe functional impairment” (Hartford Institute for Geriatric Nursing, Katz Index).

Activity	Independent (1 point)	Dependent (0 points)
Bathing	Bathes self completely or needs help with only one part of the body	Needs help with more than one part, getting in or out of the tub, or total bathing
Dressing	Gets clothes and puts them on, may need help tying shoes	Needs help with dressing or must be completely dressed
Toileting	Goes to the toilet, adjusts clothes and cleans self without help	Needs help transferring to the toilet or cleaning, or uses a bedpan or commode
Transferring	Moves in and out of bed or chair unassisted; mechanical aids are acceptable	Needs help moving from bed to chair or requires a complete transfer
Continence	Complete control over urination and defecation	Partially or totally incontinent of bowel or bladder
Feeding	Gets food from plate into mouth without help; food may be prepared by another person	Needs partial or total help with feeding, or tube feeding

Adapted from Katz et al. (1970), as reproduced by the Hartford Institute for Geriatric Nursing.

Use it at home. Score your parent honestly today, and again in three months. A drop from 6 to 4 usually means a few hours of personal care a week; 2 or less usually means daily help and a conversation about 24-hour home care. Bring the score to the doctor and to any agency you interview; it turns “Mom needs help” into a plan.

What a typical personal care visit looks like

A morning visit of two to three hours is the most common arrangement. The caregiver arrives, checks in and looks around: is the floor dry, was breakfast eaten, is anything different from yesterday. Then the routine: toilet, bath or shower, skin care, dressing, hair, teeth, breakfast, medication reminder, a short walk or the exercises a therapist prescribed. She notes what was done and what she noticed, tidies the bathroom and kitchen, and leaves the person set up until the next visit: water within reach, phone charged, lunch ready.

An evening visit reverses the order: dinner, medications, toileting, nightclothes, a safe path to bed. Families who need both usually start with mornings, because that is when bathing and dressing happen.

Dignity and consent in the bathroom

Being bathed by another adult is hard for almost everyone, and harder for a generation that never talked about bodies. The National Institute on Aging notes that bathing and dressing “are routines they likely did in private in the past” and that the person “may feel embarrassed and not want help” (NIA, Alzheimer’s Caregiving: Bathing, Dressing, and Grooming). The practical rules a trained caregiver follows:

• Ask, then act. Even when the answer is predictable, the question restores control.
• Cover. Put a towel over the shoulders or lap and wash underneath it. The Alzheimer’s Association recommends “covering the person with a bath towel while undressing to decrease feelings of vulnerability” (Alzheimer’s Association, Bathing).
• Same-sex caregiver when it matters. Many families and older adults have a preference. Say so when you set up care.
• Let the person do what she can. Holding the washcloth, washing her own face, choosing the shirt. Independence in small things is the goal, not speed.

Consent also means the right to refuse. A person who says no to a shower today is exercising a right, not being difficult. The skilled response is to offer an alternative, a sponge bath or a later time, and try again tomorrow.

Bathroom safety: where falls happen

Falls are the reason personal care exists as a job. According to the CDC, “more than one out of four older people falls each year,” there are “about 4.5 million emergency department visits due to older people falls” annually, and “nearly 319,000 older people are hospitalized for hip fractures” each year (CDC, Older Adult Falls Data). Wet floors, stepping over a tub wall and standing up from a low toilet are the moments a caregiver is there to hold.

The environment does half the work. Grab bars by the toilet and in the shower, a shower chair, a handheld showerhead, a raised toilet seat and a non-slip mat cost less than one emergency room visit. The Alzheimer’s Association’s advice applies to every household: “Install grab bars and use a seat in the tub or shower. Make sure there are no puddles on the bathroom floor,” and “lower the thermostat on your hot water heater to prevent scalding injuries.” Our fall prevention checklist and the guide to home safety modifications for seniors list what to change room by room.

When dementia changes the picture

The tasks do not change with dementia; the approach does. A person with Alzheimer’s “might regard bathing as scary, embarrassing, or physically unpleasant,” the NIA explains, and may resist verbally or physically. What works, according to the same guidance: gather supplies first, keep the room warm, “be matter-of-fact about bathing,” offer a choice such as “bath or shower” rather than “do you want to bathe,” tell the person each step before doing it, start with the hands or feet, which “are less threatening,” and “never leave a person with Alzheimer’s alone in the tub or shower.”

The Alzheimer’s Association adds flexibility: washing one part of the body each day of the week, or using a no-rinse soap with warm wet towels, is “equally effective” as a full bath. Dressing gets easier with clothes laid out in the order they go on, fewer choices, elastic waists and velcro. Pennsylvania requires “dealing with difficult behaviors” in every direct care worker’s training; a caregiver who has it knows that refusal is communication and that the answer is rarely to push harder. Our guide to home care for Alzheimer’s patients goes deeper.

What bathing assistance costs in Allentown

Personal care is billed by the hour at the same rate as other non-medical home care: a Pennsylvania median of $34 an hour through a provider in the 2025 CareScout Cost of Care Survey (CareScout state tables, PDF), with no separate Allentown figure. Families seeking bathing assistance Allentown agencies provide should expect a minimum visit, usually two to four hours, which covers a full morning routine. Three three-hour visits a week at $34 comes to roughly $1,325 a month. Medicaid Community HealthChoices, the OPTIONS program and VA benefits can cover some or all of it for those who qualify.

Who pays for personal care at home

There are six ways to pay, and most families end up combining two of them. The rules are the same whether the need is three mornings a week or a daily visit. What changes is who qualifies and how long it takes to start.

Payer	Who qualifies	What it covers	Where to start
Private pay	Anyone	The hours you agree with the agency, at the Pennsylvania median of $34 an hour (CareScout, 2025)	The agency, with the § 611.57 packet in hand
Medicaid Community HealthChoices (CHC)	Adults 21 and older enrolled in both Medicare and Medical Assistance, or who need a nursing facility level of care	Personal assistance services, home health aide, respite and other long-term services	Independent Enrollment Broker, 1-877-550-4227
OPTIONS (PA Department of Aging)	Pennsylvania residents 60 and older with unmet needs that affect daily functioning; no income requirement	Personal care services, in-home meals, care management, adult day services	Your local Area Agency on Aging, or the Department of Aging at 717-783-1550
VA Homemaker and Home Health Aide	Enrolled veterans who meet the clinical criteria; a copay may apply	Help with bathing, dressing, grooming, toileting, eating and household tasks	The VA medical center where the veteran is enrolled
Long-term care insurance	An insured who cannot do at least 2 of 6 daily activities for 90 days, or has severe cognitive impairment, once the elimination period is met	Reimbursement up to the daily or monthly limit; most policies require a licensed agency	The insurer’s claims line
Medicare	Only alongside skilled nursing or therapy ordered by a doctor	Not personal care “when this is the only care you need”	The doctor, for a home health order

Medicaid is the largest payer. Community HealthChoices serves people 21 and older who are enrolled in both Medicare and Medical Assistance, or who need a nursing facility level of care (PA DHS, Apply for Community HealthChoices). Its long-term services and supports package lists personal assistance services, home health aide, respite, home adaptations and more than twenty other services (PA DHS, CHC Long-Term Services and Supports Benefits Package). The hours are set by the plan’s assessment, not by the family, and the application starts with the Independent Enrollment Broker at 1-877-550-4227 (CHC contact information, PA DHS).

OPTIONS is the program that families with too much income for Medicaid usually miss. The Department of Aging describes it as assistance for “Pennsylvania residents, age 60 and older who would like to stay in their home,” and lists “Personal Care Services – assistance with daily living activities” among its primary services. “There are no income requirements to participate in the program. However, depending on an individual’s income, they may be required to contribute towards the cost of their services based on a sliding co-payment scale” (PA Department of Aging, Apply for the OPTIONS Program). Applications go through the local Area Agency on Aging.

For veterans, the VA’s Homemaker and Home Health Aide program sends “a trained person who can come to a Veteran’s home and help the Veteran take care of themselves and their daily activities.” “All enrolled Veterans are eligible for Homemaker Home Health Aide Care if they are eligible for community care and meet the clinical criteria for the service and it is available,” and “a copay may be charged based on your VA service-connected disability status” (VA, Homemaker and Home Health Aide Care).

Long-term care insurance pays once a licensed practitioner certifies that the insured cannot perform “at least 2 activities of daily living for a period of at least 90 days,” or needs “substantial supervision” because of “severe cognitive impairment” (26 U.S.C. § 7702B). Those are the same six activities as the Katz score above; a 4 usually meets the trigger. Medicare, as explained earlier, does not pay for personal care at home when it is the only care needed.

Frequently asked questions