Ask Fiona: I Live Alone. Can Home Health Help Me When Vertigo Hits?

Hi Fiona,

I live alone and have no one to help me when I have a vertigo episode. Do people use home health services? How do I find one that can specifically help with my vestibular disorder?

Yes, people do. And you are asking two good questions at once. The first is about getting through an episode safely when no one else is home. The second is about finding care that makes episodes less frequent or less disruptive. Home health can help with the second, but it is one of several options, and it is not always the right fit. Here is how to think about each of them.

Two very different things are called “home health”

When people say, “home health,” they usually mean one of two services, and they work very differently.

Skilled home health care comes from a licensed home health agency and is ordered by a doctor. It can include nursing, physical therapy, and occupational therapy delivered in your home. In the United States, Medicare covers this kind of care only if you meet specific conditions. You must need part-time or intermittent skilled care, and you must be “homebound,” meaning you normally cannot leave home and leaving takes a lot of effort. A doctor or other qualified provider must see you in person, confirm that you need home health care, and order it, and a Medicare-certified agency must provide it.⁸ Private insurers set their own rules, so call the number on your card and ask.

Non-medical home care means aides who help with meals, errands, housekeeping, or simply having someone in the house. This can be a real comfort for someone who lives alone. But Medicare does not cover this kind of help when it is the only care you need,⁸ so it is usually arranged and paid for separately.

Many people with a vestibular disorder are not homebound between episodes. They drive, work, and run errands most days, and then get knocked flat for hours or days at a time. If that describes you, you may not qualify for skilled home health, and that is okay. Outpatient care may actually suit you better.

Start with a diagnosis

Before you look for someone to treat you, it helps to know what is being treated. “Vertigo” is a symptom, not a diagnosis. The right plan for positional vertigo is very different from the right plan for Ménière’s disease or vestibular migraine.

VeDA does not recommend doing vestibular exercises at home without a diagnosis and a personal treatment plan from a vestibular specialist.¹ That is not red tape. Exercises that help one condition can do nothing for another. And some kinds of vertigo attacks are not the kind that exercises can prevent.¹ If you have not had a clear diagnosis yet, that is the first step. VeDA’s guide to the specialists involved in vestibular care can help you work out who to see.²

Finding care that knows vestibular disorders

Most home health agencies employ physical therapists, but not every physical therapist has specific training in vestibular rehabilitation. When you call an agency, or any clinic, ask directly:

• Do you have a physical therapist with specific training in vestibular rehabilitation?
• Can that therapist test for positional vertigo during a home visit?
• Will I get an individualized exercise program, with a clear plan for how it progresses?
• How will you coordinate with my doctor?

If the answer to the first question is a vague “all our therapists do balance,” keep looking.

VeDA’s Healthcare Provider Directory is the best place to start. Enter your zip code and add a specialty if you know the type of provider you want.³ Even if the vestibular therapist you find does not do home visits, they may know which local agencies have staff with vestibular training.

You also have options besides skilled home health:

Outpatient vestibular physical therapy

This is the most common route for people who can travel between episodes. Vestibular rehabilitation therapy (VRT) is an exercise-based program designed to reduce dizziness and imbalance.⁴ Home exercises your therapist designs for you are a vital part of it,¹ so much of your progress happens between visits. That matters if getting a ride is hard.

Telehealth

Many vestibular therapists now see patients by video. A study compared in-clinic, telehealth, and hybrid vestibular physical therapy. All three groups improved significantly, and the differences between them were not statistically significant.⁵ For someone who lives alone and cannot always drive, a video visit, or a mix of video and in-person visits, can remove a big barrier. One thing to know: a therapist generally must be licensed in the state where you are during the visit, so ask about that when you book.

A therapist who does house calls

Some outpatient physical therapists see patients at home without going through a home health agency. It is worth asking about if you are not homebound but getting to a clinic is hard.

A plan for the episode itself

Treatment takes time. In the meantime, the most important thing for someone who lives alone is having a plan before the next episode. VeDA’s advice on acute vertigo episodes puts it simply: if you have repeated episodes, your best defense is preparation.⁶

Know when it is an emergency

Get to an emergency department or urgent care center if this is your first vertigo attack, if your symptoms are getting worse, or if you have trouble speaking or swallowing, double vision or loss of vision, loss of coordination, weakness or numbness in an arm or leg, or a severe headache that is not typical for you.⁶ If you are alone and any of those are present, call 911 rather than trying to drive yourself.

Get low and stay put

When an episode starts, sit or lie down right away. If you lie down, use an extra pillow under your head. A quiet, dark room helps. If you must move, go slowly, keep your head straight, and stay near walls and rails.⁶

Stock your “landing spots”

Decide where you will ride out an episode, usually your bed or a favorite chair, and keep what you need within reach there. That means your phone and charger, water, any medication your doctor has prescribed for episodes, and a bowl or bag in case of nausea. VeDA also suggests keeping your medical ID with you and your medications close at hand.⁶

Make it easy to reach people

Keep a short list of people you can call and mark them as favorites in your phone. Tell friends, family, neighbors, and coworkers that you have vertigo episodes. Do not keep it a secret.⁶ Some people who live alone set up a daily check-in text with a friend. Others wear a medical alert button so they can call for help without finding their phone. That can be especially useful if you have fallen before.

Set up your home for your worst day, not your best one

VeDA’s home safety guide suggests walking through your home and stopping every five to seven feet to ask: If I got dizzy right here, is there something sturdy to hold, and a chair without wheels I could sit in?⁷ Add night lights along the path from your bed to the bathroom. Clear away small rugs and cords. Put the things you use most at a height you can reach without climbing or bending far.⁷ These changes are simple, and they matter most on the days when no one else is there.

Living alone with a vestibular disorder takes more planning, but you do not have to do it without help. Get a clear diagnosis. Find a therapist who treats vestibular disorders, whether at home, in a clinic, or by video. And set up your home and your phone so the next episode finds you prepared. Episodes usually become much more manageable once you have a plan and treatment that fit your diagnosis.

Author: Rob Letizia, PT, DPT — Spectrum Therapeutics, Wayne, NJ

References

1. Vestibular Disorders Association. Home-Based Exercise. https://vestibular.org/article/diagnosis-treatment/treatments/home-based-exercise/
2. Vestibular Disorders Association. Healthcare Specialties. https://vestibular.org/article/diagnosis-treatment/healthcare-specialties/
3. Vestibular Disorders Association. Step 3: Find a Vestibular Specialist. https://vestibular.org/article/diagnosis-treatment/new-patient-toolkit/step-3-find-a-vestibular-specialist/(Healthcare Provider Directory: https://vestibular.org/healthcare-directory/)
4. Vestibular Disorders Association. Vestibular Rehabilitation Therapy (VRT). https://vestibular.org/article/diagnosis-treatment/treatments/vestibular-rehabilitation-therapy-vrt/
5. Conover S. Research Comparing In-Clinic vs. Telehealth for Vestibular Physical Therapy. VeDA Blog / On the Level, Winter 2025. https://vestibular.org/blog/research-comparing-in-clinic-vs-telehealth-for-vestibular-physical-therapy/
6. Vestibular Disorders Association. How to Deal with an Acute Vertigo Episode. https://vestibular.org/article/coping-support/living-with-a-vestibular-disorder/how-to-deal-with-an-acute-vertigo-episode/
7. Vestibular Disorders Association. Home Safety. https://vestibular.org/article/coping-support/living-with-a-vestibular-disorder/home-safety/
8. Home Health Services. https://www.medicare.gov/coverage/home-health-services