Hospice vs. Home Health: What’s the Difference?

Updated

Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

One of the more challenging situations family caregivers must face is when a loved one starts to decline. Sometimes a decline is gradual and results from chronic medical conditions like Parkinson’s, multiple sclerosis, dementia, diabetes, heart and kidney disease, or other problems.

When medical conditions or diseases aren’t managed well, they can sometimes lead to safety issues in the home and difficulty performing day-to-day tasks. Even under the best circumstances, a decline in physical and mental functioning can occur. 

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When help is needed, choosing between hospice and home health isn’t as simple as it may seem. It’s not unusual for a patient to have home health for a while, decide on hospice, and then go back to home health. These periods of recovery and improvement guide decision-making.

Your loved one may have a personal hope and desire to get better, and they have the right to try. Although perspectives are changing, many people wait too long to give hospice a try. Our guide will assist you with knowing the differences between hospice and home health and how and when to choose.

Overview: Hospice vs. Home Health

There is plenty of good news about hospice and home health. Both are generally covered by insurance if you meet the criteria. Both hospice and home health care are medical support services, even though different philosophies guide them. 

Hospice generally has a more extended certification period that permits the patient to receive services much longer—as long as they continue to qualify. If a patient begins to recover and decides to pursue treatment, they have that right. They can discontinue hospice and start rehabilitation. 

Home health has a shorter certification period, and the criteria for continuing is more stringent. For example, if your loved one needs home health but has dementia, they may be unable to complete the rehabilitation tasks and make progress. At that point, home health can discharge the patient and suggest hospice if appropriate. 

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Hospice vs. Home Health: Who Are They For?

You might initially think that the distinction between hospice and home health is clearly between someone who is dying and someone who isn’t. Not everyone falls into a distinct category when they are ill and declining. Here are some guidelines on who hospice and home health are for, but always consider that the lines are blurred.

Who is hospice for?

Hospice is for people who no longer want to actively seek treatment for the condition that qualifies them for hospice. An example would be someone who has cancer, and even with aggressive treatment, there is no reasonable hope of recovery or return to previous functioning levels. 

  • Hospice is for patients who have a physician certify that they have a terminal condition likely to cause death within six months. (If your loved one does not die, they can be recertified for hospice as long as they meet the original criteria).
  • Hospice is for patients who want pain control, reduction of suffering, and comfort care.
  • Hospice is for patients and families who need additional support for their loved ones who can no longer go to outpatient medical appointments due to infirmity or terminal illness.
  • Hospice is for patients who still desire quality of life but no longer want the discomfort and complications of treatment. 

Who is home health for?

Home health is a widely used, time-limited medical service for people who want and need rehabilitation at home, assisted living, or other long-term care settings. 

  • Home health is for people who have had a decline in functioning due to a medical condition or an accident (like a fall).
  • Home health is for people who hope to recover and rehabilitate.
  • Home health requires a physician’s order and certification that the patient is homebound and needs nursing care.
  • Home health is for people who can manage on their own (or with in-home or family caregiving) after they are discharged from home health.

Hospice vs. Home Health: Type of Care Received

Both hospice and home health have a team of healthcare providers that includes nursing, social work, physician services, and rehabilitation. The type of care received, however, differs between the two in intent and purpose.

Hospice

The rules of hospice can be complicated. When you choose hospice, it is not that you’re opting for no treatment for any medical condition. Antibiotics, oxygen, even invasive procedures can be allowed on hospice as long as it isn’t for the terminal condition. 

Nursing care

Nurses are the foundation of care coordination for someone on hospice. They do the initial assessment, develop a plan of care, and communicate with the medical director and the other adjunct professionals on the team. Nurses treat wounds, administer pain medications, order equipment, and provide emotional support.

Aides

A person on hospice may spend much of their time in bed. An aide helps the patient get dressed and shower, and performs minor medical tasks.

Social work

The role of social work is to provide emotional support to the patient and the family. The hospice social worker completes a psychosocial assessment when the patient starts hospice. The social worker also assists the family with funeral planning and bereavement counseling.

Spiritual care

Hospice offers spiritual support if the patient requests it. 

Therapy

Physical therapy can be a limited part of hospice. For example, the physical therapist can train the patient on using a hospital bed, or making safe transfers and using the toilet. 

Home health

Home health also has a team of health professionals whose goal is to work with the patient towards improving health and wellbeing.

Nursing

The nurse performs the initial assessment and develops a plan of care that designates which disciplines will provide care. A nurse also checks vital signs, does wound care, and provides an overall weekly patient assessment.

Therapy

Therapy is the critical piece of home health in that these providers are the ones that set goals related to recovery. Physical, occupational, speech, and respiratory therapists are all part of the team. Physical therapy assists with ambulation and mobility.

Occupational therapy (OT) helps with learning how to eat, cook, and perform activities in the home. OTs also do home assessments and make recommendations for grab bars and other accessibility equipment. Speech therapy helps people with speech problems related to stroke or assists with dietary needs associated with swallowing problems. 

Aides

Just as with hospice, aides help patients who receive home health with bathing, dressing, and transfers. Due to Medicare regulations, aides are not permitted to provide transportation, cook, or do housekeeping. 

Social workers

Social workers connect patients and families to resources such as adult daycare, aging services, medical equipment, and more. 

Hospice vs. Home Health: Costs and Paying for Care

Fortunately, hospice and home health are both covered by Medicare and some private insurance. There are some differences in how original Medicare and Medicare Advantage plans pay for hospice and home health.  

With a Medicare Advantage Plan, once you start hospice, Original Medicare will cover everything you need related to your terminal illness. Original Medicare will cover these services even if you choose to remain in a Medicare Advantage Plan. As long as you continue to pay your Medicare Advantage premiums, you can keep your plan even while on hospice.

If you were on a Medicare Advantage Plan before starting hospice care, you could stay on that plan as long as you pay your plan’s premiums. If you have Original Medicare, all of your costs associated with hospice care are paid. 

Home health care is a little different. If you have a Medicare Advantage Plan, your options for home health companies might be limited to the ones your plan contracts with. If you have Original Medicare, you can go to any Medicare-certified home health provider. 

Hospice vs. Home Health: Admissions Process

Both hospice and home health require a physician’s order for your insurance to pay for the service. Both also use a nurse to do the initial assessment for admission. For hospice, the nurse will ensure that you are appropriate for hospice and that they can meet your needs.

For home health, the nurse will determine whether the patient is an appropriate candidate for home health nursing and therapies. In some cases, the patient may require more medical assistance than home health can safely offer. Or the patient might have such severe cognitive impairment that home health is not a viable option due to confusion, aggression, and significant memory problems. 

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Hospice vs. Home Health: Finding Care

Finding good care is always a challenge since there are so many companies to choose from. The most important part of the process is to remember that you and your loved ones are the consumer and can choose any company your insurance covers. Physicians and rehab facilities often have contractual arrangements with specific hospice or home health companies and will recommend that you select those companies over others. 

Hospice

Most home health companies offer hospice as well. But each service has an entirely different team of providers. It is almost like they are two separate companies. One company may have a great home health division but not a good hospice.

  • Ask your loved one’s physician who they have worked with and recommend.
  • Talk with friends and family for recommendations.
  • Consult with a geriatric care manager who may have experience with hospice companies for their clients.
  • Ask the social worker at a hospital or rehab facility.
  • You have the legal right to change your hospice company any time you want

Home health

Finding a good home health company is similar to the process of finding hospice, and you can follow the steps above. One added method is to look online for reviews of various companies.  As part of your selection process, make sure you inquire about length of time and continued qualifying criteria. Also find out how often nursing, aides, and therapy staff will come each week.

Hospice vs. Home Health and Care For Your Loved One

Families are often reluctant to choose hospice because they don’t want to give up hope. But once you have tried home health and explored all of the treatment options, hospice can be a huge relief and support.  Your loved one deserves and has the right to make decisions about their care—support them by using hospice and home health when appropriate. 


Source:
  1. “How Hospice Works.” What Medicare Covers, Medicare, 2021. medicare.gov

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