Hospice vs. Long-Term Care: What’s the Difference?

Updated

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

The terms that you hear as you care for your loved one can become confusing. Knowing what you need and when you need it can be overwhelming. Services such as hospice, home care, home health, nursing home care, and long-term care can overlap and even co-occur. 

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Many families reach a point of needing to decide when to initiate hospice and how hospice interfaces with long-term care. There are no concrete or set ways of caring for a loved one because, despite some common changes at the end of life, everyone is different. The important thing is to know what your options are so you can make a choice that honors your loved one’s wishes by providing them with the best care possible.

Anything that you decide should be in concert with your loved one. Once you have a full understanding of the options- what they do, how they do it, and what the cost is-you can have a calm and compassionate discussion with your loved one. 

Overview: Hospice vs. Long-Term Care

To clarify what hospice is versus long-term care, the first thing to remember is that hospice can occur in almost any long-term care setting. In some cases, your community may offer hospice in a free-standing residential environment, but most hospice takes place at home or in long-term care.

The term long-term care generally applies to any ongoing care given to an aging adult. As your loved one ages, there could be a step-down process of decline or a sudden and urgent need for care that ends up being long-term. 

Long-term care can occur at home through private caregivers and home health, assisted living, memory care, nursing home, or board and care. Some aging adults end up with one of these long-term care options and never require anything else until the end of life. Other people may need a higher level of care as they decline.

Hospice is end-of-life care, and is typically time-limited since the requirement is certification from a physician that the person has a terminal condition likely to end in death in approximately six months. But the interesting thing about hospice is that it can act as long-term support and some patients improve on hospice care. Others are on hospice for a short time, and some go on and off hospice for years.

» MORE: Death is hard, but you can make it easier on your loved ones. We walk you through what to do, including helping you get a will.

 

Hospice vs. Long-Term Care: Who Are They For?

Hospice and long-term care can seem opposite each other at first glance, as hospice care is considered short-term for people with terminal illness. However, both can be complementary or even part of a comprehensive care plan. Below, we discuss which may be more applicable for a patient and at what times. 

Who is hospice for?

Hospice is for individuals who no longer want to receive treatment for their terminal condition. They prefer comfort care and pain relief. However, hospice can be a great support whether your loved one’s death is imminent or not.

By choosing hospice, someone is opting not to access outpatient treatment or hospitalization for their qualifying condition. Someone on hospice can still receive treatment for other conditions like infections, eye care such as macular degeneration, and oxygen intake. 

If your loved one is at the point where pursuing treatment is unlikely to improve their condition, then hospice is a reasonable choice. Cancer patients and people with chronic medical conditions such as neurological diseases, dementia, and general weakness can benefit from hospice care. When someone reaches the point where their illness and pain make it too difficult to function, hospice can help with pain management and comfort care.

Who is long-term care for?

Deciding when a loved one is ready for long-term care can be difficult. Most people want to age in place with as much agency and independence as possible. But over time, safety concerns and difficulty managing activities of daily living can lead to consideration of other long-term care options. 

A slow and steady decline prompts families to consider in-home care to assist with bathing, dressing, cooking, and transportation. When the situation worsens, more care might be needed, and if family caregiving can’t provide that care or private caregiving gets too expensive,  some consider assisted living. 

Assisted living can usually meet all of the needs someone has unless they require round-the-clock nursing availability and complex medical tasks. In that scenario, a nursing home could be the only option. Someone with significant dementia may need closer supervision and the secure environment of memory care. 

It is rare, but some families have 24 hours private in-home caregiving and could have hospice in addition to that. Hospice is not round-the-clock care, and if your loved one needs more help than what hospice can provide, then other caregiving has to be arranged. 

Hospice vs. Long-Term Care: Type of Care Received

The types of care received through hospice and long-term care have some overlap, but their goals are different. Most long-term care settings work towards helping you improve your functioning and recover from an illness or surgery. Safety is always a primary concern in long-term care settings. Hospice aims to provide comfort care and ensure that your loved one is pain-free at the end of life with spiritual support.

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Hospice: type of care received

  • Nursing. Nursing is at the center of hospice care since they assess and manage the daily care of your loved one. Nurses are responsible for recommending pain control, overseeing medical issues, and ordering medical supplies.
  • Aides. Aides can come daily for short periods of time to help your loved one bathe and dress. If someone is still ambulatory but has difficulty transferring or walking, you may have to hire an additional person to assist with that. 
  • Spiritual Counsel. Every hospice company has a non-denominational chaplain for spiritual counsel and comfort. 
  • Social work. A social worker can connect families to other resources and offer emotional support. If a mortuary hasn’t been selected the social worker can give options for funeral arrangements. After someone dies, the social worker can assist with grief counseling.
  • Medical equipment. Special equipment like hospital beds with alternating air mattresses, walkers, wheelchairs, oxygen, are examples of supplies that hospice pays for. 

Long-term care: type of care received

The type of care received in long-term care depends on the setting. In-home caregivers through an agency can only perform those tasks that are permitted by state regulations. At a minimum, caregivers can help with bathing, dressing, companionship, cooking, errands, and transportation.

In long-term settings like assisted living, someone can expect a range of monthly services that are usually based on need. Staff in assisted living can help someone transfer, get dressed, bathe, and ambulate. There is nursing available in assisted living to dispense medications and take care of any minor medical issues. Meals, transportation, and activities are standard amenities. A resident of assisted living can have hospice services anytime they qualify. 

Nursing home care offers the highest level of care outside a hospital setting. 24-hour nursing is available along with various medical services like IVs, x-rays, and catheter care.  A nursing home is for people who can no longer afford assisted living, or who have medical needs so complex only a nursing home can help. You can have hospice care in a nursing home, and some have special sections for their hospice residents.

Continuing Care Retirement Communities (CCRCs) are another option for long-term care that offers a continuum of care in one location. Most CCRCs have independent, assisted, memory care and nursing home care on the same campus. When you need more care you move to the next level. Most CCRCs require a large deposit for a “buy-in” and additional monthly costs. 

Hospice vs. Long-Term Care: Costs and Paying for Care

There is quite a difference between paying for hospice vs. long-term care. Unless you have long-term care insurance or are in skilled nursing, long-term care will be private pay.  According to Genworth, the median hourly cost of care for a caregiver is $23.50 an hour. Assisted living is $4300 a month, and nursing home care for a semi-private room is $7,756.

Medicare, on the other hand, pays for hospice. You do have to continue to qualify for the benefit, but as long as you meet the criteria Medicare will pay for the full cost of hospice. 

Hospice vs. Long-Term Care: Admissions Process

Hospice, assisted living, and nursing homes all have an admissions process that is a little different. All three use a nurse to do an initial assessment to see if your loved one is appropriate for the level of care under consideration. A physician must write an order for admission to hospice and a nursing home.

For in-home care, the assessment is usually done by a staff person, not necessarily a nurse,  to ensure that caregivers can meet the needs of the client. If a potential client has ongoing medical requirements then in-home care might not be sufficient. 

» MORE: Death is hard, but you can make it easier on your loved ones. We walk you through what to do, including helping you get a will.

 

Hospice vs. Long-Term Care: Finding Care

Finding any kind of care for a loved one can be daunting. There might be lots of options or very few and both present a different set of challenges. Remember, if you select a hospice company and aren’t happy, you can change. Changing a long-term care residential setting is harder since it involves a move and can be stressful for everyone. 

Finding hospice care

Most home health companies also do hospice care. You could have a hundred options or a few. If your loved one has had home health, you could use the same company for hospice. Talking with friends and family, healthcare providers, to get their recommendations is a good start. Call your local area agency on aging to see if they know of good companies. Even an online search can be valuable. 

Finding long-term care

You can use the same methods as finding hospice, but for long-term care working with a professional can make a big difference. A good senior care placement specialist or geriatric care manager has first-hand experience with clients and providers. These professionals can offer a level of expertise not easily found anywhere else. 

Unlike hospice, when finding assisted living, memory, or nursing home care you can visit the community. An in-person visit gives you the opportunity to assess the environment, meet the staff and get a feel for the other residents. 

For in-home caregivers, you could again have many choices. Look to the same sources mentioned for hospice and long-term care settings to give you recommendations. Interview the agency and request a meet and greet with any potential caregiver for your loved one. Changing in-home care agencies is always a possibility if you aren’t satisfied with the care. 

Choosing Between Hospice vs. Long-Term Care

Now you have a clearer picture of what hospice and long-term care mean and how they can help your loved one. These decisions aren’t easy, but with advance planning and honest discussions with your loved one, you can make some wise choices. 

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