Hospice vs. Nursing Home Care: What’s the Difference?

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

You may be familiar with both the terms hospice and nursing home care. Understanding the difference between the two could be confusing unless you have had experience in one or the other. You may have a negative emotional response to both hospice and nursing home care since either form of care is for patients who have significant needs.

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By educating yourself on both of these support systems, you can plan early to provide your loved one with the appropriate care. Most people say they want to avoid nursing home placement, and with good reason. Some nursing homes sadly have a reputation for poor staffing and infection control, and the environment of many of these homes can feel very institutional.

On the other hand, people are also reluctant to opt for hospice because they think it means that they are dying or that hospice will hasten death. We will sort out the differences and inform you on how and when to choose one or the other or both. 

Overview: Hospice vs. Nursing Home Care

The primary difference between hospice and nursing home care is that a physician has to certify that you have a terminal condition with approximately six months to live to qualify for hospice care. A terminal illness is not necessary for placement in a nursing home. 

Another important distinction for nursing home care is the difference between long-term nursing home care and skilled nursing home rehabilitation. Short-term skilled nursing is for patients who qualify for rehabilitation services that are covered by their health insurance.

Long-term nursing home care requires the patient to pay privately or qualify for Medicaid. For this article, we will refer to long-term nursing home care. It is possible to receive hospice care in a nursing home but rare due to the extensive medical support available in nursing homes. 

Hospice vs. Nursing Homes: Who Are They For?

One of the frustrating aspects of hospice care is the misconceptions about who it is for and when to start. The philosophy of hospice is one of comfort and patient-centered care.  Due to fears and misunderstandings about hospice, families often wait longer than they should to start this valuable service.

Who is hospice for?

Hospice is for people who no longer wish to pursue treatment for the condition that qualifies them for hospice. For example, if you have cancer, you may no longer want to pursue aggressive treatment due to side effects and that treatment is unlikely to change your condition or the outcome. The hospice philosophy states that individuals have a right to receive comfort care, pain relief, and spiritual support without medical treatment. 

The requirement for eligibility for hospice care is that a physician certifies you have a terminal condition with a life expectancy of six months. However, patients can live on hospice for long beyond those six months, and some patients go on and off hospice for years.

Some conditions that can qualify you for hospice care are heart disease, kidney disease, cancer, ALS, Parkinson’s disease, stroke, or lung disease. Just because someone is on hospice doesn’t mean that they can’t choose treatment for other conditions not associated with their terminal diagnosis. For example, someone may choose antibiotics for an infection or treatment for macular degeneration. 

Who is nursing home care for?

Nursing home care is for people with highly complex medical needs that can’t be managed safely in the home. Generally speaking, people who go to nursing homes require round-the-clock care for activities of daily living and other medical conditions. A terminal illness is not a requirement for nursing home placement. 

It is possible for families with unlimited financial assets to keep someone at home with 24-hour nursing, but the equipment necessary to provide that care might not be possible. Most families who opt for nursing home care don’t have the resources to keep someone at home.

Hospice vs. Nursing Homes: Type of Care Received

There is some overlap in the type of care received through hospice and nursing home care, but not much. Nursing home care assumes that treatment is ongoing and hospice care presumes that the patient no longer wants medical intervention. An important note: hospice care is not 24-hour care, and any additional care needs have to be supplied by the family or paid caregivers. 

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Hospice: Type of care received

Hospice care tends to focus on alleviating pain for the patient and making their day-to-day experiences with their illness easier. Here are some of the specific types of care you may see when a patient receives hospice: 

  • Pain relief: Relieving pain and suffering is a specialty of hospice. Hospice staff is skilled and trained at using various methods to control pain related to the terminal condition.
  • Nursing services: Although every hospice has a medical director that is an M.D., the hospice nurse is at the center of care. A nurse usually visits a hospice patient at least once a week up to several times a week to assess the patient’s condition.
  • Aides: Someone on hospice might have difficulty dressing, bathing, walking, or eating. Aides assist the patient with all of these activities but are usually only available three times a week for an hour or so.  
  • Medical equipment: Insurance through hospice typically pays for any medical equipment that contributes to comfort care and quality of life. Examples are hospital beds with alternating air mattresses, continence supplies, walkers and wheelchairs, and oxygen. 
  • Spiritual services: Every hospice company has a non-denominational chaplain available for spiritual counsel. A hospice patient’s family is also eligible to receive spiritual support.
  • Social work: A social worker completes a psychosocial assessment of the patient to determine any mental health or other needs. The social worker is also available to the patient’s spouse or partner as well. 
  • Medications: Pain medications are supplied by the hospice company under the direction of their medical physician and are covered by most insurance. 

Nursing Home: Type of care received

As mentioned above, the main difference between nursing home care and other types of care like hospice is the 24-hour availability. Patients at nursing homes can expect to have someone to respond to their care needs at all hours of the day. However, there are some other options that may be different or unexpected.

  • Medical services: Nursing homes are as close as you can get to hospital care. Not every nursing home will have all the medical equipment necessary to treat you, but if they don’t, they will send you to an outpatient setting for those interventions. However, most nursing homes have labs, x-ray capability, catheter care, intravenous medications, dialysis, and more.
  • Nursing: A nurse is on staff at the nursing home 24-hours a day. 
  • Aides: An aide is available 24-hours a day to assist with getting up to the bathroom or any other personal needs.
  • Meals: Nursing homes provide all meals and snacks
  • Physical and occupational therapy: Physical and occupational therapy are offered if ordered by the physician and deemed appropriate.
  • Activities: Group and individual recreational activities are available.

Hospice vs. Nursing Homes: Costs and Paying for Care

There is a big difference in paying for care between hospice and nursing homes. Insurance pays for hospice care if you meet all of the qualifying criteria. Continued hospice care requires a re-certification process, but as long as there is a recertification by a physician that you continue to qualify, your insurance is likely to pay. 

Unless you have a long-term care insurance policy, nursing home care is private pay. According to Genworth, in 2021 the monthly median cost of nursing home care is $7,756 for a semi-private room. Most people will not have the option of a private room which costs more. Since Medicare does not cover long-term nursing home care, many families exhaust their financial resources and qualify for Medicaid, which pays for nursing home care. 

The exorbitant cost of nursing home care is one reason to plan well ahead for care. It is possible to avoid nursing home care with a combination of in-home and home health services, but not always. If your loved one no longer wishes to pursue medical treatment, starting with hospice may delay or eliminate the need for nursing home placement. 

Hospice vs. Nursing Homes: Admissions Process

Both hospice and nursing home admission require a physician’s involvement. Hospice requires a physician to certify that you have a terminal illness and have approximately six months to live. Once the physician signs that order, a hospice nurse comes to your residence to conduct the full admission.

The admission process for hospice involves a complete assessment of needs, ordering of pain medication and medical supplies, and initiation of other services like social work and spiritual support. The hospice nurse also determines, at least for the short term, how often hospice staff needs to visit.

Each state has a slightly different nursing home admissions process, but generally speaking, these are the requirements for nursing home placement. Many of these requirements prevent families from placing someone in a nursing home because they have no other alternative.

  • Physician’s order: A physician must sign a form that indicates that the patient requires a nursing home level of care.
  • Order for treatment and medications: Once your loved one is admitted to a nursing home, they will have a new treatment team and a nursing home physician. 
  • History and physical: Your loved one’s current physician provides the medical history and physical.
  • State requirements: Each state has a form that is required for nursing home admission. 
  • Tests: Most nursing homes require a negative TB test and COVID test before admission. 
  • Admissions paperwork: The admission paperwork for a nursing home is extensive and involves, but is not limited to, all demographic information, power of attorney, POLST, cost of care, and consent to treatment. 

Hospice vs. Nursing Homes: Finding Care

Finding good healthcare in any form is a challenge. First of all, identifying reliable sources of information can be tricky. How do you know who to trust? The vetting process for finding a good hospice care company will be more straightforward because you can always change companies. With a nursing home, making a change will be much tougher since it would involve changing locations.

How to find hospice care

When it comes to hospice care, it can be as easy as just talking to folks in the neighborhood to see what they recommend. However, it may also require you to do some research, especially if you are looking at companies outside of what a doctor recommends. 

  • Word of mouth: Talk to your friends and neighbors about hospice care. If they have used a particular company, they can give you first-hand information about the quality of care.
  • Ask your healthcare provider: Once word of caution in using this method. Some physician’s offices have relationships with specific companies that they refer to. This is not to say that the preferred companies they recommend are not good, just know that you have a choice of any company you want.
  • Ask an eldercare professional: Consider talking with an elder law attorney, senior care placement specialist, or geriatric care manager for their opinion. 

How to find a nursing home

In the past, many consumers turned to the Centers for Medicare and Medicaid Services (CMS) to review their star rating systems of nursing homes. Investigative reporting reveals that many nursing homes distort their data to appear to provide better care than they do. There are other ways to find reliable nursing home care.

  • ProPublica: ProPublica has a nursing home inspection report that is worth reviewing. The report looks at deficiencies and penalties of nursing homes across the country.
  • Local ombudsman program: The ombudsman program is a federally mandated program administered by the states to investigate nursing home complaints. If you call your state office you can get specific information related to nursing homes under consideration.  
  • Online: Online is an option for getting people’s opinions on their experience at specific nursing homes. But be careful since you can’t be sure that reviews are from reliable sources. 

The Difference Between Hospice Care vs. Nursing Home Care

Now you should have a better idea of the difference between hospice and nursing home care. Both have a place in the care of family members, but consider all of the factors before making a choice. Advance planning will provide you with a roadmap of preferences and costs of care so that you can make the best decision for your loved one.  


Sources:
  1. “CMS Nursing Home Ratings Offer a ‘Badly Distorted Picture of Care’ a NY Times Investigation Alleges.” Daily Briefing, Advisory, 16 March 2021. Advisory.com.
  2. “Cost of Care Survey.” Cost of Care, Genworth, 2021. Genworth.com.
  3. Groeger, Lena and Charles, Orstein. “Nursing Home Inspect." ProPublica, November 2021. Pprojects.propublica.org.
  4. Salopek, Jennifer. “Medicaid Coverage for Nursing Homes: Don’t Spend Down Without a Plan.” Financial and Legal, AARP, 21 October 2021. Aarp.org.
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