What's the Difference Between Hospice and Home Health Care?

Hospice care and home health care are both viable in-home solutions for those who are dealing with a terminal illness or other medical needs.

While hospice care provides end-of-life comfort and support for patients who have a limited life expectancy, home health care focuses on helping patients recover from a medical condition that prevents them from leaving home.

But that's not the only difference.

‍Hospice vs. Home Health Care

Let's first take a look at what these two care programs have in common.

Both programs:

• Provide personalized and compassionate care to patients in need
• Require a doctor to certify that it is medically necessary to receive these services
• Are (at least partially) covered by Medicare
• Allow patients to receive care at home
• Offer both physical and psychosocial services
• Can go on for as long as your doctor certifies that you are eligible

A Closer Look at Hospice Care

The goal of hospice care is to provide comfort and support to individuals who have a terminal illness and don't have much time left.

When someone is in hospice care, the focus shifts from curative treatments to pain and symptom management.

It aims to ensure that the patient can live out their remaining days as pain-free and with as much dignity as possible while offering some relief and comfort to their family as well.

Eligibility requirements

To qualify for hospice care benefits, you must be terminally ill. More specifically, a doctor must certify that you have no longer than 6 months to live.  

You must also sign a waiver declaring that you no longer wish to receive medical services intended to treat your illness. If you change your mind, however, you can cancel your hospice benefits at any time.

Hospice services covered by Medicare

As long as you have Part A of Medicare and meet the eligibility criteria above, Medicare will provide coverage for some or all (depending on your specific needs and the plan your hospice team creates for you) of the following hospice services.

The services must be provided by a Medicare-certified hospice care facility.

If you have a Medicare Advantage Plan, you can stay in that plan and receive services that aren't related to your illness, and Original Medicare will still cover your hospice services.

• Doctor/Nursing services
• Durable medical equipment like wheelchairs or oxygen supplies
• Medical supplies
• Drugs for pain and symptom management
• Aide and homemaker services: Assistance with personal care and household tasks
• Physical, occupational, or speech therapy
• Social services
• Dietary counseling
• Spiritual and grief counseling: for both you and your family.
• Short-term inpatient care: Hospitalization for pain and symptom management
• Inpatient respite care: temporary relief for caregivers while you receive care in an inpatient facility
• Any other Medicare-covered services that your hospice team recommends to help manage your pain or symptoms

Number of visits

You're only eligible for hospice care if you have been given a life expectancy of 6 months or less. However, if needed, care can be extended past that initial 6 months as long as a doctor recertifies you for longer.

The number of visits a hospice patient receives is tailored to your needs. Generally, the number of visits increases as time goes on since needs are expected to increase as well.

Location

Hospice care can be provided either at home – whether you live in a house, assisted living, or residence – or in a hospital.

This flexibility allows you to receive the necessary care and support you need wherever feel most comfortable.

Costs

Given that you have Part A of Medicare and the hospice care is provided by a Medicare-certified hospice care facility, Medicare will cover the cost of your hospice care; however, you may still have a few out-of-pocket expenses.  

You are responsible for a copay of up to $5 for prescription medications prescribed for pain management.

You may also be responsible for 5% of the Medicare-Approved Amount for inpatient respite care.

If you live in a nursing facility or residence, you may also have to pay for room and board.  

If you have questions about the potential costs of your hospice services, your doctor or insurance provider will be able to provide you with the most accurate information.

Understanding Home Health Care

Home health care is all about the road to recovery. It is designed to help patients recover and regain their independence after an illness, injury, or surgery.

Eligibility requirements

Like hospice, a doctor must certify that you require these health services. They must state that you need temporary or part-time skilled services like the ones we've listed below.

You must also be "homebound," meaning you can't leave your home, or have trouble leaving without the help of a cane or wheelchair, or help from another person, because of your medical condition.

Homecare services covered by Medicare

Both Part A and/or Part B of Medicare will cover home health care, as long as they are provided by a Medicare-certified home health agency.

Covered services include:

• Skilled nursing care: for things like wound care or administering medication
• Physical, occupational, or speech therapy
• Medical social services
• Home health aide care: only if you’re also getting skilled nursing care at the same time
• Injectable osteoporosis drugs for women
• Medical equipment and supplies

Number of visits and timeframe

Unlike hospice care, home health care is meant to be temporary, and the number of visits usually decreases with time as you get better.

Since one of the eligibility requirements for home health care is that you need "part-time or intermittent" services, you're only able to get care for less than 7 days per week or less than 8 hours each day over a period of 21 days (or less).  

This can also be extended with a recertification from your doctor.

Location

Home health care is only offered at home.

Your healthcare team, which will be made up of nurses, physical therapists, and occupational therapists, will come to your residence to provide support and take care of any medical needs you have.

Costs

Medicare-covered home health care services are usually covered at 100%. If there is anything that isn't going to be covered, your home health care agency should notify you beforehand in writing with an Advance Beneficiary Notice which will tell you exactly how much you'll have to pay.

For durable medical equipment – like wheelchairs, canes, or any Medicare-approved equipment your doctor prescribes for you to use at home while recovering – you will pay 20% after you meet the Part B deductible.

Transitioning From Home Health Care to Hospice

When a home health patient's illness progresses instead of improves, there may come a point when they decide that they no longer wish to cure their illness and would rather just treat their pain and symptoms.

At that time, a transition from home health care to hospice can be the natural progression in their care.

This shift will help make sure the patient continues to receive the care they need, prioritizing their comfort and overall well-being during challenging times.

Conclusion

While both hospice and home health care provide essential medical services and support in a time of need, the setting, goals, and services provided vary between the two.

If you'd like more information on which type of care your Medicare plan covers, or how your Medicare Advantage Plan comes into play when you need one of these services, reach out to us at Sams/Hockaday.

Our team of experts is here to help you navigate your plan and ensure you get the care you need.