Home Health vs. Hospice Care: What is the Difference?
VITAS is the leading provider of hospice care services — end-of-life care brought to each patient wherever they call home. Since they are both Medicare-funded home services, we often get asked how hospice services compare to home health.
Whether you are a patient, family member or caregiver, it is important to understand what the similarities and differences are between home health and hospice. Choosing the right care at the right time is key.
What Is the Difference Between Hospice and Home Health Care?
Hospice and home health care share some similarities, but the two approaches to care address distinct patients with unique needs and goals.
Hospice provides comfort care to a patient with advanced illness when curative medical treatments are no longer effective or preferred. Home health care is curative, intended to help patients recover from injury or illness, or progress toward improved functionality.
Learn more about the differences between home health and hospice care in the sections below.
What Is Hospice?
Hospice care is comfort care for patients with a prognosis of six months or less if their disease runs its natural course, as certified by a physician.
What to Expect
Routine hospice care takes place wherever the patient calls home—a private residence, nursing home, assisted living community, or residential care facility for the elderly. Daily care is provided by a family caregiver (or friend or private duty caregiver) and supported by an interdisciplinary team of hospice experts: nurse, aide, physician, chaplain, social worker, volunteer, and bereavement counselor, with additional specialists stepping in to help as necessary. All of the team members specialize in compassionate end-of-life care.
In addition to routine hospice care in the home, three other levels of care are mandated by the Medicare Hospice Benefit:
- Continuous care (we call it Intensive Comfort Care® at VITAS) involves around-the-clock attendance at a patient’s bedside by a nurse or hospice aide to manage acute symptom flare-ups per Medicare guidelines.
- Inpatient care is temporary care in an inpatient hospice unit or hospital bed until symptoms are under control and the patient can return home.
- Respite care transitions the patient temporarily to inpatient care in a Medicare-certified facility to give family caregivers a break of up to 5 days and nights to relieve stress and avoid burnout.
Common Hospice Services
- Delivery of medications, equipment, and supplies necessary for management of the patient’s hospice diagnosis—at no charge to patient or family
- 24/7/365 telephone access to hospice experts who can answer questions, address crises, and dispatch clinicians to the patient when necessary
- Spiritual and psychosocial support for patient and family alike, including assistance with funeral services, bereavement counseling, Department of Veterans Affairs benefits, and more
What Is Home Health?
Home health care provides services that are brought to patients who require intermittent skilled nursing care, physical therapy, speech-language pathology services, or continued occupational services, as prescribed by their doctor. The patient's progress must be documented.
What to Expect
Home health care is typically prescribed for treatment of a chronic condition or to help a patient recover from surgery or an injury. Unlike hospice, a patient must be homebound to receive Medicare benefits for home health services. The duration of home health services depends on the patient’s care plan and goals.
While nearly all hospice patients have zero out-of-pocket expenses related to their terminal diagnosis, home health care patients may be required to pay for medications, supplies, and equipment. Home health services do not cover inpatient stays if symptoms escalate and become unmanageable at home. Family caregivers of home health patients receive training and education, but don’t have access to the additional layers of psychosocial support enjoyed by hospice caregivers.
When Should Home Health Become Hospice?
A home health patient can become eligible for hospice as their illness progresses. If you notice the following signs in yourself or your loved one while receiving home health care, ask your doctor about hospice eligibility to relieve symptom burdens and improve quality of life:
- Unintentional weight loss of more than 10% of your normal body weight
- Palliative Performance Scale score of 50 or less based upon the following assessment of new or evolving inabilities: unable to do any physical activity, spend most or all of your time in a chair or bed, need significant or total help for most of your care, eat or drink less than usual, and are increasingly drowsy, confused, or comatose
- Reliance on others for help with three or more activities of daily living, such as bathing, dressing, urine or bowel control, moving from one place to another, walking, and feeding
- Considerable decline in mental alertness, memory, and thinking
- Difficulty breathing or shortness of breath at rest or with minimal exertion
- Ongoing functional decline while living with dementia/Alzheimer’s disease
Similarities Between Hospice and Home HealthHome health and hospice are similar. Understanding their important differences can be made easier by gaining insights into their similarities. Both types of care:
- Can be provided wherever the patient calls home
- Must be provided as a result of a doctor's order based on eligibility
- Are covered by Medicare, Medicaid, the Veterans Administration, and many private insurance companies
- Assist with daily living activities such as bathing, dressing, grooming, etc.
- Are less costly than hospital or facility care
- Can continue as long as the doctor certifies and eligibility is met
Home Health vs. Hospice Care FAQs
We frequently receive the following questions from patients, family members, and healthcare professionals who are seeking more information on the differences between hospice and home health care. If a patient is eligible to receive Medicare benefits and you or your caregiver are unsure about the kind of care that’s most appropriate, learn more about the differences between hospice services and home health care below.
If you have other questions, contact VITAS 24/7 by calling 800.582.9533.
- Who provides care? Each type of care has a team to suit the patient's needs and diagnosis.
- How long is care provided? The length varies by type of care and the patient's needs.
- How often must patients be recertified to continue services? It ranges from 60 days to six months.
- Do you have to be homebound to receive care? Hospice patients do not have to be homebound. It's different for home health care patients.
- Is care available around the clock? Hospice can provide up to 24 hours/day of skilled nursing and hospice aide services for certain patients.
- What if the patient's symptoms can't be controlled at home? Hospice care can be provided in an inpatient setting for short stays.
- Can care be provided in long-term care facilities? Home health care cannot be given to patients in a long-term care facility.
- Are prescription medications covered by Medicare? With hospice, the Medicare hospice benefit covers all prescription and over-the-counter drugs related to the patient's terminal diagnosis.
- Does Medicare pay for home medical equipment and supplies? Supplies are covered under Medicare in varying amounts depending on type of care.
- Does Medicare pay for “personal care” of the patient? For home health patients, medicare doesn't cover personal care services.
- Can you receive home health and hospice at the same time? Medicare patients can receive both if they've met the home health criteria.
- What is the difference between home health care and palliative care? Home health services are aimed at helping patients recover from a serious illness or injury.