Home Health vs. Hospice Care: What is the Difference?
Home health and hospice care share some similarities, but the two approaches to care address distinct patients with unique needs and goals.
Home Health At a Glance
Home health care is curative. The goal of home health is to help patients recover from injury, surgery, or illness, or progress toward improved functionality. A patient must be homebound to receive Medicare benefits for home health services. Patients typically require intermittent skilled nursing care, physical therapy, speech-language pathology services, or continued occupational services, as prescribed by their doctor. The duration of home health services depends on the patient’s care plan and goals.
Hospice At a Glance
Hospice provides comfort care to a patient with advanced illness when curative medical treatments are no longer effective or preferred. The goal of hospice is symptom management and quality of life. A patient must have a life expectancy of six months or less if their disease runs its natural course, as certified by a physician. “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. In addition to routine care, hospice provides continuous care or inpatient care for acute symptom management, as well as respite care.
Chart: Hospice Care vs. Home Health
| Hospice Care | Home Health | |
|---|---|---|
| Eligibility Requirements | Prognosis required: ≤ 6 months if the illness runs its normal course Skilled need not required |
Prognosis not required Skilled need required |
| Plan of Care | Quality of life and defined goals | Restorative care |
| Homebound | Not required | Required, with exceptions |
| Length of Care | Unlimited | Limited, with requirements |
| Targeted Disease-Specific Program | ✔ | Variable |
| Medications Included | ✔ | ✘ |
| Equipment Included | ✔ | ✘ |
| Levels of Care | 4 | 1 |
| After-Hours Staff Availability | ✔ | ✘ |
| Palliative Care Physician Support | ✔ | ✘ |
| Nurse Visit Frequency | Unlimited | Limited, based on diagnosis |
| RT/PT/OT/Speech | ✔ | ✔ |
| Bereavement Support | ✔ | ✘ |
When Should a Patient Receiving Home Health Consider Hospice?
A home health patient may want to consider hospice if their illness progresses and their prognosis makes them hospice eligible. A study published in the Journal of Palliative Medicine showed that patients receiving home health during the final year of life were more likely to utilize hospice, an indication of the benefits it offers to both patients and families.
The following signs indicate that hospice may be appropriate:
- Unintentional weight loss of more than 10% of normal body weight.
- Palliative Performance Scale score of 50 or less based upon the following assessment of new or evolving inabilities: inability to do any physical activity, chair or bed-bound most of the time, significant or total help required for most of care, reduced appetite or thirst, increased drowsiness or confusion, 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.
Home Health vs. Hospice Care FAQs
- 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.
- 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.
- Is inpatient care included? Hospice care can be provided in an inpatient setting for short stays.
- Are 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.