Hospice and Home Health, is there a difference?
For many, a recommendation to home health by a physician is met with relief and gratitude. On the other hand, a recommendation to hospice sometimes causes tears and resistance.
Understanding the similarities and differences may help those referred to hospice see it as a positive, helpful offer of assistance to make their journey more comfortable and less stressful.
The most important differences are:
- Intensity of services: hospice services increase in intensity over time while home health services decrease in intensity.
- Length of time services can be provided: hospice services can remain in the home much longer.
- Focus of care: Home health focuses on rehabilitation and cure, while hospice focuses on aggressive symptom management and pain control. This DOES NOT mean hospice is giving up hope. It means that they are helping you take control of your situation and ensuring that you are cared for exactly as you wish to be.
- Eligibility to receive services: Hospice requires a diagnosis by a physician of a terminal illness. See more details under the hospice category.
A Comparison of Hospice Benefits and Home Health Benefits
(Allowable benefits may differ depending on Medicare or private insurance. Check with your private insurance carrier to clarify services covered under your policy).
|Chemotherapy||Not allowed, considered treatment for cure||Allowed, but not paid for under home health benefit|
|Dietary Counseling||Provided, but limited; needs physician order||Not provided|
|Grief and loss counseling||Up to 12 months after death of loved one||Counseling allowed while services are provided; no counseling after death of loved one|
|Homemaker Services||Not provided||Not provided|
|Certified Nursing Assistant (CNA)||Provided: part-time or intermittent for “hands on personal care”; amount of care time in-home increases over time.||Provided: part-time or intermittent for “hands on personal care”; amount of care time in-home decreases over time.|
|Inpatient Care- short term||Allowed: with prior approval from hospice; requires physician’s order; for symptom management ONLY||Not covered|
|Intravenous Therapy (IV)||Not allowed: not considered symptom management||Provided|
|Medical Equipment||Allowed sometimes: only what is related to hospice diagnosis||Allowed: 80% of approved amount|
|Medical Supplies||Allowed sometimes: only what is related to hospice diagnosis.||Provided|
|Medical Transport||Allowed sometimes: must be approved in advance and related to hospice diagnosis||Not covered|
|Medications for symptom control or pain relief||Covered||Not covered|
|Nursing facility stays||Allowed: does not pay for room and board||Not provided|
|Nursing medical management and home visits||Provided: visits as needed, including after hours||Allowed sometimes: only if patient is homebound and has teachable caregiver in home, after hour on-call nurse not required|
|Occupational Therapy||Allowed: only a few visits; must be ordered by physician||Covered: in the home; must be ordered by physician|
|Oxygen||Covered: if related to hospice diagnosis; must be ordered by physician||Covered: with co-pay and deductibles applying; must be ordered by physician|
|Physical Therapy||Allowed: only a few visits; must be ordered by physician||Covered: in the home; must be ordered by physician|
|Physician Services||Covered: Medical Director visits||Covered: under regular health insurance|
|Psychosocial services- Social Worker||Covered: for patient and caregiver||Covered: for patient only|
|Respite care||Covered: 5 days/ 4 nights.||Not covered|
|Around the clock care||Covered: only in specific circumstances for short period “continuous care; must be ordered by physician||Not covered|
|Speech-language pathology services||Covered: only a few visits; must be ordered by physician||Covered: in the home; must be ordered by a physician|
|Spiritual Care||Covered||Not available|
|Transfusions||Not covered: generally, not covered and not allowed. Each hospice decides on a case-by-case basis.||Allowed, but not covered under home health benefit. Covered by other health insurance.|
|Visits to the ER||Covered: if approved in advance by hospice and related to hospice diagnosis||Covered by other health insurance|
|Visits to a Specialist||Covered: if approved in advance by hospice and related to hospice diagnosis||Covered by other health insurance.|
|Visits to your physician||Covered: ifapproved in advance by hospice and related to your hospice diagnosis||Covered by other health insurance|
|Volunteers||Provided, if available; no “hands-on care”||Not available|