Hospice vs. Home Health

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).

ServicesHospiceHome Health
ChemotherapyNot allowed, considered treatment for cureAllowed, but not paid for under home health benefit
Dietary CounselingProvided, but limited; needs physician orderNot provided
Grief and loss counselingUp to 12 months after death of loved oneCounseling allowed while services are provided; no counseling after death of loved one
Homemaker ServicesNot providedNot 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 termAllowed: with prior approval from hospice; requires physician’s order; for symptom management ONLYNot covered
Intravenous Therapy (IV)Not allowed: not considered symptom managementProvided
Medical EquipmentAllowed sometimes: only what is related to hospice diagnosisAllowed: 80% of approved amount
Medical SuppliesAllowed sometimes: only what is related to hospice diagnosis.Provided
Medical TransportAllowed sometimes: must be approved in advance and related to hospice diagnosisNot covered
Medications for symptom control or pain reliefCoveredNot covered
Nursing facility staysAllowed: does not pay for room and boardNot provided
Nursing medical management and home visitsProvided: visits as needed, including after hoursAllowed sometimes: only if patient is homebound and has teachable caregiver in home, after hour on-call nurse not required
Occupational TherapyAllowed: only a few visits; must be ordered by physicianCovered: in the home; must be ordered by physician
OxygenCovered: if related to hospice diagnosis; must be ordered by physicianCovered: with co-pay and deductibles applying; must be ordered by physician
Physical TherapyAllowed: only a few visits; must be ordered by physicianCovered: in the home; must be ordered by physician
Physician ServicesCovered: Medical Director visits Covered: under regular health insurance
Psychosocial services- Social WorkerCovered: for patient and caregiverCovered: for patient only
Respite careCovered: 5 days/ 4 nights.Not covered
Around the clock careCovered: only in specific circumstances for short period “continuous care; must be ordered by physicianNot covered
Speech-language pathology servicesCovered: only a few visits; must be ordered by physicianCovered: in the home; must be ordered by a physician
Spiritual CareCoveredNot available
TransfusionsNot 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 ERCovered: if approved in advance by hospice and related to hospice diagnosisCovered by other health insurance
Visits to a SpecialistCovered: if approved in advance by hospice and related to hospice diagnosisCovered by other health insurance.
Visits to your physicianCovered: ifapproved in advance by hospice and related to your hospice diagnosisCovered by other health insurance
VolunteersProvided, if available; no “hands-on care” Not available