What is the Difference Between Home Health & Hospice Care?
VITAS is the leading provider of hospice care services — end-of-life care brought to each patient wherever they call home. We often get asked how hospice services compare to home health.
What's the Difference?
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.
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.
If the patient is eligible to receive Medicare benefits and you're unsure about the kind of care they need, learn more about the differences between hospice services and home healthcare below.
Who provides care?
Each type of care has a team to suit the patient's needs and diagnosis.
Hospice: Most patients receive hospice services from a Medicare-certified hospice organization, which provides each patient with an interdisciplinary team—physician, nurse, hospice aide, social worker, chaplain, volunteer and bereavement specialist—who come to the patient’s home, wherever they call home: private residence, assisted living community, nursing home.
Home health: Home health agencies bring their services to the private homes of patients in need of skilled care related to their diagnosis, including, but not limited to, registered nurses, certified nursing assistants, speech/language pathologists, physical therapists and occupational therapists.
How long is care provided?
The length varies by type of care and the patient's needs.
Hospice: The patient receives unlimited visits for six months or longer, as long as the patient continues to have a limited life expectancy, as determined by a physician.
Home health: The length of service is determined by the goals of care. The amount, frequency and time period of the services need to be reasonable and the condition must improve or be maintained through therapy.
How often must patients be recertified to continue services?
It ranges from 60 days to six months.
Hospice: A physician must recertify a patient if they outlive their initial six-month prognosis. The first two recertification periods are 90 days; after that the patient must be recertified every 60 days. There is no limit to the number of times a patient can be recertified, as long as the physician’s prognosis is six months or less from the time of recertification.
Home health: Home healthcare patients are recertified after each 60-day episode of care. Medicare does not limit the number of continuous episode recertifications for patients who continue to be eligible for the home health benefit.
Do you have to be homebound to receive care?
Hospice patients do not have to be homebound. It's different for home healthcare patients.
Hospice: Hospice patients do not have to be homebound. That is, they can leave home, take a walk, do errands and even take a trip if they feel well enough.
Home health: Home healthcare patients must be certified by a doctor that they are homebound except for short durations.
Is care available around the clock?
Hospice can provide up to 24 hours/day of skilled nursing and hospice aide services for certain patients.
Hospice: Hospice can provide up to 24 hours/day of skilled nursing and hospice aide services for patients who need acute symptom management and want to remain at home.
Home health: The Medicare home healthcare benefit does not cover 24-hour care.
What if the patient's symptoms can't be controlled at home?
Hospice care can be provided in an inpatient setting for short stays.
Hospice: Hospice care can be provided in an inpatient setting for short stays until symptoms are under control and the patient can return home.
Home health: Home health agencies do not follow patients when they need inpatient care in a hospital.
Can care be provided in long-term care facilities?
Home health care cannot be given to patients in a long-term care facility.
Hospice: Hospice services are brought to patients anywhere they call home, including assisted living communities or nursing homes.
Home health: Home healthcare is provided in the patient’s private residence and 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.
Hospice: The Medicare hospice benefit covers all prescription and over-the-counter drugs related to a hospice patient’s terminal diagnosis.
Home health: Medications are not covered for home healthcare patients under the Medicare home health benefit.
Does Medicare pay for home medical equipment and supplies?
Supplies are covered under Medicare in varying amounts depending on type of care.
Hospice: Under the Medicare hospice benefit, all equipment and supplies related to the terminal diagnosis are provided and covered 100 percent. The need for equipment, oxygen and other products is determined by the patient’s palliative plan of care.
Home health: For home healthcare patients, medical equipment and supplies must be ordered by their physician and are covered 80 percent when approved under Medicare Part B qualification guidelines.
Does Medicare pay for “personal care” of the patient?
For home health patients, medicare doesn't cover personal care services.
Hospice: A hospice aide who provides personal care, such as bathing and mouth care, is a member of the hospice patient’s interdisciplinary team and is covered 100% by the Medicare hospice benefit.
Home health: Medicare does not cover personal care services for home healthcare patients.
Can you receive home health and hospice at the same time?
Medicare patients can receive both if they've met the home health criteria.
For Medicare patients who have met the home health criteria, home healthcare is covered for conditions not related to the terminal diagnosis while the patient is on hospice.