How Do Hospice and Home Health Differ?

The primary goal of hospice is to prevent suffering and help someone with a terminal disease live comfortably as long as possible.   Home Health’s [HH] goal is to maintain or improve physical function (in daily activities such as toileting, dressing, walking) in someone not at the end of life.

Both services are covered by Medicare/insurers for limited periods of time and both require a physician to certify that the service is necessary.  With hospice, once a person chooses that benefit, all costs related to that patient’s care must be covered within the daily fee that Medicare pays the hospice; and so, because their goals are quite different, it’s rare for a hospice to cover any home health services [it’s been known to happen in exceptional cases].

For staffing, both services have nurses reporting on the patient’s condition to the attending doctor; both offer help with bathing, dressing, etc., with frequency of visits from HH usually two or three times a week and from hospice ranging from weekly up to daily.

The hospice’s medical director is required to review the medications, prognosis, and general status at least every two weeks, usually in team meetings; whereas the HH sends nursing and therapy  updates to the patient’s doctor.  Some hospice medical directors [such as ours] make house calls, which helps improve care and avoids transportation inconvenience for the patient/family.

Every hospice should have a chaplain (a ‘preacher’ specifically trained in end-of-life issues) and a bereavement counselor to support families for a minimum of 13 months following the death; as well as volunteers to sit with patients, or run errands for the family.

Hospices pay for all patient medications needed for comfort [but, most control costs by using a formulary—like what insurance companies use]; non-comfort drugs or those not likely to benefit someone with a life expectancy less than six months [such as for lowering cholesterol] are not usually covered.  Home Health rarely covers medications.  A few hospices may cover limited palliative cancer chemotherapy or radiotherapy [usually to control pain].

There is no cost for any hospice service/equipment – such as a hospital bed, oxygen, or commode chair—whereas HH may have deductibles and co-pays.