Differences in hospice, home health services

Published 7:30 am Saturday, September 2, 2023

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The goal of hospice, palliative care programs, and home health is to provide the best comprehensive care for the needs of their patients. The difference between the services is the focus of that care and the level of care provided.

Vickie Wacaster, Patient and Hospice Advocate with Aveanna Hospice (formerly Comfort Care Hospice)

Home health is usually for patients recovering from an illness or injury or patients needing disease management, whose conditions are expected to improve to the maximum degree the patient can achieve.

Usually, a patient receiving home health will be very ill at the beginning of their care and gradually improve over treatment. In addition, many home health agencies provide disease management for patients still seeking curative treatment while coping with a life-limiting disease.

According to a 2019 survey by Trusted Source, many people need to understand what palliative and hospice care involves. While there is some overlap between the two, they are not the same. Both types of care manage symptoms and address other critical psychosocial needs, to improve a person’s quality of life. However, while palliative care often goes hand in hand with curative treatment, hospice care does not. A person with a severe illness may sometimes receive palliative care.

Hospice care is for patients with advanced terminal illnesses who want palliative care (comfort) and no longer seek curative treatments. The primary goals of hospice care are to provide comfort, relieve physical, emotional, and spiritual suffering, and promote the dignity of terminally ill persons.  Hospice care is for people who no longer want treatment or whose illness has stopped responding to treatment.

A person receiving palliative care may continue to have curative treatment, such as chemotherapy or surgery for cancer.

For people facing terminal illnesses’ end stages, hospice care can help ease pain, discomfort, and other symptoms. This care can help people live their final days as fully and comfortably as possible.

While they treat symptoms, hospice care teams also communicate with family members and provide 24/7 support. They also help terminally ill people and their loved ones make difficult decisions regarding end-of-life care.

Hospice care workers provide emotional support to terminally ill people and their families before and after death.

The four levels of care provided under Medicaid and Medicare coverage are:

1. Routine Home Care: Care is provided in the home or if the patient is in the hospital for a condition unrelated to the terminal illness. The care is intermittent as the hospice team visits the patient periodically to provide care.

2. Continuous Home Care: Continuous Care is provided only during a crisis to maintain the terminally ill patient at home. As death grows closer, a sudden increase in pain is not controlled by a change in the level of consciousness or family members in crisis.

3. Respite Care: Care to patients in an inpatient setting whose caregivers need respite. The patient is placed in a contracted facility that provides daily care. A patient may be placed for up to 5 days for inpatient respite. The hospice team continues to visit the patient daily to monitor and facilitate care.

4. Inpatient Level of Care: The patient requires care that cannot be provided at home, or the home support has broken down. The care is provided in a contracted facility with an RN on site 24/7. The hospice team continues to visit the patient daily to monitor and facilitate care.

Palliative care is covered under Medicare, Medicaid, and some private insurance but does not cover medication, supplies, or equipment. Usually, a patient on palliative care is also on a home health program that provides nursing visits, crises on call, and aide services. The palliative care programs I am most familiar with employ a Nurse Practitioner who makes 1 or 2 monthly home visits to monitor pain and symptoms. The nurse practitioner will call the medication to the pharmacy, and the patient will continue to cover the cost according to their insurance plan. I understand that the nurse practitioner stays in contact with the referring physician about the patient’s condition and changes like home health and hospice do.

Often we in hospice hear of referrals made for patients to a palliative care program (associated with a particular hospice) or home health. Sometimes I wonder if it’s mainly because these programs do not carry the emotional anxiety a conversation about hospice does. Therefore, some physicians may sometimes rely on a palliative care program associated with a hospice or a home health agency to approach the subject of hospice. 

Another reason home health or a palliative care program may be referred to when hospice could be utilized is the misconception that there is a penalty if the patient lives beyond 6 months. However, indeed this is no longer true. Medicare has stated that life expectancy is not an exact science. It only asks physicians to use their best medical knowledge to determine if a patient may have 6 months or less to live if the disease follows the expected course. For this reason, Medicare has established disease-specific criteria and guidelines to assist physicians and hospice professionals determine when a patient is hospice appropriate. In turn, Medicare has established two initial 90-day benefit periods; both the hospice medical director and the patient’s attending physician (if they have one) must initially certify the patient. For all other benefit periods (every 60 days), certification is only required from the hospice medical director. The certification must include a physician narrative to support a life expectancy of six months or less and an attestation statement. (CMS – Centers for Medicare and Medicaid Services). Henceforth, hospice days (when a patient may be on hospice service) are unlimited as long as the patient continues to meet the established criteria.

For Medicare recipients, hospice is a Medicare Part A benefit and does not cost the beneficiary any more or less. Most other insurances, such as Medicaid, Blue Cross, and other commercial insurances, also carry a hospice benefit.

Regardless of the insurance carrier, there is usually no additional cost to the beneficiary. Given statistics, the hospice benefit is underutilized. NHPCO estimates that only about half of the patients who could benefit from hospice actually receive it, and often, those who do receive hospice care don’t receive the full benefit (late referrals).

Interestingly, some home health agencies with a hospice affiliation will transcend their terminal patients to the hospice side when it is deemed that their patient is no longer benefiting from their home health services. However, please remember there is a difference between the emphases of the two industries. Therefore, some patients may wish to change agencies when transferring to hospice due to the agency’s location in correlation with response time. Never should anyone feel pressured to use a hospice, palliative care program, or home health agency. It is always the patient’s choice, and it is their right to be presented with a list of hospices, palliative care programs, and home health agencies with their locations.

A man travels the world over in search of what he needs and returns home to find it.” — George Moore (1852-1933), Irish novelist

— Vickie C. Wacaster is a Patient and Hospice Advocate for Aveanna Hospice (formerly Comfort Care Hospice).