At first glance, Medicare’s hospice and home health programs are very similar. Some families even use home health as a bridge to hospice. However, it is a mistake to think of the two as interchangeable. For most patients with a prognosis of six months or less, hospice provides more of the services needed.
Similarities Between Hospice and Home Health
Most hospice is delivered in a patient’s home, just like home health. Both hospice and home health deliver services from six main types of professionals: nurses, physical therapists, speech therapists, occupational therapists, social workers, and nursing assistants. Medicare covers 100% of allowable charges from both programs, but more charges are allowable under hospice.
Differences Between Home Health and Hospice
Hospice Pays for Medical Equipment, Supplies, and Drugs
While Medicare pays 100% of allowable charges for both, more is allowable under hospice. Home health does not cover the cost of drugs. Hospice does cover the cost of medications related to the hospice diagnosis.
Home health only covers supplies that are incidental to the services being performed. For instance, if a home health nurse is providing wound care, the wound care supplies do not cost extra. The hospice benefit, on the other hand, covers all supplies and equipment related to the hospice diagnosis. This can include hospital beds, walkers, and wheelchairs.
Hospice Provides Volunteers and Chaplains
Home health does not routinely coordinate volunteers or chaplain services. Hospice agencies usually have a hospice chaplain available if desired and routinely train volunteers to help families. Volunteers can mean multiple things. Some volunteers provide emotional support, help with errands, help around the house, and do other things to generally support patients and their caregivers. Hospice agencies also have a tendency to coordinate with volunteer programs such as comfort dog services.
Hospice Offers Extended Visits
Both hospice and home health are intended to be primarily intermittent services with visits lasting less than an hour. However, patients nearing the end of life sometimes need a caring, experienced professional to stay longer. The hospice benefit has specific provisions for extended visits in times of need.
Hospice Offers Greater Pain Relief
Intense pain is a common feature of terminal disease near the end of life. Fortunately, hospice is very good at pain management. Hospice can manage symptoms effectively for most patients. Sedatives and high-dosage opioids are common in hospice treatment. In hospice, clinicians are allowed to offer more pain medications. Not only does the more aggressive symptom management improve quality of life, the greater pain relief correlates with people living longer.
Hospice Offers Bereavement Services
Courtesy calls notwithstanding, home health services end when a patient is discharged. In contrast, hospice care continues even after a patient dies. Hospice programs offer months of bereavement support for families.
Hospice Nurses Specialize in End-of-Life Care
Home health nurses specialize in recovery from illness or injury. Hospice nurses, on the other hand, specialize in palliative care at the end of life. It’s a different skill set. Hospice nurses will be more practiced in helping with end-of-life documents, emotional support specific to advanced terminal disease, nutrition management in the context of end-of-life care, advanced symptom management in the context of hospice, and more.
In conclusion, both home health and hospice provide medical and personal care at home. Home health is a program crafted to help people who need nursing or rehab at home to prevent a worsening condition or for recovery. Hospice is a program crafted to be the most useful service for people in the advanced stages of a terminal disease. The hospice program offers the additional benefits of volunteers, chaplain services, more coverage for equipment and drugs, more pain relief and symptom control, bereavement support, and nurses generally more practiced in end-of-life care.