Home care vs Hospice care

modern life interiorsJuly 10, 2008

Are the services provided that different?

If so, how?

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I am not sure what you mean by home care? If you mean hospice in your home or in a hospice hospital. The hospice hospital would take complete care of the patient and at home they only come in a few days a week. My brother in law had hospice in his home until he died. I think most would rather die in their home, but I think it would be harder on the family.

    Bookmark   July 10, 2008 at 5:34PM
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modern life interiors

Thank you stargazzer

    Bookmark   July 10, 2008 at 7:04PM
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I agree, if the family can handle it then hospice at home is a good choice for the patient. However there are circumstances when hospice hospital is a better choice. For those of you with lovedo ones in nursing homes, hospice will also go there, to give family members a break and to make sure they are being well taken care of.

    Bookmark   July 10, 2008 at 8:47PM
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Mom had "home health care" for a number of years - somewhat limited in what they offered; then she had "Hospice at home" care for about five years - they offer more; now she is in a nursing home and hospice folks still are providing some care - i.e. an aide comes to bathe her every other day, the nurse comes once a week, the pastor comes weekly, the social worker visits with Dad monthly, they also provide all medication except antibiotics (Dad must pay for those); they have provided a Geri chair, an oxygen generator, a hospital bed with a pneumatic mattress. Hospice care is for 'end of life' care (in Texas once does not need to be 6 months from dying, simply have an 'incurable' condition - Mom has had MS for 50 years - she is now 91).

They also offered Dad respite care which he never took them up on as up until recently he had 24/7 caretakers for her.


    Bookmark   July 10, 2008 at 9:34PM
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There are differences between home health and hospice. Money and philosophy are crucial.


A patients Medicare entitles them to a certain number of days to receive home health care. Let's say it is 100 days. If that person comes home from the hospital after having, say, a hip replacement, and receives home health care, they use up some of those days in the ultimate recovery and return to health from that operation. If they use 20 days, they have 80 left to use for later.

Home health care ASSUMES that the patient will be making PROGRESS toward BETTER health and/or return to function. They have to document the progress of that patient. Often, a patient receiving home health due to being elderly and frail, will not be getting better, and the home health agency determines the patient is not responding to their rehabilitative efforts. Then hospice becomes the more appropriate choice.


Medicare has a hospice benefit that the patient (or the patient's representative or power of attorney) elects to use. There needs to be a diagnosis of a terminal illness, which the doctor will provide, that basically means the patient will likely expire within 6 months, if the disease runs its natural course. Usually, the patient has decided not to undergo (or is too weak to tolerate) anymore aggressive treatment such as chemo for cancer, etc. Hospice provides all the services, nursing, home health aids, equipment (special bed, commode, oxygen, medications, etc.) that the patient requires for the terminal illness that keep the patient comfortable and with little or no pain as possible. The patient also receives the benefit of any associated social work services, pastoral care, volunteer visits, and then there is at least a year's worth of bereavement support and grief counseling for the loved ones. It is true family support.

Hospice assumes the patient is in a position of NOT recovering or returning to optimal health. There are certain time frames where the hospice physician along with care team must re-certify to Medicare that the patient is still appropriate to receive hospice services.

So, in a nutshell, you see they are quite different...home health is for those who are expected to recover, hospice is for comfort care for those who are most likely, making their final journey.

Mostly, it's about Medicare rules for reimbursement and what exactly is the state of the patient's condition.

Hope that helps.

    Bookmark   July 11, 2008 at 9:05AM
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Barker did the hospice keep her on meds to prolong her life? The care home where my husband was at, knew that I didn't want life prolonging drugs. He had a "comfort care only" document. They told me that Hospice can if they want to, take control of his meds from you. That happened in my BIL's case. Finally a nurse with common sense came in and told my sis not to give him anything except pain and anti depression meds. He died a few days after that.

    Bookmark   July 11, 2008 at 10:54AM
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Hospice didn't provide antibiotics for an upper respiratory infection (prolong life) however, they didn't prevent Dad from getting a prescription and giving it to her. They DID provide antibiotics for a bladder infection (comfort issue rather than life prolonging). I suspect since this is Medicare funded that each state "may" be somewhat different - a previous poster said this was when one had been diagnosed with six moths left to live and for a long time I thought that was how it worked, but NOT SO IN TEXAS - I cannot speak for any other state. Mom has had HOSPICE care for more than THREE years - it is for END OF LIFE care - i.e. one must have an incurable condition (and at the present time MS is incurable - it can be 'slowed' down in its progression but it never goes away)

Anyone considering HOSPICE care should contact a hospice agency and ask for someone KNOWLEDGABLE to explain how it works in that state. Medicare does offer home health care and it is limited in what they can and will do and yes, they want to see 'improvement'.

    Bookmark   July 13, 2008 at 3:00PM
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Home Care and Hospice Home Care are two different things. Regular Home Care can be done by anyone you hire. Hospice Home Care is hospice care that is done because the family or patient prefers that to going to the Hospice facility. When the patient's condition gets to the point where he or she cannot be cared for well, then it's time to be moved where there is 24/7 care and staff.

    Bookmark   July 13, 2008 at 5:46PM
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We have home care here that is funded I think by the state, My mother qualifies for it and could have visits 2 or 3 times a week based on her needs. My mother kicks them out every time we try to get help for her. My husbands former wife had it 5 times a week, she was dying, and I'm not sure if it was hospice or reg home care.

    Bookmark   July 13, 2008 at 6:18PM
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HOME HEALTH CARE - this is a service that can also be provided by a home health care agency AND PAID FOR BY MEDICARE....Mom had that for several years, however, it is very limited in what they provide. When she had that level (home health care paid for by Medicare) she was still able to get around with a Scooter, feed herself, use the toilet; as her abilities declined and after a ten day hospitalization with massive bladder, kidney and lung infections, her urologist stated that we needed to consider Hospice care. I contacted the agency we use (Heartland) to ask what the requirements were....did it mean six months to live? They told me NO, you needed to have an incurable condition - they told me they had folks who had been clients for more than five years. I am in Texas - you may find it different in your state, but Medicare did pay for home health services for several years prior to hospice; the rules may have changed on home health care since she has gone to hospice.

If you have a loved one needing more care than the family can provide, your best bet is to simply call one of the agencies in your area that provide HOME HEALTH CARE and HOSPICE CARE. Ask them what qualifications you need to be accepted. Once you know if you qualify for either one, then ask them what the regulations are regarding care....that is your best bet.

Carolyn who is now dealing with a 95 year old father who is feeling guilty over putting wife of 71 years in a nursing hom; Mom aged 91 who cannot do ANYTHING for herself, and who has some dementia and DH age 58 who is fighting esophageal cancer. Does anyone have the timetable for when I am allowed to have my nervous breakdown?

    Bookmark   July 13, 2008 at 9:20PM
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Tell you what ,Carolyn. I'm in Alabama. You meet me half way at the beach and we'll scream together!!!!
If you consider Home Health Care or Hospice, get the doctor involved that has been there seeing the changes and health problems. That is extremely imprtant.
Home health is limited but can do certain tests where you wont have to make trips to a lab or the doctor's office. There are some supplies they can assist with - bedside commode, special mattress, bandages,help with getting prescriptions and getting to the doctor.
Hospice is a personal choice. They are required to tell the patient that they are with hospice. Hearing the word Hospice can do psychological harm even if medically it definitely is needed. I decided against it as my husband's primary doctor felt, as I did, my husband would give up completely. When that happens they die sooner. You need to talk to the doctor and perhaps they can recommend agencies for you to check with. The doctor does have to sign paperwork for Medicare to pay. If not, you basically will be interviewing them to pick the one you like best. You may know people that have had to use one or both. Talk to them and get their ideas.
I wish you the best, it's not an easy decision.

    Bookmark   July 14, 2008 at 3:32AM
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There is something called "Medicaid Waiver" that will also give you a homehealth aid.

My DH has MS and never knew that hospice may help. He is on the medicaid waiver that I waited 9 years for. My step sister lives in NM and she said you can get the medicaid waiver the same day you apply as long as you quality.

    Bookmark   July 16, 2008 at 5:50PM
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modern life interiors

What exactly is a medicaid waiver? I am not familiar with the term.

    Bookmark   July 16, 2008 at 7:04PM
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I did some reading at the sight below, but still don't understand what it is.

Here is a link that might be useful: Waiver

    Bookmark   July 18, 2008 at 7:35PM
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Basically it is a Waiver that allows Medicaid to kick in and pay for IN Home services, similar to what one would recieve in a nursing home. The services available may vary from state to state. Particapation in this program is based on the income of the person that needs it. I was told it was not based on combined income, but then again, this may vary from state to state.
This allows a person to remain in their home. In my case though it was deemed her level of care was too great for in home services.
Call the local assistance office in your area, they can answer many questions and send you information about the different programs available. They will also come out and do an assement of needs to see if one might qualify.

    Bookmark   July 19, 2008 at 8:35AM
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Linda has it right. Medicaid varies from State to State. The State will set rules for certain payments. Usually this will NOT include home care.

However, if the patient's condition is such that the care is really too much for the family, and there are reasons why a Nursing is not a good choice, then, the family may apply for a waiver of those restrictions for that patient.

At one time, Medicaid would not pay for Home Care under any circumstances. However, they seems to have come to realize that it's cheaper to pay for some Home Care than to pay for Nursing Home Care.

    Bookmark   July 19, 2008 at 9:31AM
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You are correct Agnes, it is an overall program to start helping seniors to be able to stay in their homes. So many seniors have limitations, but not enough to warrant them being in a nursing home, but for many that was the only choice available to them years ago. Now with the waiver program it is affording seniors a chance to remain in their homes longer. However, like every thing, it is based on income, assets and so on............but there are also programs availabe where the senior pays Part of the money and Medicaid pays the rest. So it is worth looking in to, one has nothing to loose.

    Bookmark   July 19, 2008 at 1:52PM
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