Understanding Hospice Care at Home

This article has been medically reviewed by Dr. Martin Duggan in 2021

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

Hospice care at home is a significant part of your loved one’s well-being in his/her final months of life. 7 in 10 Americans say they would prefer to die at home, yet unfortunately many aren’t able to receive hospice care at home in line with their wishes. 

Hospice care at home may be the answer for families who want to transition from curing a loved one to caring for one. In-home end-of-life care prioritizes the comfort of the patient and focuses on relieving pain. 

During hospice care, patients don’t receive unwanted treatments. Instead, given that patients have only months left to live, in-home hospice care is limited to providing physical relief and support – within the familiar setting of a family home. 

Let’s get a better understanding of hospice care at home by looking at these most frequently asked questions.

What is hospice care at home?

When an illness can’t be cured – or a patient chooses not to pursue treatment – hospice teams will take on patient care. In general, they are dedicated to managing pain and symptoms, as well as providing other types of support. In a home setting, hospice care involves medical and nursing care, as well as aid to family caregivers. 

Who provides hospice care at home?

Hospice care teams often consist of several members. In particular, the hospice nurse or aide may make daily visits to a hospice patient at home to check vitals and provide custodial care such as a bath. In addition, a doctor, social worker and chaplain may also be involved with weekly at-home visits to monitor care and comfort. 

Overall, hospice care is highly personalized according to your loved one’s needs. This team can help answer questions and offer palliative care to the patient. Typically, these health workers will look to the family caregiver for guidance on the patient’s most pressing needs.

What services does hospice care at home offer?

Besides medical and nursing care, hospice care may also include related areas, such as: 

• Physical therapy, or rehabilitation
• Respite care for caregivers
• Spiritual and psychological guidance
• Bereavement care for the family
• Financial and insurance information 

As you can see, hospice care can be quite comprehensive. You should check with your local hospice provider to understand what services they offer.

What services doesn’t hospice care at home offer?

Some family caregivers may be surprised to learn that hospice care at home isn’t usually 24/7. In fact, in-home hospice care typically involves a daily visit from a hospice nurse and semi-regular visits from a doctor, health aide, social worker, chaplain or others. There may also be visits from therapists, counselors, dietitians and volunteers. 

Hospice nurses usually come by once a day for an hour or so. However, a hospice team is always available 24/7 by phone in case of an issue or emergency. This means that family caregivers will be responsible for the bulk of custodial care, as hospice doesn’t typically cover this service. 

However, hospice agencies will provide medical equipment such as a hospital bed, oxygen machine, and wheelchair, as well as prescriptions for pain management. 

What are the benefits of home hospice care?

Hospice care at home can be the ideal decision for your family. The setting of being at home may be the patient’s wishes. Or perhaps the comfort of home helps him/her feel less anxious. In particular, dementia patients tend to recognize their surroundings and may benefit from receiving hospice care at home. 

In addition to comfort, there are other benefits to home hospice care, including:

• Home service can reduce stress for the family, as they can more easily coordinate care in the family home. 
• It can be easier for friends and family to visit the loved one, as the flexibility is greater than a facility. 
• Home hospice care uses a personalized team, which means the patient can make connections with consistent care providers. It’s also comfortable to have the same health workers entering the family home. 
• Home hospice care also avoids the isolation, confusion and perhaps discomfort of being in a facility. 
• Home hospice can be more affordable because it’s not 24/7 like a care facility. 

Overall, hospice care at home may be a more personal and comforting service than being in a care facility. 

Is home hospice care or facility hospice care best?

Of course, the decision of receiving hospice care at home or in a care facility will depend on every family’s needs and every patient’s wishes.

The clearest benefit of home hospice care is the comfort of your loved one. It’s also the most affordable option by far. 

However, hospice care provided at a care facility can also be a suitable choice. This is especially true if your loved one requires 24/7 attention that a family caregiver can’t provide. It could also be a welcoming option if the patient doesn’t have a strong connection with their current home, or doesn’t want to make end-of-life memories in that home. 

How does one start hospice care at home?

While receiving hospice care is the decision of the patient, doctors will often recommend when it’s time to start hospice care. As a general rule, hospice care is designed for those who have about 6 months or less of life left. 

Before your loved one begins a hospice program, a hospice member will visit you and find out your specific needs. From there, care will begin in the care setting of the patient’s choice, including home care. 

If you’re not sure when it’s time to call hospice, you can get more details in our guide.

What’s the difference between hospice care and palliative care?

Hospice and palliative have slightly different focuses. Hospice care is a type of palliative care intended for patients who are in the final stages of their life. For this reason, treatment to cure an illness isn’t generally administered. Instead, relieving pain and symptoms is the primary role of hospice care. 

In contrast, palliative care is for patients with serious illnesses, including cancer, heart disease, dementia and others. This care is also intended to relieve pain and symptoms, but can be provided within the framework of primary treatment. Like hospice care, it’s designed to improve quality of life for the patient, regardless of the stage of illness. For this reason, palliative care doesn’t necessarily mean a patient is dying.

When a patient with a serious illness decides to no longer receive treatment, or has only a few months left of life, hospice care will be recommended. 

Who pays for hospice care at home?

Hospice care at home can be covered by a few different healthcare programs. 

Medicare

Medicare provides a Hospice Benefit. Patients who receive Medicare-certified hospice care will not pay anything. Your doctor will certify that you’re terminally ill (have 6 months or less left to live) and you’ll sign a statement that you agree to receive hospice care instead of care intended to cure your illness. 

While hospice care is 100% covered by Medicare, keep in mind that Medicare won’t cover:

• Room and board in care facilities
• Treatment/drugs related to curing your illness
• Care not coordinated by the hospice team

In addition, you may be responsible for a $5 co-payment for certain prescription drugs related to your hospice care, as well as 5% of any respite care. 

Overall, the Medicare Hospice Benefit is quite comprehensive and will take care of almost all your needs during hospice. 

Veterans’ Administration (VA) 

Moreover, veteran’s healthcare also covers hospice care. All enrolled veterans are eligible for hospice care without any copayments. Hospice can is covered at home, or in another clinic setting. This is a comprehensive benefit that gives all enrolled veterans who need hospice care peace of mind. 

Medicaid

Medicaid may or may not cover hospice care. Remember that Medicaid isn’t just one program: every state provides a different Medicaid service, which means coverage varies by state. 

What does this mean for your hospice care coverage? You’ll need to check your state to find out if Medicaid covers hospice in your location. Hospice care is considered an optional benefit, which means some states offer coverage while others don’t. 

If your state does cover hospice care, you’ll need doctor certification that you’re terminally ill, as well as a statement that you’re waiving care intended to cure your illness. There are five levels of hospice care under Medicaid, including routine home care, continuous home care, inpatient respite care, general inpatient care and service intensity add-on care. 

You’ll need to check with your Medicaid by state to get more details about what may be covered. 

Private coverage

Your private health insurance provider may also cover hospice care at home. This will vary widely depending on your provider. Most but not all private insurance plans cover some hospice care. You should contact your provider directly for more details. 

How can I find the right home hospice care provider?

Finding the right hospice care provider isn’t as hard as you may think. You can start your search on My Caring Plan by clicking on Hospice care. 

At the same time, if you need more information about hospice care or senior care in general, you should take a look at our senior resource center. You’ll get everything you need to guide your decision-making about end-of-life planning, hospice care and more. 

We wish you and your family all the best. 

Sources:

1. What Are Palliative Care and Hospice Care?, NIH, www.nia.nih.gov
2. Where do Americans die?, Stanford School of Medicine, palliative.stanford.edu