What Is Hospice Care at Home? Services, Payment, and What to Expect

Hospice care is a type of medical care offered to patients with an anticipated life expectancy of six or fewer months. It’s not designed to cure or treat a disease or condition, but rather to manage symptoms and improve well-being. Quality of life, comfort, and dignity are all benefits of hospice care at home.

Many seniors opt to receive hospice care in their own home. However, hospice can also be provided in nursing homes, hospitals, some residential care communities, and even designated hospice centers.

Seven in 10 people in the U.S. say they would prefer to die at home, according to a Kaiser Family Foundation poll.^[01] In-home hospice care gives seniors the opportunity to do so comfortably by offering support through a dedicated care team, necessary equipment and resources, and pain and symptom management.

End-of-life care may be provided by registered nurses, nursing assistants, care aides, or even volunteers and family members without medical training. However, your loved one’s doctor, often in conjunction with a hospice physician, will continue to oversee their health plan and monitor them throughout the duration of hospice care.

Hospice care is person-centered. Your loved one’s care team will work with your family to provide individualized support based on clear communication surrounding their physical, spiritual, and emotional needs.

In-home hospice care services

Hospice care services are determined on a case-by-case basis. A senior’s care team will assess their needs and offer some or all of the following services, according to the Hospice Foundation of America.^[02]

• Home visits from a hospice physician, nurse, social worker, home care aide, and spiritual advisor, as well as volunteers
• Pain relief medication and medicine used to minimize symptoms
• Medical equipment and supplies, like mobility devices, oxygen, hospital-style beds, and bandages
• Physical or occupational therapy
• Dietary counseling
• Other pain management services covered by Medicare
• Short-term respite care for family caregivers
• Spiritual and grief counseling, which may be available to family members up to 13 months after the death of a loved one

Palliative care vs. hospice care at home

Palliative care and hospice care are often viewed as similar, but they provide distinctly different services. Both can be offered at home under the guidance of your loved one’s doctor.

• Palliative care is designed for people living with chronic conditions such as heart failure, Parkinson’s disease, cancer, or chronic obstructive pulmonary disease (COPD). Palliative care provides help with symptoms and offers comfort to a patient, such as cancer care for cancer patients. It can occur while a senior is still undergoing treatment that could cure their illnesses and/or conditions.
• Hospice care offers comfort to patients in the end stages of life. It isn’t designed to help treat serious illnesses or prolong lifespans, but rather to allow a natural, comfortable death. Hospice care is only prescribed once a senior stops medical treatment for an illness or chronic condition.

Let our care assessment guide you

End-of-life care at home gives seniors the opportunity to remain in a comfortable, familiar setting surrounded by loved ones and the possessions they’ve acquired over the years. With at-home hospice care, your mom can relax in her favorite recliner or watch the cardinals come and go from the window bird feeder she’s treasured for years.

When your loved one begins hospice care, you can expect the following assistance.

1. A care team to help you through this difficult time. A team of individuals with unique skills will work together to provide the emotional, medical, and spiritual (when applicable) care your loved one needs. This team may include your relative’s doctor, nurses, volunteers, care aides, therapists, and spiritual or religious advisors, frequently chaplains.With hospice care at home, you can expect frequent visits from members of your loved one’s care team. Twenty-four/seven phone support is also generally available. An enormous benefit of home hospice care is the holistic community this care team provides.
2. In-home equipment and amenities. Home hospice care providers can arrange for special equipment, like hospital-style beds, shower benches, and bedside toilets to be installed in your home. This equipment, generally available in a medical setting, can reduce mobility concerns and improve your loved one’s quality of life. Your loved one’s care team can help you learn how to operate these devices effectively.
3. Training and support. Even with home hospice care, families are still responsible for many aspects of their loved one’s daily care. You may need to dress your relative, help them use the toilet, and assist with other activities of daily living, such as bathing and grooming. Your loved one’s care team can help prepare you to take on these tasks and provide training resources.

Read related article:Anticipatory Grief: Learning the Signs and How to Cope

Talk with a Senior Living Advisor

Eligibility for home hospice is determined by a doctor’s opinion that a patient’s life expectancy is six months or less. About 90% of people receiving hospice care die within this timeframe, according to the National Institute on Aging.^[03] However, hospice can be renewed if a senior lives longer than the expected six months.

Your loved one’s doctor may suggest hospice care following a hospital stay or failed course of treatment. Some families may determine that hospice care at home is the right choice after a loved one has lived in a care facility like a nursing home or assisted living community, especially if they would prefer to die at home.

A prescription for hospice care at home requires three main qualifications:

• Your loved one’s doctor believes they have six or fewer months to live.
• Your relative has decided to stop treatment intended to cure a disease or chronic condition, such as cancer or heart failure.
• Your loved one understands that their condition or illness is not responding to medical attempts toward a cure and acknowledges that hospice is intended to provide comfort as the condition runs its natural course.

Once your family has determined that end-of-life care at home is the best choice, you can work with your loved one’s doctor to find a hospice provider and establish a care team.

Hospice care is a $19 billion dollar industry, most of which is funded by taxpayers, according to the National Hospice and Palliative Care Association. Seniors who qualify for hospice care generally don’t have to pay for it out of pocket. Medicare, VA benefits, and private-pay insurance companies all cover hospice services. If you don’t have insurance, there are many charitable organizations that offer hospice care services free of charge to people who qualify financially. It’s also possible to pay privately for additional services insurance doesn’t cover.

Paying for hospice care with Medicare or Medicaid

The Medicare Hospice Benefit — part of Medicare Part A plans — covers all costs associated with hospice care provided by Medicare-approved agencies. Over 90% of hospice providers are Medicare-approved.

After a senior is determined terminally ill with less than six months to live, they must sign a document electing the hospice benefit. This also waives any rights to Medicare payments for any treatments related to the terminal illness or condition, according to the Centers for Medicare and Medicaid Services.^[04] Patients and their families work with a doctor to create an individualized plan of care, and Medicare covers the patient’s needs according to that care plan.

A senior can elect the hospice care benefit for two subsequent 90-day terms. After that, they must be recertified for subsequent 60-day periods. The number of 60-day periods is unlimited, as long as the patient continues to qualify for hospice care based on the above conditions.

Paying for home hospice care with veterans benefits

Hospice benefits are available to any qualified veteran in the end stages of life who’s been determined by a doctor to have six or fewer months to live.

All veterans enrolled in the VHA Standard Medical Benefits Package are eligible for hospice care if they meet the clinical requirements, according to the U.S. Department of Veterans Affairs.^[05] If care is provided by the VA or an organization with a VA contract, there are no copays for hospice care services.

Paying for hospice care with private insurance

Many private insurance policies cover all or some of the costs of hospice care for qualifying seniors. Check with your loved one’s provider to learn more about qualification and coverage, as benefits vary from company to company.

Read more:Who Pays for Hospice Care at Home? Your Options, Explained

Even with a hospice care team, end-of-life care at home can be difficult for family caregivers. Hospice providers won’t be in your home 24/7, and you may need additional assistance to best care for your loved one. Consider the following resources.

Respite care

Respite care offers short-term relief to family caregivers. It can be arranged for a single afternoon or for several days at a time. Choosing respite care can give you time to recharge emotionally and physically.

Home care

Hiring a home care agency or aide can help relieve some of the physical burden of caring for your loved one. In-home care aides can assist with activities of daily living, like dressing, bathing, and toileting. They can also help with meal preparation and light housekeeping.

Home care may be an ideal option for family caregivers who work full-time or are members of the sandwich generation, meaning they care simultaneously for both senior relatives and children. Home care helps support families in need of care beyond what their insurance covers.

Home health care

Even though your loved one must stop receiving medical treatment intended to cure their disease or chronic condition in order to qualify for in-home hospice care, they may still have medical needs. Home health care nurses can assist with medication management, wound care, insulin injections, physical therapy, and more.

If you think your loved one could benefit from home care or home health care in addition to hospice, reach out to one of A Place for Mom’s Senior Living Advisors. They can guide your family through the process of hiring in-home care, all at no cost to you.