Both bring care into the home, and both are often covered by Medicare. But they are built for different goals, and choosing the right one changes what your loved one's days look like.
The short answer
Home health is about getting better. It brings skilled nursing and therapy to someone recovering from an illness, injury or surgery, with the aim of regaining strength and independence.
Hospice is about comfort. It is for someone with a terminal illness who has decided, with their doctors, to focus on quality of life and symptom relief rather than treatment meant to cure the illness.
Side by side
| Home health | Hospice | |
|---|---|---|
| Goal | Recovery, rehabilitation, staying safely at home | Comfort, dignity and quality of life |
| Who qualifies under Medicare | Someone who is homebound and whose doctor certifies they need part-time skilled nursing or therapy | Someone whose hospice doctor and regular doctor certify a life expectancy of six months or less if the illness runs its normal course |
| Treatment | Curative treatment continues | Comfort care replaces treatment aimed at curing the terminal illness |
| Typical team | Nurses, physical, occupational and speech therapists, home health aides | Doctor, nurses, aides, social worker, chaplain, volunteers and bereavement support for the family |
| What you usually pay with Original Medicare | $0 for covered home health services; 20% of the approved amount for medical equipment | $0 for hospice care; up to $5 per prescription for pain and symptom drugs; up to 5% for inpatient respite care |
Signs home health may be the right fit
- Your loved one is coming home from a hospital or rehab stay and needs wound care, IV medications, or therapy to rebuild strength.
- Leaving home takes considerable effort, or they need help or a device to do it. This is what Medicare means by homebound.
- Their doctor expects them to improve, or wants to keep their condition from getting worse.
Signs it may be time to talk about hospice
- Treatments are no longer working, or the burden of treatment is outweighing the benefit.
- There have been repeated hospital trips in a short time.
- Your loved one has said they want to focus on being comfortable and at home.
- A doctor has raised the question of prognosis.
Choosing hospice is not giving up, and it is not permanent. Under Medicare, a patient can stop hospice care at any time and return to treatment, and can choose hospice again later if they qualify.
Can someone have both?
Not for the same condition at the same time under Medicare. Once hospice is elected for a terminal illness, the hospice team manages the care related to that illness. Original Medicare still covers care for health problems unrelated to the terminal illness.
Questions to ask either kind of agency
- Are you Medicare-certified, and do you serve our address?
- How quickly can you start, and who do we call at night or on weekends?
- How often will a nurse visit, and will we see the same people each time?
- For hospice: do you offer continuous care at home during a crisis, and where would inpatient care happen if symptoms can't be managed at home?
Not sure which kind of care fits? A Grace With Care guide can talk it through with you. Tell us about your loved one or call 855-330-2200.
Sources
- Medicare.gov: Hospice care coverage
- Medicare.gov: Home health services
- Medicare Hospice Benefits booklet
This guide is general information, not medical, legal or financial advice. Coverage rules change; confirm details with the program or your plan.
