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How to Choose Home Health Care or Hospice

Updated on April 24, 2013

Why do people need at home care?

With the trend in healthcare leaning toward shorter hospitalizations and quicker discharges, the need for at home care has never been greater. In addition, home care may also be utilized to prevent premature or unnecessary hospitalizations. A variety of services can be provided with at home care including: patient education related to new or changed medical diagnosis, medications and treatments; laboratory blood testing; urinary catheter changes and maintenance; IV therapy; physical therapy; medication management; assistance with bathing and dressing; and so forth.

These services are primarily provided by two types of service providers: home health care and hospice. While both home health care and hospice provide at home care services, the role and scope of each program is very different; and each has different qualifying criteria and benefits. To choose an at home care provider it is important to understand the differences between them to know which can best meet your needs.

When to Choose Home Health Care:

Choose home health care when:

  • the goal of medical treatment is to heal and recover;
  • the one in need of care is homebound and resides at home;
  • the need for care is part-time and intermittent in nature;
  • medical needs can be effectively managed with 3-6 weeks of care.


What is Home Health Care?

Home health care is a short term service designed to assist in recovery from an illness or injury. This type of care focuses on healing, regaining or maintaining personal functional abilities, and remaining self-sufficient in the home. Services provided include: skilled nursing care; physical, occupational and speech therapy; and medical social services. At times assistance with bathing and dressing can be provided by a home health aide. Services are available 24 hours per day, 7 days per week. A nurse is on call after hours, evenings, and weekends.

Home health care is provided at your home. It cannot be provided at a nursing home or assisted living facility. Further, there is a "homebound" requirement. This means that if you are receiving home heatlh care that leaving the home is not recommended due to the illness or injury or that leaving the home requires considerable and taxing effort. Leaving the home for short periods of time for religious services is allowed.

Home health care is short term and usually lasts from 3-6 weeks in duration. There are times when it may last longer and times when it does not last quite as long. All depends on the speed of healing and recovery.

When to Choose Hospice:

Choose hospice care when:

  • the one in need has a terminal illness;
  • the goal of care is comfort and quality of life;
  • care required extends to 6 months or longer.


What is Hospice?

Hospice is designed to be a long term service providing up to 6 months of care to those who are terminally ill. Hospice focuses on providing medical care that manages pain and other symptoms so that life can be fully enjoyed. Services provided by hospice include: skilled nursing care; home health aide services; medical social services; physical, occupational and speech therapy; spiritual care; and volunteer services. Services are available 24 hours per day, 7 days per week. A nurse is on-call after hours, evenings and weekends.

Hospice also provides (pays for) all medications, treatments and medical equipment necessary to manage the terminal illness. A small co-pay may be required for medications. These benefits alone are a significant help financially to those served by hospice.

Hospice requires a physician's certification of terminal illness with a life expectancy of 6 months or less. Many of those using hospice, however, live longer than 6 months while others may not live as long. Services can continue beyond 6 months with continued certification by the physician.

Comparison of Home Health and Hospice

Home Health Care
Focus on healing and recovery
Focus on comfort care of the terminally ill
Must be homebound
No homebound requirement
Requires a skilled medical need
Requires physician certification of life expectancy of 6 months or less
In the home only
At home, nursing home, assisted living facility
Short term in nature (3-6 weeks)
Long term in nature (6 months or more)
Paid for by Medicare, Medicaid, Insurance
Paid for by Medicare Medicaid, Insurance

Do I need Home Health or Hospice?

To determine if you need home health or hospice, consider your medical situation.

  • Is there a good probability that you will fully recover from the current illness or injury?
  • Were you in good health prior to this episode?
  • What are your personal goals for medical treatment: cure or comfort?
  • Can your medical needs to managed with 3-6 weeks of care?
  • Is your illness long-standing and worsening over time?
  • Is your illness not responding to medical care and treatment?
  • Has the doctor indicated that your illness or injury cannot be cured?

If you were in good health prior to this illness or injury, you expect to fully recover from it, your medical needs can be managed within 3-6 weeks of care, and your personal goal for medical treatment is to cure and heal, then choose home health.

If you have a sudden, long-standing or terminal illness that is no longer responding to medical care and treatment, the doctor has indicated that you cannot be healed or cured, and your personal goal for medical treatment is to be as comfortable as you can be for the remainder of your life, choose hospice.


How do I get Home Health or Hospice?

To get home health care talk with your physician at the hospital or in the office. You will need a prescription for the service. A home health care nurse will come to your home to evaluate you and determine a medical plan of care.

To get hospice care contact either your physician or your local hospice provider. If you are uncertain about the need for hospice, your hospice provider can come to the home, hospital, nursing home or assisted living facility for an evaluation. At that time you will know if you meet the hospice criteria for admission. If so, the hospice will contact your physician for a prescription for the service.

As with all medical services, you have the right to choose your home health care or hospice provider. If you have no preference, the physician will make a recommendation and referral for you.

Some Differences Between Home Health Care and Hospice


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    • kansasyarn profile imageAUTHOR

      Teresa Sanderson 

      6 years ago from Rural Midwest

      Thanks for the read, Ted. I am glad you found the information helpful. Blessings to you!

    • kansasyarn profile imageAUTHOR

      Teresa Sanderson 

      8 years ago from Rural Midwest

      Healthexplorer, thanks for reading. It is my hope that this hub provides necessary information on how to choose either service: home health care or hospice. I agree wholeheartedly that it is a personal decision and depends so much on the nature of the illness or injury. Thanks, again!

    • kansasyarn profile imageAUTHOR

      Teresa Sanderson 

      8 years ago from Rural Midwest

      Sadly, there are all too many stories exactly like yours. Most people are unaware of what resources are available to help them in the most appropriate way. I have always believed that there is a place for all types of medical facilities and medical services along the care continuum - from hospital to hospice. All that most people know and understand, however, is what is marketed and perceived as the "norm." As you say, there is nothing wrong with any particular type of medical care. The question is whether or not the type of care provided is the most appropriate.

      Thanks for sharing. Blessings!

    • hotelmanagement profile image


      8 years ago from London

      Your hub really hit a note with me, thank you for writing such great advice. You see my nan was moved by family members directly into a care home for the elderly, much to the disgust of my mothers side of the family. But we could do nothing but stand back and watch as they, my aunt and uncle, destroyed the life my nan was leading at home. All she needed was home care, and did not need to move into a home with other people. After the move, she has deteriorated severely, not knowing where she is or why she is at this 'place'. Don't get me wrong, it is a good place...just not the place my nan should have been in.

      Thank you.

    • kansasyarn profile imageAUTHOR

      Teresa Sanderson 

      8 years ago from Rural Midwest

      Thank you so much for your review! I have worked for both home health and hospice organizations. This type of nursing is my absolute favorite - working with patients and families in their homes. I hope the article is useful to many more!

    • CarlySullens profile image

      Carly Sullens 

      8 years ago from St. Louis, Missouri

      Oh, I thank you so much for writing this hub. Most people do not know the wonderful service hospice can offer. I used to work for a hospice in Michigan. I loved my job. Both my parents died while being supported by hospice. You did such a great job explaining the similarities and differences.


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