Hospice vs Home Health Care: Understanding the Differences
VITAS Healthcare
Source: This content was published by VITAS Healthcare
Read original articleBased on information from leading healthcare providers, 2025
Two Different Services, Two Different Goals
One of the most common sources of confusion in healthcare is the difference between hospice care and home health care. While both can be provided at home, they serve fundamentally different purposes and meet different needs.
Understanding these differences can help you access the right care at the right time.
Primary Purpose: The Key Distinction
Home Health Care: Curative and Rehabilitative
Goal: Help patients recover from injury, surgery, or illness, or progress toward improved functionality.
Examples:
Focus: Getting better, regaining independence, improving health outcomes.
Hospice Care: Comfort and Quality of Life
Goal: Provide comfort care to patients with advanced illness when curative medical treatments are no longer effective or preferred.
Examples:
Focus: Managing symptoms, maintaining dignity, supporting quality of remaining life.
Eligibility Requirements
Home Health Care Eligibility
Medicare requirements:
1. Homebound status: Patient must be substantially confined to home
- Leaving home requires considerable and taxing effort
- Absences must be infrequent and short duration
- Can leave for medical appointments or religious services
2. Skilled care need: Requires services of a skilled nurse or therapist
- Not just assistance with daily activities
- Needs professional medical or rehabilitation services
3. Doctor's orders: Must be prescribed by a physician
4. Intermittent care: Services are needed on a part-time or intermittent basis (not 24/7)
Duration: No specific time limit; continues as long as patient shows improvement or maintains current level with skilled intervention.
Hospice Care Eligibility
Medicare requirements:
1. Terminal diagnosis: Life expectancy of 6 months or less if disease runs its natural course
- Must be certified by physician
- Can continue beyond 6 months with recertification
2. Choice to forgo curative treatment: Patient elects comfort care over cure-focused treatment
3. Medicare Part A: Must have hospital insurance
4. NOT required to be homebound: Can leave home, attend events, and live actively
Duration: Can continue indefinitely as long as patient remains terminally ill and physician recertifies.
Care Availability and Scope
Home Health Care Services
Services provided:
Visit frequency:
24/7 availability: No - home health does not provide round-the-clock care or on-call support
Duration per visit: Limited to what Medicare approves based on skilled care needs
Hospice Care Services
Services provided:
Visit frequency:
24/7 availability: Yes - hospice provides round-the-clock access to nursing support and can send someone to your home any time, day or night
Duration per visit: Based on patient need, not insurance limitations
Coverage and Costs
Home Health Care Coverage
Medicare Part A or B coverage:
- Medications NOT covered under home health benefit
Limitation: 60-day certification periods with recertification requirements
Hospice Care Coverage
Medicare Part A hospice benefit:
- 100% coverage for all hospice services
- Medications covered for terminal diagnosis (up to $5 copay per prescription)
- All medical equipment 100% covered
- No coinsurance or deductibles for hospice services
No limitation: Can continue indefinitely with recertification
Care Settings
Home Health Care
Where provided:
Rarely in: Assisted living, nursing homes (these facilities typically provide their own nursing care)
Hospice Care
Where provided:
Not required to be homebound: Can receive hospice while still active and mobile
Family Support
Home Health Care
Focus: Patient only
After death: No bereavement services
Hospice Care
Focus: Patient AND entire family
After death: Comprehensive grief support included
Can You Transition Between Them?
Common Care Pathways
Scenario 1: Home Health → Hospice
Scenario 2: Hospice → Home Health
Scenario 3: Concurrent Services
- Generally cannot receive both Medicare home health and hospice simultaneously for related conditions
Decision-Making Guide
Choose Home Health Care When:
✓ You're recovering from surgery or hospitalization
✓ You need skilled nursing or therapy to improve
✓ Your goal is to regain function and independence
✓ You're pursuing curative treatment
✓ You need intermittent skilled care, not 24/7 support
✓ You're homebound but working toward improvement
Choose Hospice Care When:
✓ Curative treatment is no longer effective or desired
✓ Your goal is comfort and quality of life
✓ You have a terminal diagnosis (6 months or less)
✓ You need comprehensive support including 24/7 access
✓ Your family needs support with caregiving and emotions
✓ You want medications and equipment covered 100%
✓ You want to focus on living well, not fighting disease
Real-World Examples
Example 1: Mrs. Johnson - Home Health
Mrs. Johnson, 72, had knee replacement surgery. She needs:
Appropriate service: Home Health Care
Example 2: Mr. Chen - Hospice
Mr. Chen, 78, has end-stage heart failure. Multiple hospitalizations. Doctor says 3-6 months. He wants:
Appropriate service: Hospice Care
Example 3: Mrs. Williams - Transition
Mrs. Williams, 65, with lung cancer:
- Initially: Home health after chemo for side effect management
- Later: Cancer progresses despite treatment
- Decides: Stop chemo, focus on comfort
- Transitions: From home health to hospice
Used both services at different stages appropriately
Common Misconceptions
Myth: "Home health and hospice are the same thing"
Truth: Completely different services with different goals, eligibility, and benefits
Myth: "I have to choose between my doctor and hospice"
Truth: You can keep your own doctor with hospice; home health requires doctor's orders
Myth: "Home health provides 24/7 care"
Truth: Home health is intermittent visits only; hospice provides 24/7 access
Myth: "I can't have hospice unless I'm actively dying"
Truth: Hospice is appropriate when life expectancy is 6 months or less; many patients live longer
Questions to Ask Providers
For Home Health:
For Hospice:
Get the Right Care at the Right Time
Both home health and hospice are valuable services, but they're designed for different situations. Understanding the differences ensures you:
Don't hesitate to ask your doctor which service is appropriate for your situation, or contact both types of providers to learn more.
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Sources: VITAS Healthcare, Medicare.gov, National Association for Home Care & Hospice, National Hospice and Palliative Care Organization
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