In-home hospice care focuses on maintaining quality of life and comfort rather than curing a patient who is terminally ill. Planning for a loved one’s end of life can be challenging for family and friends, especially for primary caregivers. But understanding what care options are available and how each can help an aging loved one meet their unique care goals may make these decisions a little bit easier.
Read on for a look into hospice care at home, including the goals of this type of care, the services it provides, and more.
What's the goal of hospice care in the home?
Hospice care at home aims to provide physical and emotional comfort for a terminally ill patient in a familiar environment. Hospice prioritizes a patient’s quality of life rather than treatments intended to prolong life or cure a condition.
What are the levels of hospice care?
While receiving hospice care in the home, a patient’s condition may fluctuate, necessitating different levels of care. According to Medicare.gov, there are four levels of hospice care:
- Routine care is the most common level of care. The hospice team visits a patient in their home regularly to help manage symptoms such as pain or vomiting.
- Continuous care takes place in the home when a patient is experiencing severe symptoms. A medical professional, typically a registered nurse, will provide support for anywhere between eight and 24 hours a day.
- General inpatient care is necessary when symptoms or pain cannot be managed in the patient’s home. The patient will typically go to a hospital, hospice care facility, or long-term care facility where trained staff are available to deliver round-the-clock care.
- Respite care is commonly provided in a hospital, hospice care facility, or long-term care facility to give a patient’s family caregivers a break.
Moving between the different levels of hospice care is common, especially as a patient’s condition evolves. For example, a patient may need temporary inpatient care to stabilize their condition and then resume routine hospice care services at home.
What services does in-home hospice care include?
In-home hospice care provides a variety of services that support both hospice patients and their families.
Home hospice care services for patients
Your loved one’s care team — including their doctor, hospice nurses, and therapists — will create a plan of care that may include the following:
- Medications for pain and symptom management
- Needed durable medical equipment
- Medical supplies like catheters and bandages
- Physical, occupational, and speech therapy, if needed
- Nursing and physician services
- Emotional and spiritual support
Home hospice care services for family caregivers
Caring for a loved one at the end of life can present numerous challenges. While hospice care in the home helps to keep a patient comfortable, it also offers several benefits for their family, including the following:
- Respite care
- Coaching or instruction on how to provide care
- Assistance with caregiving tasks, such as personal care and light housekeeping
- Medication management
- Access to 24/7 support via phone
- Bereavement counseling
Who provides hospice care at home?
An in-home hospice team can include the following members:
- Hospice aides
- A hospice physician
- A patient’s personal physician
- Hospice nurses
- Social workers
- Clergy or other spiritual counselors
- Trained volunteers
- Speech, physical, and occupational therapists, if needed
While the interdisciplinary team provides intermittent support as needed, a patient typically receives the majority of their day-to-day care from family, friends, or paid home care aides.
How to start hospice home care
Hospice care can typically begin when your loved one’s doctor has determined they have a life expectancy of six months or less. Their doctor will usually make a referral to a specific hospice care provider. The hospice care provider will then meet with your family to perform an initial evaluation to assess your loved one’s needs and create a care plan.
Families also have the option to research and choose their own hospice care provider. For example, some families may want to choose a hospice that is faith based or offers care for specific conditions.
In some cases, a doctor may have a hard time estimating life expectancy, and a patient may live beyond the six-month estimate. If a doctor continues to certify the need for hospice, services can continue. It's also possible for a patient to discontinue hospice care and then resume care if it becomes necessary later on.
How is hospice care at home paid for?
In-home hospice care is covered, at least in part, by most health insurance plans, including the following:
- Medicare
- Medicaid
- VA health care benefits and TRICARE
- Private health insurance
Most families rely on Medicare to pay for hospice care. However, in order to use the Medicare hospice benefit, the provider must be Medicare certified.
Read: Who Pays for Hospice Care at Home? Your Options Explained
Where to find support and answers to questions about in-home hospice care
Considering in-home hospice care for a loved one can be an emotional process. Join the AgingCare Caregiver Forum to connect with others experiencing similar situations and receive advice on senior care. If your loved one needs support, but you’re not sure if they’re ready for hospice, our Care Advisors can help you evaluate different options for in-home care.
Reviewed by home health care executive Michael Ferraina.
Sources:
Hospice levels of care (https://www.medicare.gov/care-compare/resources/hospice/levels-of-care)
Hospice Referral: An Important Responsibility of the Oncologist (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2793922/)
How is Hospice Care Paid For? (https://www.caringinfo.org/types-of-care/hospice-care/how-is-hospice-care-paid-for/)