dnolen Asked December 2014
What's the difference between Home health care and Hospice care?
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My mother-in-law had 2 strokes over a year ago and is wheelchair bound. She needs assistance with toileting, meals, baths, and other daily activity tasks.
We have her scheduled for Medicare Home Health Care but we also got a referral to the local Hospice group.
The local Hospice group reps came to the house to discuss what they could offer and it seemed to be similar to Home Health Care services.
My mother-in-law is not near death but does need assistance for daily activity care. Since the strokes, my sister-in-law has been taking care of her at my sister-in-law's home.
We were wondering what the difference is between Home Health Care and Hospice services were.
Any insight is appreciated.
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We're fortunate enough to have Home Health Care services available for my mother-in-law beginning this week.
But since my sister-in-law met with reps from Hospice, we were confused about the differences between the services.
The Hospice reps stated that their services could last quite some time which would have been better than the shorter time span that Home Health Care services last.
And I've read in the forums where people have used Hospice services and then gotten well enough to go off their services.
So we were totally confused!
Thank you for taking time to answer our question.
1-Medicare is intended for temporary in-home skilled care (nurses, aides, therapists) that is expected to be short term (60 days or less), temporary, and expected to make the person better in some way. We can often extend to another 60 day period, and another if documentation can prove the patient continues to slowly improve. Aides can only be provided 2-3 times a week.
2-Hospice, like said above, is only to be used if the doctor will state that he feels that the patient probably has 6 months or less to live. No improvement is expected to be shown as the patient is considered to be dying. Sometimes the patient does live longer than 6 months and can be extended because the doctor cannot know for sure and is sort of "guessing" at the beginning according to his professional experience. When Hospice takes over, they will stop most of the medicines that have been given to 'improve' their condition because they are not expected to improve, and just keep them on ones that will keep the patient comfortable. They will often require that their care be turned over to the doctor for their company - no longer to be seen by their own family physician or any specialists they have been seeing. The one advantage is that they offer much more personal care - around the clock if need be, including nurses, aides, grief counseling for the family, etc, and I think all of the medicines they use for the patient are paid for by Medicare (sedatives, pain meds, etc). As ferris1 states, usually Hospice is not referred to unless the doctor thinks she is terminal.
Some people will take advantage of whatever services are available through Medicare to start out with, just to see if there is any improvement to possibly be made, and then later go to Hospice once they are considered terminal. Sometimes, they will go straight to Hospice if the patient is not expected to live longer than 6 months, as stated. Medicare will not pay for both at the same time.
If you say she's not near death please reconsider hospice and like Carol said, wait until the time is right.
They might seem radical to some but organizations like hospicepatients/
can be very educational.
Some home health aide, RN visits, PT and OT will be paid by Medicare for short periods of time but generally limited to visits of 45 minutes to an hour say 3 times a day. They are not going to provide a full day of home health aide coverage. Either way after about 6 to 8 weeks, they will drop the patient either claiming they don't need the service or the person has "plateaued" (can't make any more progress-which is often not true in my experience) but either way they are out the door and you the caregiver are on your own.
If they off some care under Medicare --take it but it will not last long. Long term care by a home health aide to avoid a nursing home placement will not be covered. You need to have a long term care policy to help cover these services. This is why most people have to give up on the home care and place their elder in the nursing home. Then the Medicaid program will pay for even more expensive nursing home coverage--false economy of our government funds but this is our current state of caring for people who need 24/7 coverage or help.
At some point we will figure out it is cheaper and often better to allow the senior to receive full time coverage of home health aides in their home. But we are not there today.
Good luck as you look for home health aides. I hope you can keep your loved one in a home setting.
Home Health Care is usually very temporary, covered for 60 days after a hospital stay, then totally out-of-pocket and pretty expensive.
Hospice is generally available only to those with six month or less to live as determined by a physician. Many people live longer than that, but in order for Medicare to pay for hospice care, the doctor has to feel that the patient is considered terminal. If your mother-in-law is not considered terminal, then Medicare/Medicaid will most likely not pay for hospice, so please be sure what you sign on for.
Is your mother-in-law on Medicaid? Most Medicare help is limited to nursing care.
If Medicare/Medicaid is paying for the care that you mentioned, you are fortunate. Many states don't offer such services through Medicare. A handful have Medicaid's Cash and Counseling - I wish all states did.
Grab on to what is available and then look into hospice when the doctor says the time is right.
Take care,
Carol