Hospice or home health care: which one fits?

Both send nurses and aides to the house, which is why they get mixed up. The difference is the goal.

Home health care is about getting better

Home health is for recovering after a hospital stay, regaining strength, or keeping a condition such as heart failure under control at home.

Medicare covers it when three things are true:

• you're under a doctor's care
• a doctor certifies that you're homebound, meaning leaving home takes a major effort
• you need part-time skilled nursing or therapy

Covered home health services cost nothing. Medical equipment such as a walker or hospital bed usually carries 20% coinsurance.

When comparing agencies, look at their quality star rating and outcome numbers, such as how often patients got better at walking and bathing and how often they ended up back in the hospital.

Hospice is about comfort

Hospice is for someone with a terminal illness who has decided to focus on comfort and quality of life rather than treatment aimed at a cure. Medicare covers it when the hospice doctor and the patient's own doctor certify that life expectancy is six months or less if the illness runs its normal course. That's an estimate, not a deadline. People can stay on hospice longer if they still qualify, and anyone can stop hospice and go back to regular treatment at any time.

Care usually happens wherever the person lives, including a nursing home or assisted living. Hospice care itself generally costs nothing, though there can be small copays for some medications and for short inpatient respite stays that give family caregivers a break.

When comparing hospices, the family survey is the best guide: would families recommend it, and did their loved one get help with pain and other symptoms when they needed it?

Still not sure?

Ask the doctor or the hospital discharge planner which one fits. Then search by ZIP code here to see which agencies say they serve your area.