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Home Care and Hospice Care — What You Should Know

There may be a time when you or an older adult in your life need special in-home care for a chronic or serious illness, injury, or condition. It’s important to understand the specialized services that are available with home care and hospice care so that you or a loved one can get the help and reassurance you need.

“While home care and hospice both provide care in the home setting, each is designed for distinctly different medical events,” explains Cynthia Baker, MD, corporate hospice medical director of Alacare Home Health and Hospice in Birmingham, Ala. “Home health care is designed for patients with chronic or acute medical problems that require skilled care, such as the administration of IV medication, wound care, or physical therapy. Hospice care is specialized care focused on helping patients have a comfortable, functional end-of-life experience in the home.”

Home Health Care

Home health care is a benefit designed for older adults who are experiencing a chronic condition or acute illness that requires in-home care. “The goal of home health is to restore the patient’s health and/or function to the greatest extent possible,” says Dr. Baker. A physician referral is required in order to receive the home health benefit.

To qualify for home health care, two requirements must be met:

  1. The patient must be homebound. “This means that it requires great effort for you to leave your home, usually requiring the assistance of someone else,” explains Dr. Baker. “If you’re able to go out regularly by yourself, the homebound requirement hasn’t been met.”
  2. The patient must have a skilled need. “This is usually a nursing need, such as changing wound dressings or monitoring a patient after the administration of a medication, such as insulin,” Dr. Baker explains. “Some patients may also require in-home physical, occupational or speech therapy.”

Home health care occurs in 60-day episodes. “At the end of this time, the patient is reevaluated to determine if the healthcare goals were met. If not, the home health benefit may be extended,” says Dr. Baker.

Hospice Care

Hospice care is specialized end-of-life care administered in the home setting for patients with a terminal, life-threatening illness. “Hospice is a Medicare benefit that requires two physicians to state that a patient has six months or fewer to live if the disease follows the normal, expected course,” explains Dr. Baker.

“The goal of hospice care is to provide patients with the most comfortable and functional end-of-life experience they can have. We want to control symptoms such as pain and nausea so that patients can feel as well as possible and can participate in life as long as they can,” she stresses.

Medicare requires four hospice team members for each patient, including:

  • Hospice Physician
  • Registered Nurse
  • Medical Social Worker
  • Counselor

In addition to this team, hospice volunteers and home health aids also assist patients with tasks such as bathing and personal care. “The four members of the hospice team meet every two weeks to ensure that the best treatment plan is being implemented for the patient,” explains Dr. Baker. “In addition to the hospice physician, patients can also continue to see their regular physician with whom they’ve had an established relationship. In fact, we encourage physicians to remain active in their patient’s care while in the hospice program.”

Hospice provides for 24/7 availability, though this doesn’t necessarily mean that a hospice worker remains in your home around the clock. “Nurses visit patients regularly with the exact frequency being determined by the patient’s needs,” says Dr. Baker. “The patient has the right to refuse the chaplain, social worker, and home care aids. However, patients are not permitted to refuse the nursing visits in order for the hospice benefit to continue.”

There are four levels of hospice care, depending on each patient’s unique needs and medical condition. These include:

  • Routine Home Care — The majority of patients receive this level of care, which involves a nurse and other members of the hospice team administering care in the home or nursing home setting.
  • Continuous Care — This level involves administering at least eight hours of care a day during crisis health situations in which a nurse and other healthcare professionals are working to get symptoms under control to avoid sending the patient to the hospital.
  • In-patient Respite Care — This level of care is available when the patient’s family needs a break from caretaking or must be away from home for an extended period. The patient is moved to a nursing home or hospital where they receive the same hospice care they were receiving at home. The maximum time limit for this level of care is five continuous days per respite event.
  • In-patient General Care — In this level of care, the hospice patient is admitted to the hospital for the medical management of an acute symptom or illness that couldn’t be managed at home. Once the symptom is managed, the patient is discharged back to his or her home setting.

When the patient passes away, the hospice chaplain and social worker are available to provide bereavement care to the family for up to a year. “Hospice provides an important bridge of care to help patients have a dignified, comfortable, and hopefully peaceful end-of-life experience,” observes Dr. Baker.

Article last updated: April 22, 2009 10:15 AM