End-of-life decisions are never easy. One of the most important decisions you may make regarding health care as you age could be whether you need a nursing home or hospice care.
To make the best choice for you and your family, it helps to know the difference between the nature of the care provided through a nursing home as compared with hospice.
Nursing Home Care
Nursing home facilities offer residential care for the elderly and disabled. The treatment patients receive from a nursing home differs from what is available in hospice care. Residents at nursing homes receive treatment to extend their lives. Care that you can expect from a nursing home may include custodial and some skilled care.
Custodial care includes nonmedical treatment, such as assistance with dressing, bathing, cooking, laundry, and other types of personal care. The provider does not need a medical license to give residents this type of care.
Skilled nursing care is provided by licensed medical practitioners. Nursing home residents may receive some skilled care, including wound care, physical therapy, injections, and other care that they may need to ensure their physical wellbeing.
Note that Medicare generally does not cover custodial care. While Medicare Part A (hospital insurance) coverage may be available for enrollees with certain medical conditions, it is often limited to those who need short-term care in a skilled nursing facility, rather than a nursing home. (Learn more about Medicare’s limited nursing home coverage.)
If you are eligible for Medicaid, a program for individuals with limited income and assets, there are nursing homes in many states that accept Medicaid patients.
What Is Hospice Care?
Hospice care is an option for patients who do not wish to receive treatment to help improve their condition or extend their life but want comfort care as they reach the end of their lives. Your hospice care team may include doctors, nurses, social workers, spiritual advisors, and volunteers.
A hospice care team is trained in treating end-of-life pain. Hospice care can be administered in a patient’s home or in an institutional setting. It also may provide support to family members and caretakers, including respite care.
If a patient has Medicare Part A and meets the following qualifications, they may have hospice care services, including pain-relieving medication and home aide services, covered:
- A primary care physician or a hospice care doctor confirms that the patient’s condition is terminal and they will not live for more than six months.
- The patient is willing to receive palliative care only and not care that is intended to try and improve their condition.
- The patient signs a statement confirming that they will receive hospice care instead of any other Medicare-covered treatments related to their physical condition.
For Medicaid recipients with a terminal illness, certain states may provide help in paying for hospice.
A Note on Concurrent Care
Complicating matters is the fact that Medicare will generally not cover nursing home care and hospice care, known as concurrent care, at the same time. Currently, individuals on Medicare must give up Medicare payment for care related to their terminal condition if they want to receive Medicare’s hospice benefit. As a result, many individuals facing a terminal illness may not opt for hospice support services.
Policymakers have been pushing for a benefit within Medicare that would allow patients who wish to benefit from hospice care services (for example, a hospice aide, in-home respite care, or nutritional support) to receive curative treatment (for example, chemotherapy) simultaneously.
The Centers for Medicare and Medicaid Services has spent the past several years testing various models, including one known as the Medicare Care Choices Model (MCCM). MCCM has been shown to improve the quality of patients’ end-of-life while also resulting in Medicare savings. However, this option has not yet been made permanent.
End-of-Life Dilemma: Which Should I Choose?
While considering the next steps to take in your health care plan, speak candidly with your family and health care team about your needs and how you see your future.
If you have questions about coverage options that may be available to you in a nursing home or with hospice care, you may consider speaking to an elder law attorney in your area.
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