Hospice
Hospice is a Medicare benefit providing comfort-focused care for patients with a terminal prognosis of six months or less, as certified by two physicians. Electing hospice means the patient waives curative treatment for the terminal condition in exchange for an interdisciplinary comfort care model, usually delivered at home. For home health agencies, hospice is the most important adjacent setting: it is where many patients should transition when they stop improving.
How the hospice benefit works
Hospice care is organized in election periods: two 90-day periods followed by unlimited 60-day periods, each requiring recertification of the terminal prognosis. Payment is per diem across four levels of care: routine home care (the vast majority of days), continuous home care during crises, general inpatient care for symptom management that cannot be handled at home, and inpatient respite for caregiver relief. The per diem covers the interdisciplinary team (physician, nursing, aide, social work, chaplain, volunteers, bereavement), plus medications, supplies, and durable medical equipment related to the terminal diagnosis. Patients can revoke the election at any time and return to conventional Medicare coverage, including home health if they qualify.
Hospice vs. home health
The two benefits serve different goals and cannot overlap for the same condition. Home health is restorative or stabilizing care for homebound patients with an intermittent skilled need; there is no prognosis requirement, and patients continue curative treatment. Hospice requires a six-month prognosis and a decision to stop curative care for the terminal illness. A patient technically may receive home health for a condition unrelated to the terminal diagnosis while on hospice, but this is uncommon and closely scrutinized. Payment differs too: home health pays per 30-day period under the Patient-Driven Groupings Model (PDGM), while hospice pays a daily rate. Staffing models, documentation, quality measures (HIS and HOPE for hospice, OASIS for home health), and survey requirements are all separate.
Recognizing when a home health patient needs hospice
Home health teams are often the first to see hospice eligibility emerging. Signals worth a case conference:
- Repeated hospitalizations or ED visits despite a well-executed plan of care
- Progressive functional decline across OASIS assessments and recertifications
- Unintentional weight loss, increasing dependence in ADLs, or worsening dyspnea at rest
- The patient or family expressing a preference for comfort over treatment
- Recertifying primarily because the patient keeps declining, not because skilled goals are achievable
Delayed transitions hurt everyone: patients get short hospice stays measured in days, families lose bereavement support time, and the agency carries declining patients who drive up hospitalization measures.
Referral and business dynamics
Many home health agencies operate hospice lines or maintain preferred hospice partnerships, and the discharge-to-hospice conversation is a core competency for clinical managers. A clean handoff includes a goals-of-care conversation, physician engagement for the terminal certification, a discharge OASIS, and warm transfer of medication and family context. Agencies without a hospice affiliate should still track hospice referral patterns, because hospitals and physicians increasingly evaluate post-acute partners on whether patients land in the right setting, not just whether the agency kept the census. Live discharges from hospice also flow the other way: a stabilized or revoking patient may return to home health.
Frequently asked questions
Can a patient be on home health and hospice at the same time?
Only in the narrow case where home health treats a condition completely unrelated to the terminal illness. In practice this is rare and draws payer scrutiny. For the terminal condition and anything related to it, the hospice per diem covers the care and the home health agency must discharge or transfer.
Does a patient have to be homebound for hospice?
No. Homebound status is a home health requirement, not a hospice requirement. Hospice eligibility rests on the terminal prognosis of six months or less and the patient's election of comfort-focused care.
What happens if a hospice patient lives longer than six months?
Nothing punitive happens to the patient. Hospice can continue indefinitely through unlimited 60-day benefit periods as long as the physician recertifies that the prognosis remains six months or less if the disease runs its normal course. Patients who stabilize may be discharged alive and can re-elect later.