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WHO PROVIDES CARE – HOME HEALTH VS HOSPICE.HOME HEALTH Home health agencies bring their services to the private homes of patients in need of skilled care related to their diagnosis, including, but not limited to, registered nurses, certified nursing assistants, speech/language pathologists, physical therapists, and occupational therapists. HOSPICE Most patients receive hospice services from a Medicare-certified hospice organization, which provides each patient with an interdisciplinary team—physician, nurse, hospice aide, social worker, chaplain, volunteer, and bereavement specialist—who come to the patient’s home, wherever they call home: private residence, assisted living community, nursing home.
HOW LONG IS CARE PROVIDED?HOME HEALTH The length of service is determined by the goals of care. The amount, frequency, and time period of the services need to be reasonable and the condition must improve or be maintained through therapy. HOSPICE The patient receives unlimited visits for six months or longer, as long as the patient continues to have a limited life expectancy, as determined by a physician.
HOW OFTEN MUST PATIENTS BE RECERTIFIED TO CONTINUE SERVICES?HOME HEALTH Home health care patients are recertified after each 60-day episode of care. Medicare does not limit the number of continuous episode recertification for patients who continue to be eligible for the home health benefit. HOSPICE A physician must recertify a patient if they outlive their initial six-month prognosis. The first two recertification periods are 90 days; after that, the patient must be recertified every 60 days. There is no limit to the number of times a patient can be recertified, as long as the physician’s prognosis is six months or less from the time of recertification.
DO YOU HAVE TO BE HOMEBOUND TO RECEIVE CARE?HOME HEALTH Home health care patients must be certified by a doctor that they are homebound except for short durations. HOSPICE Hospice patients do not have to be homebound. That is, they can leave home, take a walk, do errands, and even take a trip if they feel well enough
IS CARE AVAILABLE AROUND THE CLOCK?HOME HEALTH The Medicare home health care benefit does not cover 24-hour care. HOSPICE Hospice can provide up to 24 hours/day of skilled nursing and hospice aide services for patients who need acute symptom management and want to remain at home.
WHAT IF THE PATIENT’S SYMPTOMS CAN’T BE CONTROLLED AT HOME?HOME HEALTH Home health agencies do not follow patients when they need inpatient care in a hospital HOSPICE Hospice care can be provided in an inpatient setting for short stays until symptoms are under control and the patient can return home.
CAN CARE BE PROVIDED IN LONG-TERM CARE FACILITIES?HOME HEALTH Home health care is provided in the patient’s private residence and cannot be given to patients in a long-term care facility. HOSPICE Hospice services are brought to patients anywhere they call home, including assisted living communities or nursing homes.
ARE PRESCRIPTION MEDICATIONS COVERED BY MEDICARE?HOME HEALTH Medications are not covered for home health care patients under the Medicare home health benefit. HOSPICE The Medicare hospice benefit covers all prescription and over-the-counter drugs related to a hospice patient’s terminal diagnosis.
DOES MEDICARE PAY FOR HOME MEDICAL EQUIPMENT AND SUPPLIES?HOME HEALTH For home health care patients, medical equipment and supplies must be ordered by their physician and are covered 80 percent when approved under Medicare Part B qualification guidelines. HOSPICE Under the Medicare hospice benefit, all equipment and supplies related to the terminal diagnosis are provided and covered 100 percent. The need for equipment, oxygen, and other products is determined by the patient’s palliative plan of care.
DOES MEDICARE PAY FOR “PERSONAL CARE” OF THE PATIENT?HOME HEALTH Medicare does not cover personal care services for home health care patients HOSPICE A hospice aide who provides personal care, such as bathing and mouth care, is a member of the hospice patient’s interdisciplinary team and is covered 100% by the Medicare hospice benefit.
CAN YOU RECEIVE HOME HEALTH AND HOSPICE AT THE SAME TIME?HOME HEALTH For Medicare patients who have met the home health criteria, home health care is covered while the patient is on hospice for conditions not related to their terminal diagnosis. HOSPICE
For Medicare patients who have met the home health criteria, home health care is covered while the patient is on hospice for conditions not related to their terminal diagnosis.