Nursing Homes vs. Hospice Care

Nursing Homes vs. Hospice Care: A Side-by-Side Comparison

When Should You Consider a Nursing Home?

It’s best to consider a nursing home if your relative has multiple or chronic conditions and needs comprehensive services. Nursing homes would then be a good fit, as they provide 24/7 care to those who need daily assistance and various kinds of medical attention.

Seniors tend to arrive in nursing homes after caregivers take care of them at home or after spending time in assisted living facilities. Many folks end up in nursing homes after a fall or mishap that happened due to living alone. Their health may be less than robust, but these residents are generally not “terminal.” They don’t have an illness or condition that should prove fatal in six months or less, which is the requirement to be eligible for hospice care.

That said, if they develop a serious illness and have a terminal condition, it is possible to receive hospice care in some nursing homes. Keep in mind that nursing homes usually have few hospice residents compared to the general population.

So, how do you know your relative is ready for a nursing home? The decision depends on the person and the family. But it’s usually when they’re unable to care for themselves safely or have chronic conditions.

If they’re cognitively challenged, for example, and need a good deal of help with activities of daily living — such as dressing, bathing, or moving around — they’ll likely be referred to nursing homes. Staffers such as nurse’s aides help with the care, which is available day and night, seven days a week. Nursing homes usually provide a wide range of entertainment, classes, and social activities as well.

When Should You Consider Hospice Care?

Learning that there are no other medical options left and treatments are no longer effective for your loved one can be difficult to hear. That’s where hospice care can help. At its basic level, hospice care aims to ease someone’s pain and suffering in their final months. Those who work for hospices offer pain relief, comfort, compassion, dignity, and support — both for the patients and their family members.

As soon as you hear the news, you should consider hospice services. When a patient is in hospice care, medical staff are no longer looking to treat or “cure” the disease; however, they are still around to ease your relative’s transition into this next phase of their life. Much of your loved one’s daily care can be provided by family or friend caregivers who have been trained by hospice personnel and work together with them.

According to the National Hospice and Palliative Care Organization (NHPCO), here’s what an interdisciplinary hospice team usually does to help your loved one and the family:3

• Instructs the family on how to care for the patient
• Manages the patient’s pain and other symptoms
• Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time
• Provides medications and medical equipment (hospital bed, wheelchairs, or walkers)
• Assists the patient and family members with the emotional, psychosocial, and spiritual aspects of dying
• Provides grief support and counseling to your loved one, family, and friends
• Delivers special services like speech and physical therapy when needed

Home care aides help with basic necessities, such as dressing and getting out of bed, and many also help with laundry, cooking, and the like. Medical service providers and nurses provide pain medications. Doctors are typically involved in helping establish a plan of care and are called in for complex issues. Hospice workers also help your relative and family with resources and coordinate care.

Hospice care is usually given wherever a person lives, be it at home, in a nursing home, or in an assisted living facility. There are also hospice-specific facilities; however, the goal, if possible, is for hospice care to go to where the patient already is. Sometimes a person receiving hospice care must be treated at a hospital. In such cases, the aim is usually to discharge them and return them to their home setting.

Starting Care in a Nursing Home

Similar to hospice care, a doctor certifies that nursing home care is necessary, and that starts the process of getting into a nursing home. Depending on your relative’s financial resources, they might already have an estate plan and/or long-term care insurance. Those with limited resources may need to apply for Medicaid.

Nursing homes are quite expensive. Many nursing homes accept residents who are on Medicaid. Remember that this program requires that their assets have fallen below a certain amount. What your relative (and their spouse, if applicable) is allowed to have varies by state. Furthermore, if they’re on Medicaid, most of the income they earn is expected to go toward helping pay for their nursing home care.

Hospice Care in Nursing Homes

Nursing homes and long-term care facilities often have small hospice units. Their staff may not provide the specialized hospice care. Instead, nursing homes may work with local hospice agencies to provide hospice care.5 Meanwhile, the nursing home staffers may continue to offer custodial care, such as help in dressing and bathing. Getting hospice care through a nursing home may be a good option for people who can’t remain at home.

Starting Hospice Care

Your relative will qualify for hospice care if they’re terminal and expected to pass within six months. That’s when you should find out about local hospice care. The first choice for most seniors is to get hospice care at home near family and friends in a familiar environment. Family members and friends can volunteer as caregivers or the family can pay for home aides. Some hospice groups even offer financial assistance programs that may help.

A typical week receiving hospice care at home might involve two visits from a hospice aide, one visit from a registered nurse, one visit from an occupational therapist, visits from multiple family members, a visit from the chaplain, and volunteer visits for a few hours each. This allows the primary caregiver to either take a break or attend to other things.

A hospice aide (not an aide for activities of daily living) can help with activities such as:

• Mouth care/oral health
• Filing and cleaning nails
• Motion exercises
• Dressing changes
• Tube changes
• Bed linen changes
• Moving a patient in the bed to prevent bedsores
• Rubbing lotion on forehead, arms, feet, etc.
• Help with toileting and incontinence
• Light housekeeping

Unfortunately, people often wait too long before accepting hospice care. Sometimes this is because it’s hard to admit that your loved one is dying. Other times it’s because caregiving becomes too complex and you realize you need the help of hospice. The earlier someone starts receiving hospice care, the better. The predominant focus will then change to that of quality of life.6 Having hospice care best ensures that your loved one’s final months will be comfortable; it will help them live out their last days with comfort and dignity.

How to Pay for Hospice Care

Hospice care is a Medicare and Medicare Advantage benefit; it’s covered by most private health insurance companies, though the levels of coverage vary. It’s also usually covered by Medicaid and VA benefits. Room and board in a nursing home or hospice residential facility are not covered.8

Who Decides About Hospice Care?

Unless you have guardianship or the power to make certain types of medical decisions on their behalf due to dementia or Alzheimer’s Disease, the choice of whether or not to receive hospice care rests with your loved one. If they prefer to seek further treatment instead of hospice care, that too is their decision. Be sure to discuss the different options with them.

An estimated 1 million people who could be eligible for hospice care die each year without using it, according to a study from the Journal of the American Geriatrics Society. Services are especially underused by individuals who are not dying from some form of cancer.9

The sooner you get hospice services, the better. You and your loved ones will have more time to deal with the emotional stress regarding what’s happening and show your love and appreciation for one another. Your loved one can also get the comfort that untrained people can’t always provide. Hospice workers are trained, after all, to alleviate needless suffering. Many patients enter hospice care late on their journey. About 50 percent of patients were enrolled in hospice care for only 18 days or less when they could have been receiving valuable hospice services for months.10

Still not sure which type of care your loved one needs? Watch our video below that compares different types of senior care and housing.