I was recently at a home health conference. Why was I there? Talking about end of life with home health workers? Yes, absolutely. Patients die while having home health services just like people die in hospitals, nursing and residential care facilities.
End of life knowledge is beneficial to the patient and family no matter what services are being provided. People don’t die like they do in the movies, yet most people don’t know that. Unfortunately, many medical professionals don’t know the progression of end of life either. They don’t know the signs and even what to do as death approaches — because they are not taught. (Perhaps this is a soapbox for me to get on in another blog.)
Back to home healthcare. What are the differences between hospice and home health services? The biggest difference between the two is the prognosis. Medicare requires that through home health treatment and medical assistance, the patient is expected to improve. Hospice, on the other hand, is required to show a non-fixable prognosis, to show that the patient is not getting better and is in fact approaching death.
Here are some more differences between the two.
Visit length:
Home Health -They assess the patient and administer treatment. The length of the treatment is determined by the amount of time it takes to provide the necessary treatment.
Hospice -In addition to assessing and treating, hospice workers support and guide the caregiver and family, address emotional and spiritual concerns, and educate as to signs of approaching death.
Reasons for the visits:
Home Health -The visits are medically ordered.
Hospice - The hospice professional determines the reasons for visits. The reason does not have to be medical.
Additional services provided:
Home Health -A range of therapies are offered with the intention of getting the person back to leading their normal life. These can include physical, speech, and occupational therapies.
Hospice - The above therapies are offered, but generally referrals are too late to provide assistance. If a patient is on the medicare hospice benefit, the medical equipment, supplies, and medicines related to the life-threatening illness are paid for. Bereavement follow-up after the death is also provided.
Reimbursement:
Home Health - Coverage is determined on a per-visit basis. Medicare can determine it is not a valid visit and decline to pay. Some insurance policies offer home health services, often with a co-pay.
Hospice - Coverage is on a daily basis, no matter how many visits there are in a day...
On call system:
Home Health - Visits are for medical necessity.
Hospice - Visits are made no matter the hour or reason the caregiver has. The reasons for a visit can include approaching death, fear, or to pronounce death.
Medical team’s interaction with the patient & family:
Home Health - While there is some instruction for families as it relates to the disease, they are primarily there for the patient.
Hospice - Both the patient and the family are considered integral parts of the care. Sometimes the staff is more involved with the family than the patient.
In our medical system of services both home health and hospice have their place. Both are necessary. And end of life instruction is crucial.
Something More… about Yes, Death Happens in Home Health, Too
My Exclusive End-of-Life Care Course with Activated Insights is a program of online courses designed to train, educate, and guide caregivers in end of life care, whether you’re a home healthcare professional, a family member, or a patient. These courses provide insights and knowledge that caregivers can use to compassionately serve their patients during their final days. Care professionals can also earn CE hours through the end-of-life care series. Each learner will earn a certificate of completion, and 5 CE hours will be awarded to participating healthcare professionals.
5 comments
Traci Eaton
About that soapbox…. The more said the better. For the betterment of life for the patient, the care giver and the medical professionals of all levels we need to act in full acceptance of the cold hard fact that ‘Death is not failure.’ It is the ultimate outcome of every life and is a potential consequence of daily life from the moment of conception. We will never ‘cure’ death and will live lives of higher quality by giving our best efforts to enhancing what we have of it by giving equal worth to every moment from the first to the last. This will require some hard eyed realism for most human beings and I am not altogether certain that we have it in us as a species.
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BK Books replied:
Hi Traci, I think we generally do the best we can with the challenges our life gives us. Just being alive for some can be hard work. Blessings! Barbara
About that soapbox…. The more said the better. For the betterment of life for the patient, the care giver and the medical professionals of all levels we need to act in full acceptance of the cold hard fact that ‘Death is not failure.’ It is the ultimate outcome of every life and is a potential consequence of daily life from the moment of conception. We will never ‘cure’ death and will live lives of higher quality by giving our best efforts to enhancing what we have of it by giving equal worth to every moment from the first to the last. This will require some hard eyed realism for most human beings and I am not altogether certain that we have it in us as a species.
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BK Books replied:
Hi Traci, I think we generally do the best we can with the challenges our life gives us. Just being alive for some can be hard work. Blessings! Barbara
Joy Fernon
Thank you, Barbara, for the work you are doing to educate family and medical professionals about end of life and when home health or hospice is the best choice. I attended the recent Zoom meeting sponsored by the Elizabeth Kubler Ross Foundation and heard you speak so forthrightly about this topic. You listened to my experience supporting my husband whose life-threatening illness of multiple myeloma was not responding to treatment, nor responding to a hospitalization to treat an infection of a blister on his finger. Sadly, no one was honest about his prognosis. Without that honesty, notified of his imminent discharge after a 10-day stay for an IV antibiotic, I was presented with a choice between home health or hospice for him. I was confused. I chose home health, fully expecting that rehab was appropriate. There was one home health visit. The two nurses checked his vitals, listened to his chest and gave no indication that he should be in hospice. Within three days, he was back at the hospital and diagnosed with pneumonia and sepsis. He died 18 hours later. I feel that the medical system failed us on so many levels. I know what you are doing is making a difference!
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BK Books replied:
Oh Joy, I am so sorry the medical establishment failed you. Unfortunately I hear too may similar stories. Blessings to you all you. Barbara
Thank you, Barbara, for the work you are doing to educate family and medical professionals about end of life and when home health or hospice is the best choice. I attended the recent Zoom meeting sponsored by the Elizabeth Kubler Ross Foundation and heard you speak so forthrightly about this topic. You listened to my experience supporting my husband whose life-threatening illness of multiple myeloma was not responding to treatment, nor responding to a hospitalization to treat an infection of a blister on his finger. Sadly, no one was honest about his prognosis. Without that honesty, notified of his imminent discharge after a 10-day stay for an IV antibiotic, I was presented with a choice between home health or hospice for him. I was confused. I chose home health, fully expecting that rehab was appropriate. There was one home health visit. The two nurses checked his vitals, listened to his chest and gave no indication that he should be in hospice. Within three days, he was back at the hospital and diagnosed with pneumonia and sepsis. He died 18 hours later. I feel that the medical system failed us on so many levels. I know what you are doing is making a difference!
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BK Books replied:
Oh Joy, I am so sorry the medical establishment failed you. Unfortunately I hear too may similar stories. Blessings to you all you. Barbara
Sally
My dad (94 years old) had 24/7 home health care for variety of reasons. It was not covered by Medicare nor was it in and out care like PT or OT. It was quality and it was expensive. Could he have died? Sure. Anyone can die anywhere for variety of reasons.
Now my dad is in a supposed “good” assisted living facility. His attorney visited him today and attorney said (to me) “I don’t know exactly what they do here. I’d call it unassisted living.” The staff is so short-staffed as most places that the care is suboptimal. Could my Dad die in this facility? Most certainly. I don’t think it’s safe at all. We will move him back home or to a better facility if we can find one.
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BK Books replied:
Hi Sally, Health care is so expensive and to receive substandard care is unacceptable. Contact Medicare. gov and report the facility. If we don’’t speak up then change won’t occur. Blessings to you and your dad. Barbara
My dad (94 years old) had 24/7 home health care for variety of reasons. It was not covered by Medicare nor was it in and out care like PT or OT. It was quality and it was expensive. Could he have died? Sure. Anyone can die anywhere for variety of reasons.
Now my dad is in a supposed “good” assisted living facility. His attorney visited him today and attorney said (to me) “I don’t know exactly what they do here. I’d call it unassisted living.” The staff is so short-staffed as most places that the care is suboptimal. Could my Dad die in this facility? Most certainly. I don’t think it’s safe at all. We will move him back home or to a better facility if we can find one.
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BK Books replied:
Hi Sally, Health care is so expensive and to receive substandard care is unacceptable. Contact Medicare. gov and report the facility. If we don’’t speak up then change won’t occur. Blessings to you and your dad. Barbara
Loydell Johansing
How do you sign up for your certificate program? I may have to help a family member in the future I may have to learn how to be a caregiver
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BK Books replied:
You can find Barbara’s online course here: https://activatedinsights.com/end-of-life-courses/.
We also recommend our book, By Your Side: A Guide for Caring for the Dying at Home, which offers gentle, practical guidance for family caregivers. You can find it here: https://bkbooks.com/products/by-your-side-a-guide-for-caring-for-the-dying-at-home.
How do you sign up for your certificate program? I may have to help a family member in the future I may have to learn how to be a caregiver
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BK Books replied:
You can find Barbara’s online course here: https://activatedinsights.com/end-of-life-courses/.
We also recommend our book, By Your Side: A Guide for Caring for the Dying at Home, which offers gentle, practical guidance for family caregivers. You can find it here: https://bkbooks.com/products/by-your-side-a-guide-for-caring-for-the-dying-at-home.
Mary
“Visits are made no matter the hour or reason the caregiver has.” This may not be a true statement for everyone. It was definitely not true for me. My dad was on hospice. I had read all of your materials, and was pretty sure I was seeing signs of death rapidly approaching. I called on a Friday afternoon, asked for the nurse to come, and was refused. I called again on Saturday morning and evening and was refused on both of those calls as well. My dad died shortly after midnight on Saturday, without any hospice support. I have nothing positive to say about hospice.
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BK Books replied:
Mary, I am so sorry for the poor care you received from hospice. What you described is not what hospice care is to be like. I suggest you go to Medicare.gov and file a complaint. It won’t change your experience but may help others. Blessings! Barbara
“Visits are made no matter the hour or reason the caregiver has.” This may not be a true statement for everyone. It was definitely not true for me. My dad was on hospice. I had read all of your materials, and was pretty sure I was seeing signs of death rapidly approaching. I called on a Friday afternoon, asked for the nurse to come, and was refused. I called again on Saturday morning and evening and was refused on both of those calls as well. My dad died shortly after midnight on Saturday, without any hospice support. I have nothing positive to say about hospice.
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BK Books replied:
Mary, I am so sorry for the poor care you received from hospice. What you described is not what hospice care is to be like. I suggest you go to Medicare.gov and file a complaint. It won’t change your experience but may help others. Blessings! Barbara