End-of-life decisions are never easy. Among the most important decisions you may face as you age is whether to seek care in a nursing home or opt for hospice services. Understanding the differences in care between these two options can help you and your family make informed choices.

Nursing Home Care

Nursing homes provide residential care for elderly and disabled individuals, offering both custodial and skilled medical services. The primary focus of nursing home care is to extend life and improve quality of living through a range of treatments.

Custodial care includes non-medical assistance with daily activities such as dressing, bathing, meal preparation, and housekeeping. This type of care is often provided by caregivers who are not required to hold medical licenses.

In contrast, skilled nursing care is provided by licensed medical professionals, such as nurses and physical therapists. This care includes medical services like wound care, administering injections, and physical therapy to support the resident’s overall health.

It’s important to note that Medicare generally does not cover custodial care. However, Medicare Part A (hospital insurance) may cover short-term skilled nursing care under specific circumstances, typically following a hospital stay. Nursing home care is often funded privately or through Medicaid for eligible individuals with limited income and assets.

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, on the other hand, focuses on providing comfort to patients in the final stages of life. Rather than attempting to prolong life, hospice care prioritizes pain management, emotional support, and ensuring dignity at the end of life.

Hospice care teams are made up of diverse professionals, including doctors, nurses, social workers, spiritual counselors, and volunteers, all specializing in end-of-life care. Hospice services can be provided at home or in an institutional setting, depending on the patient’s preferences and needs.

In addition to patient care, hospice also offers family support, including respite care, which allows caregivers to take short breaks from their responsibilities.

For patients with Medicare Part A, hospice care services, including pain relief and home aide assistance, are generally covered if the following conditions are met:

• A physician confirms that the patient’s condition is terminal with a life expectancy of six months or less.
• The patient opts to receive palliative care rather than curative treatment.
• The patient formally agrees to receive hospice care in place of other Medicare-covered treatments related to their terminal illness.

For Medicaid recipients with a terminal illness, certain states may provide help in paying for hospice.

A Note on Concurrent Care

Medicare currently does not allow for simultaneous coverage of nursing home (curative) care and hospice care. This restriction can lead to difficult decisions for terminally ill patients who might benefit from both hospice and ongoing treatments aimed at prolonging life.

Policymakers have been advocating for changes to this system. The Medicare Care Choices Model (MCCM) has tested allowing patients to receive both hospice and curative treatments, showing promising results in improving quality of life while reducing costs. However, this option has yet to be made a permanent part of Medicare.

How to Make the Right Decision

Choosing between nursing home care and hospice can be emotionally overwhelming, but it’s important to consider your personal goals for care, how you envision your future, and what kind of support you and your family will need. Open conversations with your loved ones and your healthcare team are crucial in this process.

If you have questions about your care options, coverage, or how Medicaid and Medicare may apply to your situation, it is recommended to consult with an elder law attorney to ensure you have a plan that meets your needs.