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Nursing Homes vs Hospice

Maybe your loved one was healthy for years before beginning a gradual decline that has now turned severe. Alternatively, perhaps your loved one’s health was fine, but has taken a sharp and sudden turn for the worse. You’re wondering if it’s time for a nursing home or hospice. Which is better for your loved one’s situation, and what are the main differences between the two options?

Nursing Homes

People tend to arrive in nursing homes after having been cared for in some way at home or after spending time in assisted living. In fact, many folks end up in nursing homes after a fall or similar type of mishap highlights the risks of them living alone. Their health may be less than robust, but these residents are generally not considered “terminal.” For the most part, they don’t have an illness or condition that should prove fatal in six months or less. That said, it is possible to receive hospice care in nursing homes if you have such an illness. In normal circumstances, a nursing home tends to have just a few hospice residents, sometimes only one—or zero. So, what do you get out of a nursing home if you don’t need hospice services? Essentially, nursing home residents tend to require a good deal of help with daily living activities, such as dressing, bathing or moving around. Staffers such as nurses’ aides help with the care, which is available 24 hours a day, seven days a week. Residents generally aren’t allowed to leave on their own, at least not without notifying someone, but nursing homes usually provide a wide range of entertainment and socialization activities.

 “Terminal” and Hospice

At its very basic, hospice care is care that aims to ease someone’s pain and suffering in their final months. The emphasis is on pain relief, comfort, compassion, dignity and support, both for the patients and their family members. It is not on trying to “cure” a disease or illness. Many types of hospice care are available, and the options can seem overwhelming. For example, there could be:
  • Doctor services
  • Spiritual services
  • Medical services/nursing care
  • Medical social services
  • Home care aide services
  • On-call care
  • Inpatient care
  • Volunteer care
  • Speech, occupational or physical therapy
  • Respite care
  • Bereavement support
To elaborate on a few of these: On-call care is when someone is cared for at home by family members or loved ones who have 24/7 access to call someone with questions or to request a visit. Home care aide services can help with basic necessities, such as dressing and getting out of bed, and many also help with laundry, cooking and the like. Pain medications and medical support tend to come via medical services and nursing care. Doctors are typically involved only to the extent that they help establish a plan of care. Hospice care can occur wherever a person lives, be it at home, in a nursing home or in an assisted living facility. There are also hospice-specific facilities, but the goal, if possible, is for hospice to go to where the patient already is. It does happen sometimes that a person receiving hospice care must go to the hospital. In such cases, the aim is usually discharge and a return to the previous setting.

To Start Hospice Care

For you to start receiving hospice care, a doctor makes a referral. A representative from a hospice program should be in touch within one or two days, although hospice can certainly begin sooner in emergency cases. You may qualify for hospice care if you have a terminal condition that is expected to resolve itself within six months. It does happen that some people receiving hospice care live longer than that, and their doctors re-certify them for another six months and so on. A few rare folks even end up leaving hospice care altogether and get better. Unfortunately, people often wait too long before starting or accepting hospice care. This could be because it’s hard to admit that you or your loved one is dying or that taking on the burden yourself as a caregiver is proving just too hard and complex. The earlier someone starts receiving hospice care, the better. The final months will be more comfortable and have more dignity.

To Start Nursing Home Care

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 financial resources, whether you have done estate planning and/or have long-term care insurance, you may need to apply for Medicaid. Many nursing homes accept residents who are on Medicaid, but the program does require that your assets have fallen below a certain amount. What you (and your spouse, if applicable) are allowed to have varies by state. Furthermore, if you’re on Medicaid, most of any income you earn is expected to go toward helping pay for your nursing home care.

Hospice Care in Nursing Homes

Nursing home staff themselves do not provide hospice care because this type of care requires special training, plus the staffing numbers simply aren’t there at most nursing homes. Instead, hospice staffers go to the nursing home to provide hospice-specific care, and the nursing home staffers continue to give custodial care, such as dressing and bathing.  
Nursing Home Hospice
Care period Typically long term Short term (six months or less, with renewals possible)
Financials Medicaid, private insurance, Veterans Health Administration, long-term care insurance, life insurance, self (or a combination) Medicare, Veterans Health Administration, Medicaid (in most states), private insurance, community sources, self (or a combination)
Daily living activities such as feeding and laundry Yes Usually no but should be arranged separately
Focus on getting better? Medication for ongoing conditions can be given, and residents can visit doctors for treatment (usually offsite) No, focus is on comfort, pain management and dignity, among others. However, hospice is not irreversible. It can be stopped if the patient decides to seek treatment for the condition.
 

Which Option Fits Your Needs?

If you’re living at home, are diagnosed with something and expected to live less than six months, you probably don’t want to go into a nursing home. In many cases, if not most, it will be possible for you to stay at home and receive hospice care. That said, it is all but necessary to have family members or friends who are willing to volunteer as caregivers or who can pay for home aides. Alternatively, some hospice groups have financial assistance programs that may help. If it happens that you shouldn’t or cannot stay at home, then going to a hospice-specific facility rather than a nursing home is usually what occurs. 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, many visits from multiple family members, a visit from the chaplain and several volunteer visits for a few hours each while your primary caregiver attends to other needs. Alternatively, you might have an aide who is paid to help with your daily needs. A hospice aide (not an aide for daily living) can help with activities such as:
  • Mouth care/oral health
  • Filing nails and cleaning nails
  • Motion exercises
  • Dressing changes
  • Tube changes
  • Bed linen changes
  • Moving a patient over in bed to prevent bedsores
  • Rubbing lotion on forehead, arms, feet, etc.
Most of your daily care will be provided by family/friend caregivers who have been trained by hospice personnel on how to care for you. If you’re already in a nursing home, then you’ll probably receive your hospice care there.

The Choice Is Yours

Unless you’ve given someone else guardianship or the power to make certain types of medical decisions on your behalf, the choice of whether to receive hospice care is yours. If you want to seek treatment instead of hospice, you should be able to. If you choose hospice care, the sooner you can get started, the better. You and your loved ones will have more time to deal with the emotional stress of what’s happening and any unresolved issues. You can also be comfortable for longer. Too many patients die within a week or two of entering hospice when they could’ve been receiving services for at least three months.

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