The question of simultaneously receiving hospice and home health care involves complex federal health care regulations regarding treatment near the end of life. For services related to the same terminal illness, the answer is generally no, due to specific rules governing the Medicare Hospice Benefit. However, a person can receive both types of care concurrently under specific circumstances, such as when two different, unrelated health conditions require treatment. Understanding the distinct philosophies behind each service is key to navigating these rules.
The Distinct Goals of Home Health and Hospice
Home health care is defined by a goal of recovery, rehabilitation, or maintenance of functional status. This curative care aims to improve a patient’s condition following an illness, injury, or surgery. Services are typically provided on an intermittent basis, often including skilled nursing care, physical therapy, or speech-language pathology. The duration of home health is limited to the period required for the patient to meet recovery goals or stabilize their condition.
Hospice care, in contrast, operates under a palliative philosophy, focusing on comfort and quality of life for a person with a terminal illness. To qualify for the Medicare Hospice Benefit, two physicians must certify that the patient has a prognosis of six months or less. This model involves accepting that the underlying disease process cannot be cured, and the patient agrees to forgo curative treatments for that specific condition. The care team includes nurses, aides, social workers, and spiritual counselors, providing comprehensive support wherever the patient resides.
The Regulatory Barrier to Simultaneous Care
The primary reason a patient cannot receive both services for the same condition is linked to electing the Medicare Hospice Benefit. When a person chooses this benefit, they must sign a statement acknowledging the benefit’s palliative focus. This signed election effectively waives the patient’s right to Medicare coverage for most other services related to the terminal illness. The waiver includes skilled home health services that would otherwise be covered for the same condition.
This regulation, overseen by the Centers for Medicare & Medicaid Services (CMS), ensures the hospice provider assumes full financial and clinical responsibility for managing the terminal diagnosis. Once the election is made, the hospice agency coordinates and provides virtually all care needed for that specific illness. Billing Medicare for skilled home health services for the same terminal condition during the hospice election period results in denied claims. This structure prevents duplicate payments for overlapping care intended to treat the same underlying illness.
Scenarios Where Both Services May Be Used
While simultaneous care for the same terminal illness is prohibited, a patient can receive concurrent home health services if the condition is entirely separate from the terminal diagnosis. For instance, a patient receiving hospice care for advanced lung cancer may break their hip in a fall. Skilled physical therapy and nursing visits for the broken hip are considered curative and unrelated to the terminal cancer, allowing Medicare to cover those home health services. The decision on whether a secondary condition is “unrelated” is made by the hospice team and the attending physician, requiring careful documentation to avoid regulatory issues. Non-skilled, supportive care is also available alongside hospice, provided by a hospice aide as part of the benefit. This includes help with activities of daily living like bathing and dressing.
A patient may transition between the two types of care by revoking the hospice benefit. Revocation immediately reinstates full Medicare coverage for curative treatment, including skilled home health. This mechanism is not simultaneous care, but it allows the patient to resume curative efforts if their condition improves or they choose to pursue aggressive treatment. The ability to revoke and re-elect the benefit allows for flexibility as goals and medical needs change.