Hospice and nursing homes are distinct concepts that serve different purposes, but they often intersect. Hospice is a specialized form of care focused on comfort for individuals with a life-limiting illness. A nursing home, also known as a Skilled Nursing Facility (SNF), is a residential setting that provides long-term care or short-term rehabilitation services. While a nursing home is a physical facility, hospice is a philosophy and set of services delivered by a dedicated team. The key differences lie in their fundamental goals, the location of service delivery, and their financial coverage structures.
Hospice vs. Nursing Home: Defining Purpose and Philosophy
The fundamental difference between hospice and a nursing home is the goal of the care being provided. Hospice care is palliative, meaning the focus shifts from seeking a cure to maximizing the patient’s comfort and quality of life near the end of life. This care addresses physical symptoms, such as pain and nausea, alongside emotional and spiritual needs for the patient and family. To qualify for the Medicare Hospice Benefit, a physician must certify that the patient has a terminal illness with a prognosis of six months or less.
In contrast, a nursing home’s purpose is either long-term custodial support or short-term rehabilitation. Custodial care involves providing assistance with activities of daily living (ADLs), such as bathing, feeding, and dressing, for people who cannot live independently. Skilled Nursing Facilities (SNFs) offer intensive, short-term medical services, like physical therapy or wound care, with the goal of improvement and eventual discharge back home. The philosophy of a nursing home is maintenance or recovery, which contrasts with the comfort-focused, non-curative approach of hospice.
Care Settings: Where Hospice Services Are Delivered
Hospice is best understood as a service that travels to the patient, rather than a fixed facility where the patient must reside. Most hospice care is delivered in the patient’s private residence, but it can also be provided in assisted living facilities or hospitals. This model allows the patient to remain in a familiar environment while receiving specialized support.
A nursing home, however, is a specific type of residential facility with 24-hour staffing and medical oversight. This distinction creates the overlap: a patient can receive hospice care while residing in a nursing home.
In this dual-care scenario, the nursing home provides room, board, and routine custodial care. The hospice agency sends its specialized interdisciplinary team—nurses, social workers, spiritual counselors, and aides—to the facility to deliver palliative services. This arrangement allows the patient to benefit from the nursing home’s continuous presence while receiving the specialized end-of-life expertise of the hospice team. For brief periods of intense symptom management, a patient might also be admitted to a dedicated Hospice Inpatient Unit (IPU), which is separate from a standard nursing home.
Financial Structures: Who Pays for What
The payment structures for hospice and nursing home care are different, reflecting the distinction between a specialized medical service and residential living. Hospice care is primarily funded by the Medicare Hospice Benefit, which falls under Medicare Part A. This elective benefit covers virtually all services, medications, and medical equipment related to the terminal illness at generally no cost to the patient. Electing this benefit requires the patient to waive coverage for curative treatments related to the terminal diagnosis.
In contrast, long-term custodial care in a nursing home is not covered by Medicare. Medicare Part A only covers short-term, post-hospital stays in a Skilled Nursing Facility for up to 100 days, and only if specific rehabilitation criteria are met. Long-term nursing home residency is typically financed through private pay, long-term care insurance, or Medicaid for individuals who meet financial eligibility requirements.
When hospice care is provided to a patient living in a nursing home, a dual payment structure is created. Medicare pays the hospice agency a daily rate to cover palliative services, nursing visits, and medications related to the terminal diagnosis. Simultaneously, the patient or their payer must continue to pay the nursing home for the room, board, and custodial services. This financial separation reinforces that hospice is an added service, not a replacement for the residential and custodial care provided by the facility.