Whether you choose hospice care at home or in a facility will depend on your relative’s preferences, their care requirements, the support that is available, and your family’s situation. Hospice at home gives the advantage of familiarity and comfort, but most of the daily care between hospice visits is generally provided by family members or by paid caregivers. In a facility the responsibilities will vary according to the type of setting, the staffing available, and the patient’s care plan.
You needn’t decide this by yourself. Let the hospice team describe to your family what each option would involve, covering overnight support, the costs, and the situation if your care needs change.
This was a decision of great personal significance to me. In the book One Caregiver’s Journey I explain the difficulties of coming to the realization that my mother was approaching the end of her life, even though she was 102 it was still hard to consider letting her go.
Hospice at Home vs. a Facility: A Quick Comparison
Hospice represents a form of care and not a particular place; it may be given in a private home, in an assisted living community, in a nursing home or on an inpatient basis.
| What to consider | Hospice at home | Hospice in a facility |
| Environment | Familiar surroundings and routines | A setting outside the private home, or the facility where the person already lives |
| Daily personal care | Usually provided by family or paid caregivers between hospice visits | Provided according to the facility’s services and care plan |
| Hospice support | Scheduled visits and access to help for concerns | Hospice staff coordinate with facility staff, or provide care in an inpatient unit |
| Overnight needs | Families need a realistic plan for supervision and assistance | Staffing and available assistance vary by facility |
| Caregiver responsibilities | Can involve substantial hands-on care and coordination | Some daily responsibilities may shift to facility staff |
| Costs | Additional paid caregiving may be needed | Room, board, and other charges may apply |
| Changing symptoms | The hospice team reassesses needs and arranges appropriate support | Available treatment depends on the setting and level of care |
I suggest that, prior to making your decision, you ask each provider to outline what a typical day and night of care looks like. This way you’ll have a better understanding of who will be providing the care and where any gaps might occur.
My Experience Choosing Hospice Care for My Mother
My mother had more than one evaluation before she was admitted to hospice. At an early assessment she sang to the nurse and carried on for an hour. Later on, since her congestive heart condition had made walking harder, the doctor from her home physician service suggested that she should have another evaluation.
I felt uncomfortable when a representative from that provider spoke to me, since I wasn’t able to obtain clear information regarding the hospice team or the services we would be receiving, and as a result I refused to go with that provider and brought my concerns to its director.
A hospice nurse who works in a hospital carried out a comprehensive assessment, posed some questions, and outlined the process for admission. We decided to have hospice care at home and my mother died there roughly one month later.
The most helpful thing was working out who would back us. The team consisted of nurses, a social worker, and a spiritual advisor. Since our parish priest was already on good terms with my mother, we decided to keep relying on him for our spiritual support.
The lessons I had gained showed me that I should keep asking questions until I was sure that I understood the plan. It is only right that families should have clear explanations when they are going through such a difficult period.
When Hospice at Home May Be a Good Fit
Home hospice is appropriate for a person who wishes to stay in familiar surroundings and who has a feasible arrangement for daily care.
Consider whether:
- The person you care about would rather stay at home.
- Family members or paid caregivers can look after the visits.
- The house can provide for the equipment that is necessary.
- The tasks that are part of the care plan can be learned by caregivers.
- Support can be obtained when the primary caregiver needs a break.
Familiarity may be reassuring, but it is necessary to have an open conversation about the workload. Looking after someone with regard to bathing, toileting, repositioning, and their overnight needs can be both physically and emotionally exhausting.
I recommend that you record the names of the people who will be in charge of daytime care, nighttime care, meal preparation, household duties, and having backup coverage. You should ask the hospice team which of the tasks need to be trained.
Does Home Hospice Offer 24 Hour Care?
Routine home hospice care should not be interpreted as involving a nurse being present by the patient’s side throughout the day and night. You should ask the provider about their scheduled visits, after-hours calls, urgent visits, and their response times.
Continuous home care under Medicare is a distinct level of hospice care which is used for short periods when qualifying conditions are satisfied, rather than being the normal daily arrangement.
When Hospice in a Facility May Be More Suitable
Imagine a situation where the home setup is not safe or not sustainable in meeting the person’s needs.
Reasons to explore this option include:
- The caregivers are unable to carry out the physical tasks that are required.
- Help available on overnight basis is not provided.
- The house is not big enough to provide the care that is needed.
- Your beloved person is already residing in a nursing home or an assisted living community.
- It has to be evaluated to see if it requires a different level of hospice care.
Selecting a facility can in a thoughtful way support your loved one and help to protect the health of the caregiver.
Facility-Based Hospice and Inpatient Hospice Are Different
Getting hospice care in a nursing home or an assisted living facility is different from having general inpatient hospice care.
The hospice team operates together with the current staff in the residential facility and it is important that their responsibilities be clearly explained.
General inpatient hospice care is provided for pain or symptoms which cannot be dealt with in some other setting and is usually of a short duration with regular reassessment when the patients’ needs change.
Suggest asking, “Is the care in question a routine hospice service or an inpatient admission for the purpose of managing symptoms?” and at the same time find out who is responsible for providing personal care, nursing support, and overnight assistance.
Find Encouragement in the Caregiving Journey
One Caregiver’s Journey
By Eleanor Gaccetta
Genre: Memoir / Family Caregiving
Caring for a loved one can bring moments of joy, exhaustion, and uncertainty. In One Caregiver’s Journey, Eleanor Gaccetta shares heartfelt memories, humor, and practical insights from nine and a half years of caring for her mother. Discover a personal story that reminds caregivers they are not alone.
Find Your Copy on AmazonFive Factors to Discuss Before Making Your Decision
1. Your Loved One’s Wishes
If the person you care about is able to take part, find out which of these is most important to them—privacy, staying in familiar surroundings, having visitors, receiving spiritual support, or having assistance available nearby.
The conversation should be guided by the preferences while taking into account what both the care team and the family are able to provide.
2. Current Care Needs
Request that the hospice team should evaluate the patient’s symptoms, mobility, personal care needs, and equipment requirements and ask for a clear explanation of the duties that caregivers will have to carry out.
3. Caregiver Capacity
Think about your own health, the quality of your sleep, your work commitments, and the support that is available to you. Just because you love someone doesn’t mean that you can safely look after all the aspects of their care by yourself.
If you want to read more about these responsibilities, see Becoming a Family Caregiver: What You Need to Know.
4. The Home Environment
Talk about the need for access to the bedroom and bathroom, the available space for equipment, and safe movement throughout the home. Ask the team what changes or supplies might be required.
5. A Plan for Changing Needs
If you need to know who to contact when the symptoms get worse, the caregiver falls ill, or the present situation becomes difficult, then knowing what to do next can help to reduce uncertainty.
Does Medicare provide coverage for hospice care at home or in a facility?
Medicare does cover hospice services which are provided by an approved hospice for eligible patients. However, the hospice coverage does not include all living expenses automatically.
Medicare usually does not pay for normal room and board whether you are at home or in a residential care facility. It will cover eligible short-term inpatient or respite care arrangements made by the hospice team. In some cases, copayments will be required.
Request that the provider put in writing an explanation of the coverage and any possible charges. Families who are using Medicaid or private insurance should also check their plan’s rules.
It is recommended that you ask for individual explanations regarding the hospice services, the cost of room and board, and any other paid caregiving. You should also look over the existing information on Medicare’s hospice coverage.
Questions to Ask a Hospice Provider
Before agreeing to services, ask:
- Who is going to evaluate my loved one and tell me if they are eligible?
- What professionals are going to take part in the care plan?
- With what frequency are appointments arranged?
- Who looks after the person with regard to bathing, toileting, and other daily activities?
- What kind of support is on offer during the night and on weekends?
- What would occur if the symptoms could not be controlled in the present setting?
- What medications, supplies, and equipment are covered?
- What might be the costs that our family has to pay?
- What kind of training will be given to caregivers?
- What kinds of emotional, spiritual, and bereavement support are available?
It is recommended that you keep the answers alongside your care plan and contact numbers. If an explanation is not clear, ask for clarification before signing.
What if the family caregiver needs a break?
Let the hospice team know if caregiving is becoming difficult and find out about the support that is available, the backup arrangements and the respite options.
Medicare’s inpatient respite care allows a caregiver a brief stay in an approved facility for up to five consecutive days in order to give them a break. This is different from standard inpatient care given for uncontrolled symptoms. The hospice team can explain the eligibility criteria and make the necessary arrangements.
The need for rest won’t reduce your commitment, and a sustainable plan should include support for caregivers.
What Hospice Support Meant to My Family
When my mother was in her last weeks, friends and relatives came to see her, and I stayed with her at night, listening to her breathing.
One night when I needed assistance with changing her wet bed, a hospice nurse came to our house, settled my mother comfortably, and taught me how to do it. I’ll always remember that act of kindness.
That is what we experienced, since all families have different situations. Find out from your provider what kind of assistance is on offer so that your expectations coincide with the services provided.
Frequently Asked Questions
Is it possible to get hospice care in an assisted living facility or a nursing home?
Certainly. Hospice care can be given in the place where a person lives, in all such settings. Find out how the hospice staff and the facility staff share their responsibilities.
Is it possible to transfer from home hospice to a facility?
A change could be made if the care requirements or family circumstances alter. The arrangements will be influenced by availability, clinical needs, coverage and costs. You should talk to the hospice team about the options.
Should hospice care at home be the better option?
There is no one setting that is best for all families. The choice must take into account the patient’s wishes, their care needs, the capacity of the caregiver, and the services that are available.
Does selecting a facility imply that I have let down my loved one?
The fact that you choose extra support doesn’t indicate that you’ve failed; instead, you can still stay involved by making visits, having conversations, offering advocacy, and providing emotional support.
Choosing Care With Understanding and Support
The decision between getting hospice care at home and receiving it in a facility is something that should be based on clear information and kind advice.
Start with your loved one’s wishes. Ask what daily care will involve, confirm what support is available, and plan for changing needs. Permit yourself to ask for help.
In One Caregiver’s Journey, I share the love, uncertainty, and lessons that shaped my years caring for my mother. I hope that experience helps other caregivers feel less alone as they make their own decisions.
This article shares personal caregiving experience and general information about U.S. hospice services. Discuss individual care needs with the hospice team and confirm coverage with the provider and insurer.
