For people who are facing a terminal or late-stage illness, hospice care can provide pain and symptom relief that focuses solely on comfort. Hospice care at home allows a loved one to spend their final months and moments in a comfortable and familiar space where they can be surrounded by family and friends.
As your family comes to terms with a terminal diagnosis or as you look ahead to plan for your loved one’s end-of-life care, this guide can help you understand what to expect when hiring 24/7 hospice care, the costs of hospice services, and what services are likely to be covered by insurance.
How does 24/7 hospice care at home work?
Hospice is a type of palliative care that focuses on comfort and pain management as opposed to curative treatment. Hospice services are available to patients who have a terminal diagnosis and a life expectancy of six months or less.
Most home hospice providers offer a few different levels of end-of-life care. Routine home hospice care is the most commonly used option. At this level, hospice staff aren’t present in the home 24/7 to provide hands-on care. Instead, they make routine visits to a patient’s home on a daily, weekly, or as-needed basis, but staff are on call throughout the day and night. A member of the hospice care team should always be available when immediate needs arise, but the patient’s family will still be responsible for the bulk of their daily care between visits.
Another level referred to as continuous home hospice care can provide round-the-clock care, but only on a short-term basis. When medically necessary, staff will work in shifts to provide up to 24/7 hospice care at home to help a patient through a crisis.
Does my parent need 24/7 hospice care?
The level of hospice care needed will depend on how severe a person’s condition is and how rapidly it’s progressing. Most people rely on routine home hospice care for end-of-life support, but a loved one’s needs can fluctuate.
Continuous home hospice care is only available to patients with an urgent need for help managing end-of-life symptoms. This primarily includes skilled nursing care, but can also involve increased personal care support and homemaker services. Temporary 24/7 hospice care is usually provided on a short-term basis to help address the following acute issues:
- Seizures
- Pain
- Difficulty breathing
- Agitation or anxiety
- Nausea
- Vomiting
- Diarrhea
- Changes in consciousness
If a loved one doesn’t qualify for these intensive hospice services but still needs more support at home, consider a mix-and-match approach that’s tailored to their particular situation. Pairing routine home hospice care with regular in-home care is a common solution. It may ensure loved ones are well cared for while also reducing the burden on you and other family members.
It’s also important to understand that even though your parent may wish to die at home, in some cases home hospice care may not be appropriate. Some seniors will need round-the-clock skilled nursing support beyond the abilities of even continuous hospice care. While staying at home may have once been the goal, their condition may require a move to a hospital, a nursing home, or an inpatient hospice unit where they can receive more frequent and intensive care.
Who pays for 24/7 hospice care at home?
On most health insurance plans, hospice coverage extends to 24/7 care at home. Hospice services are covered by most types of health insurance, including the following:
- Medicare
- Medicaid
- VA health care and TRICARE
- Most private health insurances
Private insurance typically covers a portion of hospice care, but be sure to check with the insurance company to find out what’s included in your loved one’s plan. Patients without insurance can pay for hospice care out of pocket, but this is uncommon. Some hospice organizations offer services for free or at a reduced rate for those who cannot afford end-of-life care. You may need to explain your loved one’s insurance and economic status to any hospices you’re considering to see what options are available. Most hospice providers have financial staff who can answer questions and explain confusing regulations.
How much does 24/7 hospice care cost?
Out-of-pocket costs for 24/7 home hospice care are usually minimal for hospice patients who are covered by Medicare, Medicaid, or another source of health insurance. As you talk with hospice providers about your loved one’s needs, they’ll be able to explain what prescriptions, services, and medical equipment are covered and if any of these must be paid for privately. Any add-ons to their regular offerings may be available at an extra cost.
The following Medicare payment rates to providers can give you a general idea of what it costs to pay for hospice out of pocket in 2022, according to the Centers for Medicare & Medicaid Services:
- Continuous or 24/7 home hospice care: $63.42 per hour, totaling $1,522.04 per day
- Routine home hospice care: $211.34 per day for the first 60 days and $167 for each additional day
These costs cover all needs related to a patient’s terminal illness, including medications, pain management, medical equipment, symptom management, and medical supplies. The hospice team may also support you and your family through this difficult time and offer ongoing grief counseling.
Hiring an in-home caregiver in addition to a regular hospice team can help minimize stress and allow you to spend more quality time with your parent. If you’re considering the idea of supplementing hospice with in-home care for your loved one, the cost for a home health aide is around $154 per day, according to Genworth’s 2021 Cost of Care Survey.
Support for caregivers
Helping your parent navigate end-of-life decisions and creating plans for care can be challenging and overwhelming. Many families wait to seek hospice treatments until their parent or loved one is very near to death. On average, half of patients receiving hospice care die within the first month, and between 30-40% of patients die within the first week. While it’s common to delay seeking hospice care until these last moments, hiring hospice sooner can be beneficial in helping ensure your loved one is comfortable for as long as possible.
Throughout this challenging time, it’s likely you’re feeling a range of emotions — from anticipatory grief to exhaustion and even relief that a loved one’s pain will soon be over. Know that all your feelings are normal and that you’re doing your best in a difficult situation. While it may be hard to watch someone prepare for death, making sure their wishes are respected is a meaningful gift you can give them.
During tough times, connecting with others who are going through similar experiences can be helpful for family members and caregivers. Our Caregiver Forum is a place where you can share advice, seek help, and get answers to a wide range of caregiving topics.
Reviewed by senior care expert Leslie Fuller, LMSW, CDP.
Sources:
Hospice Levels of Care (https://www.medicare.gov/care-compare/resources/hospice/levels-of-care)
Can Hospices Predict Which Patients Will Die Within Six Months? (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4118712/)
Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for Fiscal Year (FY) 2023 (https://www.cms.gov/files/document/r11542CP.pdf)
National Hospice and Palliative Care Organization: Hospice FAQs (https://www.nhpco.org/hospice-care-overview/hospice-faqs/)
Genworth 2021 Cost of Care Survey (https://www.genworth.com/aging-and-you/finances/cost-of-care.html)
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