Who Pays For Hospice Care At Home? 6 Options To Know

Ana Safarian • July 10, 2024

It's tough enough to face the reality that a loved one is already nearing the end of their life—and figuring out how to pay for hospice care is a whole other headache. 


A hospice care service ensures that your loved one's quality of life won't be diminished as they approach the finish line—even under the thought that their serious illness won't be cured anymore. Come to think of it, it's a great end-of-life gift for them, but there's a looming concern: the costs.


Is Hospice Free?


Hospice care is not inherently free, whether at home or in a facility. 


However, there are still many options for patients to get hospice services at no direct cost to themselves by tapping various funding sources.


The term "free" in this context generally means that the patient—or their family—does not need to pay expenses out of their own pockets because the costs will be covered by financial assistance programs. However, the extent to which hospice care is "free" will still depend on the patient's eligibility for these programs and the specific services they provide. 


Who Pays For Hospice Care At Home In California?


If you're worried about the costs of hospice care, you're not alone. Many families face this concern, but several options can help lighten the financial burden. Knowing about the different funding sources available can make a big difference, ensuring your loved one receives the care they need without adding financial stress. Here are the primary ways to cover hospice care costs at home in California:


Medicaid


Medicaid serves as a lifeline for many low-income families in California needing hospice care at home. This benefit includes a wide range of services for terminally ill individuals, such as:


  • nursing care
  • medical social services
  • physician visits
  • counseling for patients and their families
  • short-term inpatient care
  • medical supplies
  • home health aides
  • therapy services


To access these benefits, patients must elect the hospice benefit by filing a statement with a chosen provider, acknowledging that other Medicaid services for curing their terminal condition are waived. However, they can revoke this choice at any time to resume regular Medicaid benefits.

A physician must certify that the patient is terminally ill, and a hospice plan of care must be established before services begin. Medicaid hospice care comes in different levels:


  • Routine Home Care (RHC): Standard care at home.
  • Continuous Home Care (CHC): Intensive nursing care during a crisis.
  • Inpatient Respite Care (IRC): Short-term care to relieve caregivers.
  • General Inpatient Care (GIC): Short-term care for pain control or symptom management that can't be handled at home.


There’s also a Service Intensity Add-On for care provided by a nurse or social worker in the last week of life.


Medicare


Medicare is a lifeline for many seniors in need of hospice care. To qualify, the patient must have Medicare Part A and receive certification from both their hospice doctor and their regular doctor (if they have one) that they are terminally ill with a life expectancy of six months or less. 

The patient must also choose comfort care over curative treatments and sign a statement opting for hospice care instead of other Medicare-covered treatments for their terminal illness and related conditions.


Medicare covers nearly all expenses related to hospice care, including doctors' services, nursing care, medical equipment, and medications for pain relief and symptom management. While hospice care itself incurs no costs, there may be small copayments for outpatient prescription drugs and a portion of the Medicare-approved amount for inpatient respite care. 


If the patient develops health issues unrelated to their terminal illness, Medicare will continue to cover those separately.


Private Insurance


Many work-based and private insurance plans include some hospice care coverage, but specifics can differ widely. It's essential to check with your insurance company to understand what your plan covers and the settings in which hospice services are available.


Every insurance plan has its own criteria for hospice eligibility and covered services. Reviewing your policy or speaking directly with your insurer will help you understand these details. While some plans may cover a comprehensive range of hospice services, others might offer more limited benefits.


If you have long-term care insurance, it may also help cover hospice care at home. This can include continuous home care, which is particularly beneficial during crises when intensive nursing care is needed. Knowing the extent of your insurance coverage can simplify managing hospice care costs and provide peace of mind during a difficult time.


Tricare


Tricare, run by the Defense Health Agency, ensures that military service members, retirees, and certain family members receive hospice care at home. This support is available throughout the U.S. and its territories, but not overseas.


Tricare's hospice services include physician visits, nursing care, counseling, medical equipment, necessary medications, and therapies like physical, occupational, or speech therapy. They also provide short-term inpatient care when it's needed.


VA Benefits


Alongside Tricare, the U.S. Department of Veterans Affairs (VA) offers hospice care for veterans and their families. This benefit is for those with a terminal illness and a life expectancy of six months or less, who are not pursuing curative treatments. The VA works with community and home hospice agencies to provide thorough and compassionate care, ensuring veterans can receive hospice services in the comfort of their homes.


Charity Funding


When seniors face the financial strain of hospice care, supportive options are available. Many hospice providers have funding programs to assist those who are medically eligible but lack insurance or the means to pay out of pocket.


Additionally, community organizations can be a lifeline, often stepping in to cover some or all of the hospice care costs based on a senior's eligibility and financial need. Groups like the American Cancer Society and the National Hospice and Palliative Care Organization often offer grants or financial aid to families in need. These charitable efforts ensure that everyone has access to the compassionate care they deserve, regardless of their financial situation.


Private Pay


For some families, covering hospice care out-of-pocket or through private pay might be necessary. While this option can be expensive, it offers the flexibility to choose providers that best meet their needs. 


Families can manage these expenses more effectively by negotiating costs with hospice providers and exploring more affordable care options. Some providers may also offer sliding-scale fees based on income, providing some relief for those bearing the full financial responsibility.


What Is Usually Not Included In Hospice Care?


While hospice care covers a wide range of services, there are some treatments and services typically not included:


  • Curative Treatments. Hospice focuses on palliative care and symptom management rather than curing the illness. Treatments aimed at curing the illness, like chemotherapy or radiation therapy, are generally not covered.
  • 24-Hour In-Home Care. Standard hospice care usually does not provide round-the-clock in-home care. Families may need to seek additional help for 24-hour support.
  • Room and Board. If the patient is in a hospice facility, room and board costs are typically not covered by hospice benefits and may require additional payment.
  • Personal Care Supplies. Items such as adult diapers, wipes, and personal hygiene products are often not covered and may need to be purchased separately.
  • Transportation. Routine transportation to and from medical appointments is not usually covered by hospice care.


Does Hospice Cover 24-Hour Care At Home?


Standard hospice care usually does not include 24-hour care. However, there are circumstances where round-the-clock care might be necessary, such as severe pain management or significant caregiver respite needs.


In these cases, families may need to arrange and pay for additional services. Options include hiring private caregivers or using supplemental services from hospice agencies that offer 24-hour care. 


Additional Resources


Aside from the primary options for paying for hospice care, several additional resources can provide financial assistance:


  • Social Security benefits may be available to help cover the costs of home hospice care.
  • Veterans and their families may be eligible for specific benefits and assistance through the Department of Veterans Affairs (VA).
  • Various nonprofit organizations offer financial assistance programs to support individuals receiving hospice care.
  • Depending on the area, there may be local or community programs that provide financial aid or resources for hospice care.


Conclusion


Caring for a loved one during their final days can be overwhelming, but understanding your options regarding who pays for hospice care at home will ensure a smooth decision process from then onwards.


Whether it's through Medicaid, Medicare, private insurance, Tricare, charity funding, or private pay, there are many ways to ensure your loved one receives the compassionate care they deserve. By planning ahead and knowing what is covered and what isn't, you can make informed decisions that best suit your family's needs.


If you're considering Olympia Hospice Care for your loved one, don't hesitate to reach out to us. We are here to answer all your questions and provide the support you need. Let us help you provide the best care for your loved one!

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When a loved one is approaching the end of life, it's quite a common struggle to see that they are unable to digest food or hydrate themselves with water anymore. And so IV fluids, or intravenous hydration, are often done to replenish this and provide them the comfort they need. The choice to do them is usually made on a case-by-case basis. Factors such as the patient’s overall condition, goals of care, and quality of life come into play. This leads many to ask: does hospice give IV fluids at home? Well, the answer depends on several key considerations, including the patient’s needs, the hospice provider’s approach, and what ultimately aligns with comfort-focused care. In this guide, we’ll explore when and why IV fluids might be given at home during hospice, what alternatives exist, and how hydration is thoughtfully managed at the end of life. Do Hospice Patients Get IV Fluids? In hospice care, the main goal is to keep the patient as comfortable as possible, not to cure illness or extend life at all costs. Because of that, treatments like IV fluids are not always used. Instead of focusing on medical procedures, hospice teams focus on easing pain, shortness of breath, and other symptoms that may come up near the end of life. Should You Give IV Fluids at End of Life? Choosing to give IV fluids at the end of life involves both medical reasoning and personal values. There have been discussions, new and old, regarding the ethics of providing water and needed calories to dying patients to sustain them even amidst this difficult period. Some families see fluids as a way to provide comfort or maintain a sense of care. Others may feel unsure about stopping them, especially when emotions are running high. If they are unable to communicate, families and care teams work together to make thoughtful choices that support comfort, peace, and dignity during the final stage of life. But if you're looking for a sound and medical reason for this question, the decision often comes down to what the patient seems to need at the moment. As the body nears its end , its natural functions begin to slow. This includes how it handles food, water, and fluids it basically needs less of these things as it transitions towards death. At this stage, the body often no longer needs or benefits from the same kind of hydration it once did. There has also been a 2023 study about fluid resuscitation that highlighted how large amounts of IV fluids can potentially cause electrolyte imbalance and hypervolemia (fluid or volume overload). Overhydration can lead to further organ dysfunction and would just worsen the state of the already-suffering patient. So, with all that being said, giving a hospice patient IV fluids won't really do any much help as their organs don't function properly anymore, and the liquid passed won't be turned into urine. Giving the patient fluids may sound like an empathetic decision, but truthfully, it just does more damage than good. Remember, hospice care focuses on reducing anything that might add stress to the body, especially if it doesn’t improve how the patient feels. Instead of using treatments like IV fluids that may place extra strain on the body, hospice teams shift their focus to comfort, using methods that are gentle and supportive. For families asking, does hospice give IV fluids at home , do understand that stopping fluids is not meant to cause harm. It’s often part of a thoughtful plan to avoid unnecessary interventions as the body prepares to rest. How Long Can a Hospice Patient Survive Without Fluids? The amount of time a person can live without fluids during hospice care depends on several factors, including their overall condition, illness, and how far along they are in the dying process. For some, it may be just a few days. For others, it could be a week or slightly longer. For instance, in 2003, a survey was implemented among hospice nurses in the Oregon area to draw substantial conclusions from the situations of their patients who opted to pursue food and fluid refusal to hasten the process of their passing. A good 85% of the patients died within 15 days of stopping food and water intake. At this point in their life, if there is no fluid or food added anymore, comfort is just the highest priority. So, Can Patients Have IV Fluids at Home? In some cases, yes, patients can receive IV fluids at home while under hospice care. However, this is not always offered by default. Each hospice program has its own policies, and decisions are guided by the care plan, patient needs, and what’s safe to manage in a home setting. If IV fluids are considered helpful, the hospice team will determine whether it’s possible to arrange the supplies, train caregivers, or assign a nurse to administer them. This usually happens only when fluids are expected to bring short-term relief without causing added discomfort. Families asking does hospice give IV fluids at home should speak directly with their hospice provider. Open communication helps clarify what’s available, what’s appropriate for the patient’s condition, and how best to support their comfort during this time. Who is Allowed to Administer an IV at Home? Administering IV fluids at home requires medical training. In most cases, a licensed nurse or hospice care provider is the one to place and manage the IV. This ensures the process is safe, sterile, and tailored to the patient’s needs. Some hospice programs may allow trained family members to assist with ongoing care after the IV is started, but this depends on the situation and local regulations. Safety protocols, such as infection control and proper monitoring, are essential whenever IV fluids are given at home. What Is the Alternative to IV Fluids at Home? When IV fluids are not used, there are simple ways to keep a patient comfortable without putting stress on the body. Hospice teams may suggest: Moistening the mouth with oral swabs dipped in water or a gentle mouthwash Offering ice chips to ease dryness, if the patient can safely handle them Providing small sips of water when swallowing is still possible Applying lip balm to prevent cracked or dry lips Using a cool mist humidifier to keep the air moist and reduce discomfort These methods don’t replace hydration but can relieve dry mouth and help the patient feel more at ease. How Do You Give Fluid to an End-of-Life Patient at Home? Providing gentle hydration at home starts with keeping the patient’s mouth and lips moist. A soft sponge or oral swab dipped in water can be used to moisten the inside of the mouth. If the person is alert and able to swallow, a spoonful of water or ice chips may be offered slowly and carefully. Always follow the guidance of the hospice team, as each patient’s needs and swallowing ability can vary. The focus is on comfort, not on meeting fluid intake goals. Small, thoughtful steps often provide more relief than larger medical interventions at this stage. Personalized Care, Thoughtful Guidance with Olympia Hospice  At Olympia Hospice Care , we understand that families often ask difficult questions when trying to make the best choices for their loved ones. These decisions can feel overwhelming, but you don’t have to navigate them alone. Our team is here to provide clear answers, compassionate support, and care that honors comfort, dignity, and peace. If you're considering hospice care at home and need guidance on hydration options or overall care planning, contact us today . We’re here to help you find the right path forward with confidence and care.
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