[NurseFeelGood2005]

Hey everyone,
What are the main differences between hospice nursing and home health nursing aside from the obvious one that hospice nurses provice end of life care. What other services are provided by hospice nurses that are different than the services that are provided by home health nurses? And vice versa?
Thanks
Chrissy

[doodlemom]

Hospice - 24 hr on call, Home health, you can call 24 hrs a day, but they will tell you to go to the ER for almost everything. Hospice - the nurse does not have to have a skilled reason for coming. Home health, the nurse needs to have a skilled need to come (dressing change, O2 sat, foley change, etc.. Hospice nurses do not have to call and get orders for equipment as it is covered in our per diem; home health nurses do. Hospice nurses pronounce: home health will call 911 for you and the medics will pronounce. There are major differences in the other services that you get with hospice...cna, sw, chaplain, volunteer. Then there are the medications, equipment, supplies.

[srvrose]

These are Medicare requirements for Home Health:

· The individual must have Medicare Part A or B.
· A doctor must certify that the patient is homebound. This means the illness or injury keeps the patient from leaving home except with the help of another person or a supportive device, such as crutches, a cane, walker, or wheelchair. The patient may leave home occasionally to do things such as go to medical appointments (including therapeutic, psychosocial, or medical treatment at an adult day care program) or attend religious services.
· The doctor must certify that the patient needs part-time or intermittent skilled nursing care or skilled therapy services (physical or speech therapy), or a combination of both.
ü Patients who need “intermittent” skilled nursing care, meaning either fewer than seven days a week or every day for a temporary period of time of up to 21 days, qualify.
ü Patients who need “part-time” skilled nursing care, meaning any number of days each week, for less than eight hours a day qualify.
· The home health agency draws up a plan of care that lists what services are needed, how often they are needed, and for how long, which the doctor must certify. The doctor must review this plan of care at least every 60 days.
· This kind of agency is generally called a Medicare-certified home health agency, abbreviated as “HHA.” This means the home health agency has been approved for Medicare participation by the government and has signed a participation agreement.

The Medicare requirements are:

• The individual must have Medicare Part A or B.
  
• The individual’s physician and the hospice medical director (or other physician affiliated with the hospice) must certify that the individual has a life expectancy of six months or less, if the terminal illness runs its normal course.
• Individuals who elect hospice must waive all other Medicare coverage of care related to their terminal illness, although they still have coverage for services unrelated to the terminal illness.
• The individual’s physician and the hospice medical director must draw up and regularly review a plan of care.
• The individual has to get the care from a Medicare-certified hospice program.

Most important for us, the patient does not have to be homebound and does not have to meet oxygenation goals to qualify for O2 support.