Can You Have Home Health and Hospice at the Same Time?

When managing the care of an aging loved one, medical situations are rarely simple. A patient may be facing a terminal illness while simultaneously dealing with an unrelated injury or acute condition.

This complex reality leads many families to ask a highly specific question: Can you have home health and hospice at the same time?

The short answer is generally no. Medicare will not pay two different agencies to treat the same terminal condition. However, there is one major exception: A patient can receive both home health and hospice simultaneously if the home health care is treating a condition that is completely unrelated to the terminal hospice diagnosis.

Navigating this exception—known as concurrent care—requires strict adherence to Medicare guidelines and intense coordination between the two care agencies. Here is exactly how it works.

In This Guide

• The General Rule: Choosing One Path
• The Exception: Unrelated Diagnoses
• Real-World Examples of Concurrent Care
• The Challenge of Care Coordination
• Navigating Your Care Options
• Frequently Asked Questions

The General Rule: Choosing One Path

To understand why concurrent care is so rare, you must understand how Medicare funds these two distinct services.

• Home Health Care is rehabilitative. It is designed to help a patient recover from an illness or injury.
• Hospice Care is palliative. It is designed to provide comfort at the end of life when curative treatments have stopped.

When a patient elects the Medicare Hospice Benefit, they sign a document stating they are waiving their rights to standard Medicare Part A payments for any treatments related to their terminal illness. From that point forward, the hospice agency receives a daily rate from Medicare to cover everything related to that specific terminal diagnosis—including nursing care, medications, and medical equipment.

Because the hospice agency is already being paid to manage the terminal illness, Medicare will not pay a separate home health agency to come in and treat that same illness. Doing so would be considered "double billing" or duplicating services.

The Exception: Unrelated Diagnoses

The only way a patient can receive both services simultaneously is if they develop a new, acute medical issue that is entirely unrelated to the reason they are on hospice.

According to the Centers for Medicare & Medicaid Services (CMS), if a patient requires skilled nursing or physical therapy for a condition that is not related to their terminal prognosis, they can use their standard Medicare Home Health benefit to treat that specific issue, while remaining on the Medicare Hospice benefit for their terminal care.

Who Decides What is "Unrelated"?

This is the most critical part of the process. The Hospice Medical Director is the ultimate authority in determining whether a new medical issue is related or unrelated to the terminal prognosis.

Because terminal illnesses (like advanced cancer or end-stage heart failure) affect the entire body and cause a general decline in health, it is often very difficult to prove that a new symptom is completely unrelated.

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Real-World Examples of Concurrent Care

To make this complex rule easier to understand, let's look at a few real-world scenarios.

Scenario A: The Broken Hip (Approved for Both)

• The Situation: John is on hospice care for end-stage Alzheimer's disease. While walking to the bathroom, he falls and breaks his hip. He undergoes surgery to repair the hip.
• The Ruling: A broken hip is an acute injury that is completely unrelated to the terminal diagnosis of Alzheimer's.
• The Result: John can remain on hospice for his Alzheimer's care (receiving comfort meds and aide visits), while simultaneously receiving home health physical therapy to help him recover from the hip surgery.

Scenario B: The Pneumonia Complication (Denied for Both)

• The Situation: Mary is on hospice care for end-stage COPD (a severe lung disease). She develops a severe case of pneumonia and requires respiratory therapy and IV antibiotics.
• The Ruling: Because pneumonia is a respiratory infection, the Hospice Medical Director determines it is directly related to her terminal COPD diagnosis. It is considered a natural progression of her declining lung function.
• The Result: Mary cannot use home health care for the pneumonia. Instead, the hospice agency is responsible for managing the pneumonia symptoms to keep her comfortable.

Scenario C: The Diabetic Ulcer (Approved for Both)

• The Situation: Robert is on hospice for terminal pancreatic cancer. He also has a long history of diabetes. He develops a severe diabetic ulcer on his foot that requires complex, daily wound care.
• The Ruling: The diabetic foot ulcer is related to his pre-existing diabetes, not his terminal pancreatic cancer.
• The Result: Robert can receive home health skilled nursing specifically for the wound care on his foot, while the hospice team manages his cancer pain.

The Challenge of Care Coordination

Even if a patient qualifies for both services under the "unrelated diagnosis" rule, making it happen logistically is incredibly challenging.

When concurrent care occurs, the home health agency and the hospice agency must communicate constantly. They must ensure that:

1. They are not duplicating services (e.g., both agencies cannot bill Medicare for sending a home health aide to bathe the patient).
2. Their care plans do not conflict (e.g., the home health physical therapist isn't pushing the patient too hard while the hospice nurse is trying to ensure they rest comfortably).
3. Their billing codes are perfectly separated so Medicare does not reject the claims.

Because of the high risk of Medicare audits and the intense administrative burden, many home health agencies are hesitant to take on a patient who is already on hospice, even if it is legally allowed.

📋 Understanding Medicare Coverage? Read: Medicare and Post-Acute Care: What's Covered and What You'll Pay

Navigating Your Care Options

If you find yourself in a situation where your loved one needs both rehabilitative care for an injury and comfort care for a terminal illness, your first step should be to speak directly with the Hospice Medical Director. They must approve the dual-care plan before any home health agency will step in.

If you need to find certified providers to help manage your loved one's complex needs, the National Directory of Post-Acute Providers (NDPAP) is here to help.

• Search Home Health Agencies in Your City
• Search Hospice Providers in Your City

Our directory allows you to find verified agencies in your exact location, ensuring you have the right team in place for every stage of the journey.

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Frequently Asked Questions

Can you switch back and forth between home health and hospice?

Yes. If a patient is on hospice but their condition improves or stabilizes, they can "revoke" their hospice benefit and return to standard Medicare. If they then need rehabilitative care, they can start home health. There is no penalty for revoking hospice, and you can re-elect it later if your condition declines again.

Does Medicare Advantage allow concurrent care?

The rules for concurrent care (the "unrelated diagnosis" exception) apply to both Original Medicare and Medicare Advantage (Part C) plans. However, if you have a Medicare Advantage plan, you must ensure that both the hospice agency and the home health agency are in-network with your specific plan to avoid out-of-pocket costs.

(For more answers to common questions about finding post-acute care, visit our FAQ page. Are you a provider? Claim your directory listing here.)