How to Transition from Home Health to Hospice Care

Making the decision to transition a loved one from home health care to hospice care is one of the most difficult choices a family can face. It requires a profound shift in mindset—from hoping for a cure and rehabilitation, to focusing entirely on comfort, dignity, and quality of life.

While the emotional transition is heavy, the logistical and medical transition does not have to be.

If your loved one is currently receiving home health services but their condition is declining, understanding how and when to make the switch to hospice can bring immense relief to both the patient and the family. Here is exactly what you need to know about the transition process, Medicare coverage, and what to expect.

In This Guide

• Recognizing the Signs: When is it Time to Transition?
• The Core Difference in Care Goals
• How the Transition Process Works (Step-by-Step)
• Will I Keep the Same Nurses?
• How Medicare Handles the Switch
• Finding a Hospice Provider Near You
• Frequently Asked Questions

Recognizing the Signs: When is it Time to Transition?

Home health care is inherently rehabilitative. The goal is to help a patient recover from an illness, injury, or surgery (such as receiving physical therapy after a hip replacement or nursing care for a healing wound).

However, if a patient is suffering from a chronic, progressive, or terminal illness, there often comes a point where rehabilitative therapies are no longer effective or are causing more exhaustion than benefit.

It may be time to discuss transitioning to hospice if you observe the following signs:

• Frequent Hospitalizations: The patient is making repeated trips to the emergency room or being admitted to the hospital frequently for the same declining condition.
• Treatments Are No Longer Working: Curative treatments (like chemotherapy, dialysis, or aggressive medications) are no longer stopping the progression of the disease, or the side effects are severely impacting the patient's quality of life.
• Significant Weight Loss: Unintentional and rapid weight loss, accompanied by a loss of appetite or difficulty swallowing.
• Decline in Daily Functioning: The patient is spending the vast majority of their day in bed or a chair, and requires maximum assistance with Activities of Daily Living (ADLs) like bathing, dressing, and using the restroom.
• A Desire for Comfort: The patient explicitly states they no longer want to endure painful treatments, blood draws, or hospital visits, and simply want to be comfortable at home.

The Core Difference in Care Goals

To understand the transition, you must understand the shift in the medical philosophy:

• Home Health Care = Recovery. The nurses and therapists are actively working to "fix" a problem and discharge the patient once they have improved.
• Hospice Care = Comfort. The hospice care team (which includes nurses, aides, social workers, and chaplains) is actively working to manage pain, reduce anxiety, and support the family through the end-of-life journey. They are not trying to cure the underlying disease.

(For a deeper dive into the differences between these services, read our comprehensive guide: Home Health vs. Home Care vs. Hospice.)

🔍 Find Post-Acute Care Providers Near You Search our directory of 77,900+ providers to find home health, hospice, SNF, and rehab services in your area. Search Providers →

How the Transition Process Works (Step-by-Step)

If you believe it is time for hospice, the transition process is highly regulated by Medicare to ensure a smooth handover of care.

Step 1: The Doctor's Evaluation

Hospice care requires a physician's order. The patient's primary care doctor and the hospice medical director must both certify that the patient is terminally ill, with a life expectancy of six months or less if the disease runs its normal course.

Step 2: Choosing a Hospice Agency

You are not required to use the hospice agency recommended by your hospital or current home health provider. You have the right to interview and select any Medicare-certified hospice agency in your area.

Step 3: Discharging from Home Health

Medicare will not pay for both home health and hospice care simultaneously for the same terminal diagnosis. Therefore, the patient must be officially "discharged" from the home health agency. Your chosen hospice provider will typically coordinate this paperwork directly with the home health agency to ensure there is no gap in care.

Step 4: The Hospice Admission Assessment

Within 48 hours of receiving the doctor's order (and often much sooner in urgent situations), an admissions nurse from the hospice agency will visit the home. They will assess the patient's pain levels, order necessary medical equipment (like a hospital bed or oxygen), arrange for comfort medications to be delivered, and establish a personalized care plan.

Will I Keep the Same Nurses?

This is one of the most common concerns for families who have grown attached to their home health nurse or physical therapist.

In most cases, no, you will not keep the same clinicians.

Even if your home health agency also operates a hospice division, the clinical teams are usually separate. Home health nurses are trained in rehabilitation and recovery; hospice nurses are highly specialized in pain management, symptom control, and end-of-life care.

While saying goodbye to a beloved home health nurse can be sad, families quickly find that the specialized expertise and deep emotional support provided by the new hospice team is exactly what they need for this new chapter.

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

How Medicare Handles the Switch

Financially, transitioning from home health to hospice is seamless for patients with Medicare.

Both the Medicare Home Health Benefit and the Medicare Hospice Benefit are covered under Medicare Part A. When you elect the hospice benefit, Medicare covers 100% of the costs related to the terminal illness. This includes:

• All nursing and aide visits
• Medical equipment (hospital beds, wheelchairs, bedside commodes)
• Medical supplies (bandages, catheters, incontinence supplies)
• Prescription medications for pain and symptom relief
• Grief counseling and bereavement support for the family

You will have little to no out-of-pocket expenses for services related to the hospice diagnosis.

Finding a Hospice Provider Near You

The most important step in this transition is finding a hospice agency that aligns with your family's values and provides exceptional, compassionate care.

The National Directory of Post-Acute Providers (NDPAP) allows you to search for verified, Medicare-certified hospice agencies in your exact location.

• Search Hospice Providers in Your City

You can filter by location, read about the services they offer, and find the right team to support your family during this profound time.

---

🔍 Compare Providers in Your Area Browse verified providers, compare services, and find contact information. Search All Providers →

Frequently Asked Questions

Can you go back to home health if you improve on hospice?

Yes. It is not uncommon for a patient's health to stabilize or even improve once they receive the intensive support and medication management that hospice provides. If a patient's prognosis improves beyond six months, they can "graduate" or be discharged from hospice. They can then resume regular Medicare benefits, including home health care if they still need rehabilitative support.

Who makes the final decision to start hospice?

The patient (or their legally appointed healthcare proxy/Power of Attorney) makes the final decision. Even if a doctor recommends hospice, the patient must sign an election form choosing to forgo curative treatments and receive palliative comfort care instead.

Can we keep our primary care doctor?

Yes. You have the right to choose your attending physician. Your long-time primary care doctor can continue to oversee your care and work in partnership with the hospice medical director.

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