How Hospice and Non-Medical Home Care Work Together

What hospice actually sends, and what it doesn't

The first surprise for most families is how much hospice does, and the second surprise is how quickly the house is empty again after the visit ends.

Under the Medicare hospice benefit, a team comes to the home: a nurse who visits on a schedule and is reachable by phone around the clock, a hospice aide for personal care on set days, a social worker, a chaplain if you want one, and durable medical equipment — hospital bed, oxygen, commode — plus medications tied to the terminal diagnosis. That is a real, substantial benefit, and it costs the family nothing out of pocket in most cases.

What hospice does not do is live in the house. Visits are intermittent by design. The aide may come several mornings a week for an hour or so; the nurse comes on her own schedule. Ask your hospice team to write down the actual expected visit schedule before you plan anything else, because the number they give you is the number that defines your gap.

There are narrow exceptions — hospice can authorize short periods of continuous care during a symptom crisis, and inpatient respite in a facility for a limited stretch. Those are temporary and clinically triggered. They are not a staffing plan for an ordinary Tuesday.

The gap is the overnight and the in-between

Add up the hospice hours on the calendar. Then look at the other 160-odd hours in the week. That remainder is what the family is covering, and it is where the plan usually breaks.

It rarely breaks during the day. It breaks at 2 a.m., when someone needs to be turned or repositioned, or is agitated, or tries to get to the bathroom alone. It breaks when the daughter who drove in from Woburn has now been awake for three nights and has to go back to work. It breaks when there's a second parent in the house who also needs looking after.

A non-medical caregiver doesn't replace any part of the hospice team. She occupies the hours between their visits.

What a non-medical caregiver does during hospice — and what she won't

Our caregivers are not clinicians, and on a hospice case that line matters more than usual. We keep it clean: the hospice nurse handles everything clinical, and the caregiver handles everything else.

What a Westmark caregiver does on these cases:

• Bathing, dressing, toileting, incontinence care and transfers between visits — the daily personal care that doesn't wait for the aide's scheduled day
• Repositioning and keeping someone comfortable in bed or a chair, within what the hospice team has shown the family to do
• Meals, hydration, and gentle encouragement when appetite drops off
• Overnight presence — awake, in the house, so the family can actually sleep
• Light housekeeping, laundry, and keeping the room calm and uncluttered around the hospital bed
• Noticing changes and calling the hospice nurse. A caregiver who is there for eight hours sees things a one-hour visit cannot.
• Company. Reading aloud, music, sitting quietly. Not leaving someone alone.

Who pays for which part

Hospice is the medical benefit, usually billed to Medicare. Private-duty caregiving is private pay. The two don't overlap and they don't conflict — hospice has no objection to a family hiring additional help, and good hospice teams are glad when you do, because it means someone reliable is in the house between their visits.

Westmark's hourly rates are published and don't change because hospice is involved: companion care, personal care, and dementia care rates are all on one page. Hospice cases most often fall under personal care at $38/hour, overnight awake coverage at $38/hour, or 24-hour live-in at $816/day. Weekends and holidays add $3/hour. There are no deposits, no enrollment fees, and no long-term contract — this is not the time to be locked into anything.

Our ongoing standard minimum is six hours per visit. If hospice began at a hospital discharge, the 4-hour post-discharge block at $44/hour is available to bridge the first days while you figure out the real schedule. And if you're weighing whether the family can keep carrying this alone, we wrote separately about what to do when family can't cover the care.

Setting it up without adding work to your week

Call once and we'll come out for a free in-home assessment — no obligation, no cost, and we'll do it quickly, because hospice timelines are not leisurely. We'll walk the house, look at where the bed is, ask what the hospice visit schedule looks like, and build hours around the gaps rather than on top of them.

Tell us who the hospice nurse is and how she prefers to be reached. Our caregiver's job includes calling her. Families often think they have to be the switchboard between hospice and the caregiver; they don't.

Schedules change fast on hospice cases. We ask for 48 hours' notice to change or cancel a visit, and we staff 24/7 — when you call at 11 p.m., a real person picks up at (508) 233-8062. We serve Billerica, Burlington, Woburn, Winchester, Reading, Boston, Quincy, Framingham, Hopkinton, Holliston, Hudson and Bellingham. Every caregiver has passed a CORI background check, reference verification, an in-person interview and a skills evaluation, and we're insured and bonded.

If you want to start with the hour count rather than the phone call, request a quote and we'll come back with a schedule and a weekly number. More on what in-home support covers is on our home care page.

Common questions