End-of-life decisions are never easy. One of the toughest decisions you may have to make is whether you need nursing home care or hospice care. It helps to know the difference.

Nursing Home Care

Nursing homes residents receive treatment to extend their lives. This care includes custodial and skilled care. Custodial care means assistance with dressing, bathing, cooking, laundry, and other types of personal care. The provider does not need a medical license to provide this type of caie. Skilled nurslng care is provided by licensed medical practitioners. Skilled care is medical treatment that includes wound care, physical therapy, injections, and other care that ensures their physical well-being. Skilled care residents usually also receive custodial care. Medicaie generally does not cover custodial care. Medicare Part A covers certain medical conditions but is limited to short-tern care in a skilled nursing facility (rather than a nursing home).

What is Hospice Care?

Hospice care is an option for patients who do not wish to receive treatment or extend their life, but want comfort care as they reach the end of their lives. Hospice care teams include doctors, nurses, social workers, spiritual advisors, and volunteers. A hospice care team is also trained in treating end-of-life pain. Hospice care can be administered in a patlent's home or in an institutional setting. Hospice may also provide support to family members and caretakers, including respite care. In an institutional setting, Hospice patients generally receive custodial care as well.

A Note on Concurrent Care

Complicating matters is the fact that Medlcare will not cover custodial care at all and generally will not cover Skilled care and hospice care (known as concurrent care) at the same time. Currently, individuals on Medicare must give up Medicare payment for care related to their terminal condition if they want to receive Medicare's hospice benefit. As a result, many individuals facing a terminal illness may not opt for hospice support services. Policymakers have been pushing for a benefit within Medicare that would allow patients to receive hospice care services and curative treatment simultaneously. The Centers of Medicare and Medicaid Services has spent the past several years testing various models, including one known as the Medicare Care Choices Model (MCCM). MCCM has been shown to iirpiove the quality of patients' end- of-life while also resulting in Medicare savings. However, this option has not yet been made permanent.

End-of-Life Dilemma: Which Should I Choose?

While considering the next steps to take in your health care plan, speak candidly with your family and health care team about your needs and how you see your future. If you have questions about coverage options that may be available to you in a nursing home or with hospice care, speak to your elder law attorney.