Hospice at home means a hospice team brings comfort-focused medical care to the place where a person lives. Medicare, Medicaid and most private insurers pay for it, but it does not put a caregiver at the bedside 24 hours a day. Nurses visit and are reachable by phone around the clock, and the family (or privately paid aides) covers the hours in between.
What is hospice care at home?
The New York State Department of Health describes hospice as a federal benefit for people with a terminal diagnosis and a prognosis of less than six months who have chosen to stop healing treatments. The goal is comfort and dignity, plus support for the family.
“At home” can mean the person’s own apartment, a relative’s home, a nursing home or assisted living. For the difference between palliative care and hospice, see our guide to palliative and hospice care in New York.
Who qualifies, and how do you start?
For Medicare to pay, Medicare.gov says the person must have Part A, and the hospice doctor (and the person’s regular doctor, if there is one) must certify a life expectancy of six months or less. The person must also accept comfort care instead of treatment meant to cure the illness, and sign a Hospice Election Statement before services begin.
Six months is a forecast, not a deadline. Medicare uses two 90-day benefit periods, then unlimited 60-day periods, with recertification that the person is still terminally ill. Someone who lives longer than expected can stay on hospice.
The New York State Department of Health says referrals can come from anyone familiar with the patient, including family and friends. A typical path looks like this:
- Ask for an evaluation. Tell the doctor, or call a hospice directly.
- Doctors certify the prognosis. The hospice doctor and the regular doctor must agree.
- Sign the election statement. The patient signs it, or a representative if the patient cannot.
- Build the care plan. A hospice team member visits and, per the American Cancer Society, creates the plan with the patient and caregivers.
- The hospice arranges the services in that plan: visits, medicines, equipment and supplies.
What are the four levels of hospice care?
Medicare divides hospice into four levels. Routine home care is the everyday one.
| Level | What it is | Key limits |
|---|---|---|
| Routine home care | Regular hospice care where the person lives. A hospice nurse visits regularly, other team members visit as needed, and someone is reachable by phone 24 hours a day. | The caregiver at home handles all other care. |
| Continuous home care | Mostly nursing care for a brief crisis, such as hard-to-control symptoms, to keep the person at home instead of in a facility. | Short-term only. A day counts only if at least 8 hours of care are provided, mostly nursing. Not every hospice offers it, so ask. |
| General inpatient care | Intensive symptom or pain management that cannot be handled at home, in a hospice unit, hospital or skilled nursing facility. | Usually 5 days or less, then the person returns to the earlier level. |
| Inpatient respite care | A short stay in an approved facility so the family caregiver can rest. | Up to 5 consecutive days at a time, only occasionally. Medicare.gov lists a 5% copayment. |
Sources: the federal definitions in 42 CFR 418.302 and 418.204, and the American Cancer Society’s levels of hospice care page.
Does hospice cover 24-hour care at home?
Not as an everyday benefit. The National Institute on Aging says round-the-clock custodial care is rarely part of hospice and that most day-to-day care comes from family and friends, although a hospice team member is usually reachable by phone 24/7.
The one exception is continuous home care. Federal rules allow nursing care to be covered around the clock during a period of crisis, but it must be mostly nursing, it is meant to keep the person at home through that crisis, and it ends when symptoms are under control. Someone who needs help overnight with turning or toileting, but not a nurse, does not fit that definition.
Regular Medicare does not fill the gap either: Medicare.gov lists “24-hour-a-day care at your home” among the things Medicare home health does not pay for. See what Medicare covers for home care.
What does hospice provide, and what does the family arrange?
The New York State Department of Health lists around-the-clock access to nursing staff, periodic nurse visits, certified home health aide help, a medical director, a social worker, spiritual support, equipment, medications, volunteers and grief support.
| Hospice covers | The family arranges (or pays for) |
|---|---|
| Nurse visits and a phone line answered day and night | Someone to be physically present between visits, including nights |
| Hospice aide visits for personal care, as set in the care plan | Extra aide hours, overnight aides or a live-in caregiver |
| Medicines for pain and symptom control related to the terminal illness (Medicare: up to $5 copay per prescription) | Medicines meant to cure the terminal illness are not covered by hospice |
| Equipment and supplies in the plan of care | Items the hospice has listed as unrelated to the terminal illness |
| Doctor oversight, social worker, chaplain, volunteers | Bills, paperwork and legal authority (see POA and guardianship) |
| Short-term inpatient or respite stays arranged by the hospice | Room and board, whether at home, in a nursing home or in an inpatient hospice facility |
| Bereavement counseling for the family, available for up to one year after the death | Funeral arrangements |
Two practical points. First, call the hospice first when something goes wrong. The American Cancer Society warns that going to the ER without contacting hospice can put benefits at risk and leave the family with the bill. Second, for elections beginning on or after October 1, 2026, federal rules (42 CFR 418.24) require the hospice to give you a written list of items and drugs it considers unrelated to the terminal illness and will not cover. Read it.
Who pays for hospice at home?
- Medicare. Medicare.gov says hospice from a Medicare-approved provider has no cost to you, apart from the small copays above and room and board. If you have a Medicare Advantage plan, Original Medicare pays the hospice, and the plan still covers other benefits (42 CFR 422.320).
- Medicaid. The state lists Medicaid among hospice payers. If the person already has Medicaid home care, ask the hospice social worker and the Medicaid plan how those hours work alongside hospice. See Medicaid home care in New York.
- Private insurance. The state says most commercial insurance covers hospice. Call the plan for details.
- VA. Enrolled Veterans can get hospice when they meet the clinical need, with no copays, including through community hospice agencies VA works with. A VA social worker is the starting point.
How do families cover the hours hospice does not?
Most families use a mix:
- Family and friends in shifts. The NIA says you need not stay at the bedside every minute unless your traditions require it. Taking turns is easier on everyone.
- Private-pay aides for a few hours, overnight or around the clock. See what home care costs in New York and private home care.
- Live-in care for long stretches of daily help: live-in care in New York City.
- Medicaid hours, if the person qualifies. Tell the hospice team who is coming into the home so the care plan reflects it.
What if a spouse can no longer be the main caregiver?
Caregiver forums are full of this situation. Hospice does not solve it automatically, because the plan assumes someone at home provides daily care. If a husband or wife is wearing out, act early:
- Tell the hospice nurse and social worker plainly. They cannot plan around a problem they do not know about.
- Ask for respite. A short facility stay can give the caregiver a break.
- Ask whether the care plan can change, such as aide visit times that match the hardest part of the day.
- Fill the remaining hours with family, friends or paid aides.
- If symptoms are unmanaged, ask about continuous home care or short inpatient care.
- If home is no longer safe, ask the social worker about a hospice residence or nursing home, and about room and board costs before you decide.
Caregiver burnout and the respite benefit
The National Institute on Aging lists signs of caregiver stress, including exhaustion, trouble sleeping, getting easily angered, feeling sad or hopeless and skipping your own care. Many caregivers later say they did too much alone and wished they had asked for help sooner.
Hospice builds in one formal break. Inpatient respite lets the patient stay in an approved facility for up to five consecutive days while the caregiver rests, and federal rules limit it to occasional use. Ask where respite is provided and how often you can use it. For breaks without a facility, see respite care in New York.
How do I choose a hospice in New York?
Start with the New York State Department of Health’s Directory of Hospices and its Hospice Providers’ Health Profiles. Then check Medicare Care Compare, which publishes family survey results from the CAHPS Hospice Survey on communication, timely help and emotional support. You can change hospice once per benefit period.
Questions worth asking before you sign:
- Do you provide continuous home care if it is needed?
- Where are inpatient and respite stays, and which hospitals or nursing homes do you work with?
- How do you handle night and weekend calls, and how quickly does a nurse come out?
- How many aide visits can we expect, and can the schedule change?
For complaints about hospice care, the state publishes 1-800-628-5972.
What to expect in the last weeks
Everyone’s course differs, and not everyone has every change. The American Cancer Society says that in the days to weeks before death, a person may become very weak, need help with daily care, eat and drink very little and have trouble swallowing pills. In the final hours to days, many people sleep most of the time, breathing may pause, and hands and feet may feel cool and look mottled.
The NIA says losing appetite is normal near the end of life and advises against forcing food. If swallowing pills becomes hard, the American Cancer Society suggests asking the care team about liquid pain medicine or a pain patch.
Plan ahead for the moment itself. The American Cancer Society says to call hospice first, because 911 after an expected death at home may lead EMS to try to revive the person unless the right paperwork is in place. In New York, the Department of Health’s Center for Hospice and Palliative Care points to the MOLST form (DOH-5003) for recording wishes about CPR and other life-sustaining treatment. Ask the hospice team what is needed. The NIA’s guide to care and comfort at the end of life is gentle and practical.
We are a licensed home care agency in Brooklyn and Queens (New York State Department of Health licence #2572L001). If you are working out how paid aide hours could fit alongside a hospice team, call (718) 232-2777 or use our contact page. You can also read about our in-home care. We are not a hospice agency, and our aides support, but do not replace, the hospice team.
General information, not medical or legal advice. Rules and benefit amounts change. Everything above was checked on 9 October 2026 against health.ny.gov, medicare.gov, ecfr.gov, nia.nih.gov, cancer.org, va.gov and cms.gov. Confirm details with the hospice and your insurer.
Frequently asked questions
Does hospice provide 24-hour care at home?
Usually not. Hospice gives scheduled visits and 24/7 phone access to a nurse, but family or paid caregivers provide hands-on care in between. Continuous home care, mostly nursing, can cover a short medical crisis if the hospice offers it.
Who pays for hospice care at home?
Medicare, Medicaid and most commercial insurers pay, and VA covers eligible enrolled Veterans with no copays. Under Medicare, hospice itself has no charge, with up to a $5 copay per symptom-control prescription and 5% for inpatient respite.
How long can someone stay on hospice?
Medicare allows two 90-day periods, then unlimited 60-day periods, as long as the hospice doctor recertifies that the person is still terminally ill. Living longer than six months does not end hospice by itself.
Does hospice pay for a private caregiver or home health aide?
Hospice covers visits from its own aides as set in the care plan, but not a private caregiver you hire. Extra hours are paid by the family or by Medicaid if authorized.
Can we switch hospices or leave hospice?
Yes. A patient can change hospices once in each benefit period by submitting a written statement to both hospices. A person can also end the election and later re-elect for any remaining benefit periods.
Does Medicare Advantage cover hospice?
Hospice is paid by Original Medicare, not the Advantage plan. The person stays in the plan, which continues to cover other benefits.
Can I call hospice if I do not have power of attorney?
Yes. The New York State Department of Health says anyone familiar with the patient can make a referral. The patient, or a representative if the patient cannot, must sign the election statement. See our guide to POA and guardianship.
