When a loved one qualifies for hospice, one of the first questions families face is where care will take place. For most people, the answer is home – but that is not always the only option, and it may not always be the right one.

Hospice care can be delivered in two primary settings: in the home (wherever your loved one lives) or in a facility through inpatient care. Both share the same goal: comfort, dignity, and quality of life. But they serve different needs, and understanding the difference can help your family make a more confident decision during an already difficult time.

This guide walks through what each setting involves, when one may be more appropriate than the other, and what you can expect from both.

What Is Home Hospice Care?

Home hospice care brings the full hospice team directly to your loved one, whether they live in a private residence, assisted living facility, memory care community, or nursing home. The goal is to allow them to remain in the place they feel most comfortable, surrounded by the people they love.

At Homage Hospice Plus, home hospice includes:

• Regular visits from skilled registered nurses for symptom management, medication coordination, and ongoing assessment
• Personal care support from certified nursing assistants (CNAs) for hygiene, comfort, and daily living needs
• Clinical oversight from nurse practitioners and physicians
• Emotional and family support through social services
• Spiritual care from our chaplain team
• Companionship and respite help through volunteer services
• 24/7 on-call availability, so families are never without support in the middle of the night

Medical equipment and medications are typically delivered the same day care begins or the following morning, so families do not have to worry about coordinating logistics during an already overwhelming time.

What Is Inpatient Hospice Care?

Inpatient hospice care is facility-based care designed for patients whose symptoms have become too complex or severe to manage safely at home. It is a short-term, intensive level of care, not a permanent placement, and it is fully covered under the Medicare Hospice Benefit when medically necessary.

This level of care is sometimes called General Inpatient Care (GIP) and is intended to provide around-the-clock clinical support for situations such as:

• Uncontrolled pain that cannot be managed with current home medications
• Severe nausea, vomiting, or respiratory distress
• Acute agitation or confusion (sometimes called terminal restlessness)
• A medical crisis that requires close, continuous nursing monitoring
• Situations where caregiver safety has become a concern at home

Inpatient care is not a step backward or a sign of failure. It is a resource – one that exists specifically to protect your loved one’s comfort when their needs exceed what can be safely addressed in a home setting.

Once the acute symptoms are stabilized, many patients return to home hospice care. Others remain in the inpatient setting for the remainder of their time, particularly if returning home is no longer safe or feasible.

Key Differences at a Glance

	Home Hospice	Inpatient Hospice
Setting	Home, ALF, nursing home, or memory care	Hospice facility or contracted inpatient unit
Best for	Stable symptoms manageable with scheduled visits	Acute or severe symptoms requiring 24/7 nursing
Caregiver involvement	Family plays a central support role	Family presence is welcome; less direct caregiving is required
Duration	Ongoing through the hospice enrollment period	Short-term until symptoms are stabilized
Medicare coverage	Covered under the Hospice Benefit	Covered when medically necessary under the Hospice Benefit
Team access	Scheduled visits plus 24/7 on-call	Continuous on-site nursing and clinical staff

When Is Home Hospice the Right Choice?

Home hospice tends to be the right fit when:

• Symptoms are manageable with scheduled nursing visits and medications at home
• The patient strongly prefers to remain in their own environment
• Family or caregivers are present and able to assist with day-to-day support
• The home setting is safe for the patient’s current level of need
• There is no acute medical crisis requiring constant clinical supervision

For the majority of hospice patients, home care remains appropriate throughout their entire enrollment. The hospice team adjusts visit frequency and care intensity as needs evolve, so the level of support can increase significantly without requiring a change in setting.

If your family is wondering what the first days of home hospice look like, the What to Expect page provides a clear overview of the process from first call through ongoing care.

When Is Inpatient Hospice the Right Choice?

Inpatient care becomes the appropriate option when:

• Pain or symptoms escalate beyond what can be controlled with home-based medications
• A medical crisis occurs – such as severe breathing distress, uncontrolled seizures, or a sudden decline
• Terminal agitation or confusion requires close monitoring and IV medication management
• Family caregivers are overwhelmed or physically unable to provide safe care at home
• The patient’s condition has changed rapidly and clinical observation is needed around the clock

It is worth noting that symptoms like significant breathing changes or profound restlessness, which are common near the end of life, can sometimes indicate that a higher level of care is needed. Our blogs on breathing changes at the end of life and terminal agitation in hospice can help families recognize these signs and know when to reach out to the care team.

The most important thing to know: you do not need to figure out which level of care is appropriate on your own. That is exactly what the hospice team is there for. If something feels unmanageable, call. The team will assess and respond.

Can a Patient Switch Between Home and Inpatient Care?

Yes – and this is more common than many families realize.

Hospice is not a one-setting commitment. Patients can move between home care and inpatient care as their condition changes, and then return home once symptoms are under control. The hospice benefit is designed to be flexible because the dying process itself is rarely linear.

If a patient stabilizes after a period of inpatient care, the team will work with the family to transition back home when it is safe and appropriate. If symptoms worsen again, the inpatient option remains available.

The Full Team Behind Both Settings

Whether your loved one receives care at home or in a facility, the multi-disciplinary team at Homage Hospice Plus remains consistent. Every patient is supported by:

• Registered nurses manage symptoms and coordinate medications
• CNAs providing personal care and comfort
• Nurse practitioners and physicians oversee the care plan
• Chaplains offering spiritual support for patients and families of all faiths and backgrounds
• Social workers helping navigate decisions, emotions, and family dynamics
• Volunteers providing companionship, respite, and practical support

This is not a one-person operation. It is a coordinated team working together around the goals and values that matter most to your loved one and your family.

For families caring for a veteran, Homage also offers a dedicated veterans hospice program that honors their service and unique care needs across both settings.

Still Unsure Which Setting Is Right?

That is a completely normal place to be. Families do not need to arrive at their first call with a decision already made.

Homage Hospice Plus offers both inpatient care for patients who need intensive, around-the-clock symptom management and home hospice care for those who are most comfortable in a familiar environment. The team will help you understand which fits your loved one’s current needs, and can adjust as those needs change.

If you have questions or are ready to talk through your options, the team is available 24/7 at (972) 468-8281, or you can schedule a consultation online.