Home Hospice and Home Care: How Hospice Caregivers and Private Caregivers Work Together

Home hospice brings a team of nurses, aides and counselors to your parent’s home, but it doesn’t provide a caregiver around the clock. Most families are surprised by how much daily care is left to them. That’s where an in-home hospice caregiver from a home care agency fits in: covering bathing, meals, repositioning, nights and the hours between hospice visits. At Nona’s Home Care, private caregivers work alongside hospice for $40 to $50 an hour, or $850 to $1,100 a day for 24-hour care. Here’s how the two work together.

When a parent enrolls in hospice at home, many families assume someone will be there all the time. Then the first week arrives, the nurse visits for an hour, and the family realizes they are responsible for everything in between: turning, toileting, feeding, medications on schedule, and being awake at 3 a.m. This gap is the most common source of exhaustion and guilt for families during hospice care. Hospice and home care work best together: hospice provides the medical team, and a hospice at home caregiver from a private agency covers the hours in between.

What does home hospice cover?

Under the Medicare hospice benefit, which Medi-Cal and most private insurance mirror, hospice covers:

• Regular visits from a registered nurse and a hospice aide
• Physician oversight and a hospice medical director
• Medications for pain and symptoms related to the terminal diagnosis
• Medical equipment such as a hospital bed, wheelchair, and oxygen
• Supplies such as incontinence products and wound dressings
• Social worker and chaplain support
• Bereavement support for the family for about a year after death
• 24/7 phone access to a hospice nurse

What does hospice not cover?

• Nurse visits and symptom management
  • Covered by hospice? Yes
  • Who usually fills it: Hospice
• Hospice aide for bathing (a few times per week, short visits)
  • Covered by hospice? Yes
  • Who usually fills it: Hospice
• Hands-on help between visits
  • Covered by hospice? No
  • Who usually fills it: Family or private caregiver
• Overnight supervision
  • Covered by hospice? No
  • Who usually fills it: Family or private caregiver
• Meals, laundry, housekeeping
  • Covered by hospice? Generally no
  • Who usually fills it: Family or private caregiver
• Around-the-clock caregiver at home
  • Covered by hospice? No (except short crisis periods)
  • Who usually fills it: Private 24-hour care
• Short inpatient respite for the family
  • Covered by hospice? Yes, up to 5 days at a time in a facility
  • Who usually fills it: Hospice

Hospice can provide “continuous home care” during a short medical crisis, such as uncontrolled pain, but this is temporary. It is not a way to get ongoing 24-hour caregiving.

What does a hospice caregiver do?

The term “hospice caregiver” can mean two different people, and families often confuse them.

A hospice aide works for the hospice agency. Aides typically visit a few times a week for 30 to 60 minutes. During a visit, a hospice aide usually:

• Bathes your parent or gives a bed bath
• Helps with grooming, oral care and skin care
• Changes bed linens and helps with dressing
• Reports changes to the hospice nurse

A private in-home hospice caregiver works for a home care agency and stays for as many hours as your family schedules. A private caregiver usually:

• Repositions your parent regularly to prevent pressure sores
• Provides personal care at home, including toileting and incontinence care
• Offers food and fluids as tolerated, and gives mouth care
• Gives medication reminders on the hospice schedule
• Watches for changes and calls the hospice nurse when needed
• Sits with your parent overnight so the family can sleep, as awake or sleeping overnight caregivers
• Offers companionship and calm, steady presence

The hospice team directs the plan of care. The private caregiver follows it and fills the hours hospice can’t.

How many hours of care does home hospice actually provide each week?

Hospice provides visits, not shifts. A typical week of home hospice might include:

• Nurse visits: often one to three a week, more as needs increase
• Hospice aide visits: often two to three a week, mainly for bathing
• Social worker and chaplain: as needed, often every week or two
• 24/7 phone line: a nurse available by phone at any hour
• Continuous care: short-term, around-the-clock nursing during a medical crisis

Added up, that’s often only a few hours of in-person care each week. The rest of the week, someone still needs to be with your parent. That gap is why many families add private care, starting with a few hours a day and building to 24-hour care in the final weeks.

How do private caregivers work with hospice?

A private caregiver from a licensed home care agency provides the non-medical care the hospice team does not:

• Repositioning every few hours to prevent pressure sores
• Toileting, incontinence care, and changing linens
• Feeding assistance and offering sips of fluid
• Mouth care and gentle hygiene
• Reminding the family when medications are due and observing effects
• Watching for changes (breathing, agitation, pain) and calling the hospice nurse
• Sitting with your parent so family members can sleep, eat, or simply be family

The caregiver follows the hospice plan of care. The hospice nurse remains in charge of medical decisions, and a good agency will coordinate directly with the hospice team. Nona’s partners with hospice teams across San Diego and Orange County and regularly places caregivers in hospice homes.

Who is the family caregiver during hospice?

Hospice relies on a primary caregiver, usually a spouse or adult child, to be present between visits. Hospice teaches that person how to reposition, give comfort medications on schedule, and recognize changes.

In practice, that’s a full-time job on top of grief and exhaustion. An in-home hospice caregiver can take over the hands-on work so the family can spend their time being family, and it doubles as respite care for family caregivers. Many families use a private caregiver, from companion care during hospice to full hands-on help, for:

• Overnight shifts, so the primary caregiver sleeps
• Morning routines, when bathing and changing take the longest
• Afternoons, so family members can work or rest
• Full 24-hour care in the last days or weeks

How many hours of private care do families need during hospice?

• Early (still somewhat mobile, family nearby): 4 to 8 hours per day, or overnights only
• Middle (mostly bed-bound, needs turning): 12 hours per day, often overnight
• Final weeks or days: 24-hour care, rotating caregivers

Overnight care is often the first thing families add. A family caregiver who has not slept in a week cannot be present in the way they want to be. See our 24-hour care options and our comparison of live-in vs. 24-hour care.

How much does private home care cost during hospice?

Medicare pays for hospice itself, usually with no cost to the family. Private caregiving is paid separately. At Nona’s, hourly care is $40 to $50 per hour depending on the level of care, and 24-hour care is $850 to $1,100 per day depending on care. Long-term care insurance usually continues to pay during hospice, and VA benefits may help for veterans. Because hospice timelines are unpredictable, it matters that Nona’s has no minimums, no deposits, and no long-term contracts.

When should a family consider hospice?

Hospice is available when a doctor certifies that a person likely has six months or less to live if the illness runs its normal course. Many families wait too long; the median hospice stay is only a few weeks, even though the benefit is designed for months. Signs it may be time to ask the doctor include repeated hospitalizations, steady weight loss, sleeping most of the day, and a decision to stop treatment aimed at a cure.

Choosing hospice does not mean giving up. People can leave hospice if they improve or change their mind.

Can hospice be provided in a board and care or assisted living home?

Yes. Hospice can be provided wherever your parent lives, including a board and care home (RCFE) or assisted living community. The hospice team visits there just as it would at a private home.

Facility staff still care for many residents at once, though. Some families add a private caregiver inside the community for one-on-one support, especially at night or in the final weeks. Check the community’s policy on outside caregivers first.

How do you support the family during hospice at home?

The hardest part of hospice at home is often not the medical care but the fatigue, anticipatory grief, and family tension. Practical steps help:

• Divide roles clearly: one person talks to the hospice nurse, another handles visitors, another manages meals.
• Protect sleep. Schedule overnight help before exhaustion sets in.
• Use the hospice social worker and chaplain; they are part of the benefit.
• Let caregivers handle the physical tasks so family time can be about presence.

Our family caregiver burnout guide covers the warning signs to watch for.

What does a day of hospice and private home care look like?

Families are often unsure how hospice visits and private caregivers fit together in a single day. In practice, the two work side by side, with hospice handling medical oversight and comfort care while the private caregiver covers the hours in between.

• Morning: The private caregiver helps with gentle bathing or a bed bath, repositioning, mouth care, and a small breakfast if your parent wants one.
• Midday: A hospice nurse or aide may visit to check symptoms, adjust comfort medications, or help with bathing. The caregiver shares what they have noticed since the last visit.
• Afternoon: The caregiver keeps your parent comfortable, offers fluids, plays music or reads aloud, and gives family members a chance to rest or run errands.
• Evening and overnight: If needed, an overnight caregiver watches for discomfort, helps with repositioning, and calls the hospice line if symptoms change.

The rhythm will look different for every family. The key is clear communication, so the hospice team knows who is in the home and the caregiver knows when and how to reach hospice.

How do you choose a caregiver to work alongside hospice?

Not every caregiver is comfortable with end-of-life care. When you are adding private help during hospice, ask the agency about the caregiver’s experience with comfort care, repositioning, and supporting families through the dying process.

Ask how the caregiver will communicate with the hospice team, what they will do if your parent’s breathing changes, and who they will call first. Make sure the caregiver knows about your parent’s POLST or advance directive. Consistency matters a great deal at this stage, so ask whether the agency can keep the same small group of caregivers. A calm, experienced caregiver can make hospice and home care feel like one team, and that gives the family more time to simply be present.

How do families care for themselves during hospice?

Hospice is emotionally and physically demanding for families, even with extra help. Take turns resting, accept meals and offers of help, and use the hospice team’s social workers and chaplains, who are there for the family as well as the patient.

Private caregivers can give family members the time to sleep, eat, and simply be present without managing every task. Many families say that having a caregiver handle personal care let them spend their time as a spouse, son, or daughter rather than as a nurse. Hospice bereavement services often continue after a death and can help with grief.

How do you choose a hospice provider in San Diego and Orange County?

Your parent’s doctor or hospital can refer you to hospice, but you choose the provider. Ask each hospice these questions:

• How often will the nurse and aide visit at first?
• How quickly does a nurse come after hours?
• Do you offer continuous care during a crisis?
• How do you coordinate with a private home care agency?
• What respite options do you offer the family?

Nona’s coordinates with your hospice team so the private caregiver follows the hospice plan of care and reports changes to the hospice nurse.

Frequently asked questions

Does hospice provide 24-hour care at home?
No. Hospice provides visits and 24/7 phone support, plus short-term continuous care during a crisis. Families arrange ongoing 24-hour care themselves.

Can you have a private caregiver and hospice at the same time?
Yes. This is common and encouraged. The caregiver provides daily care; hospice provides medical oversight.

Does Medicare pay for a caregiver during hospice?
Medicare covers hospice aide visits but not ongoing private caregivers.

Who is in charge of care: hospice or the home care agency?
The hospice team directs medical care. The home care agency follows that plan and reports changes.

Can hospice be provided in a board and care or assisted living home?
Yes. Hospice comes to wherever your parent lives, including residential care homes.

What is the difference between a hospice aide and a private caregiver?
A hospice aide works for the hospice and makes short visits, typically a few times a week, mainly for bathing and personal care. A private caregiver works for a home care agency and stays for the hours your family schedules, from a few hours a day to 24-hour care. Private caregivers fill the time between hospice visits.

How often does a hospice aide visit?
A hospice aide typically visits two to three times a week, often for 30 to 60 minutes, though it varies by hospice and by your parent’s needs. Visits usually focus on bathing, grooming and linen changes. As needs increase, visits may become more frequent, but hospice aides don’t provide shift-based care.

Can a hospice caregiver stay overnight?
Hospice aides don’t stay overnight, except during short periods of continuous care in a medical crisis. A private in-home hospice caregiver can stay overnight, either awake to reposition and monitor your parent or sleeping nearby for light needs. Many families start with overnight care so the primary caregiver can rest.

Hospice and home care together: key points

Does hospice provide 24-hour care? No. Hospice provides nurses, aides for short visits, equipment, medications, and emotional support, but not a caregiver in the home around the clock. That is why families combine hospice and home care, adding a private caregiver with hospice for daily hands-on help, overnights, and supervision.

Start with the hardest hours, usually nights and personal care, and expect needs to increase over time. Private end of life care at home costs $40 to $50 per hour depending on the level of care, and 24-hour care is $850 to $1,100 per day. Long-term care insurance often keeps paying during hospice, so check your policy. Our 24-hour home care services and guide to live-in vs. 24-hour home care explain the options for around-the-clock coverage.