Home Care and Hospice: Partnering to Improve End‑of‑Life Care for California Families

The Challenges of Family Caregivers in End-of-Life Care

If you are a primary caregiver for a terminally ill loved one, you know how stressful and demanding it can be. You’re managing medications, helping with bathing and mobility, coordinating doctor’s visits, and comforting your loved one emotionally – often 24 hours a day. It’s no surprise that caregiving takes a toll on health and stress levels. In one survey, 84% of family caregivers said caregiving had a moderate or high impact on their daily stress. Sleepless nights and constant worry can become the norm. On top of this, caregivers must make critical decisions about treatment and comfort. They may feel unprepared to handle worsening symptoms or fear that they’re “not doing enough.”

This is where hospice and home care services come in as essential partners for family caregivers. These services are designed to reduce the burden on families while ensuring that the patient receives high-quality, compassionate care. By understanding the distinct roles of hospice and home care – and how they work together – caregivers can find relief and focus on what matters most: spending meaningful time with their loved one in their final days.

You can’t pour from an empty cup. Taking time for yourself is responsible. Care teams like those from A Place At Home – Encinitas will help you feel like yourself again. You deserve time to recover, and your loved one deserves compassionate care. You can have both.

What Is Hospice Care?

Hospice care is a specialized form of palliative care for individuals who are in the final stage of life (typically with a prognosis of six months or less). Hospice focuses on comfort rather than cure, addressing physical, emotional, and spiritual needs. Care is often provided wherever the patient calls home – whether that’s a private residence, nursing home, or assisted living. A key aspect of hospice is its team-based approach: an interdisciplinary team of professionals works together to support the patient and their family. This team usually includes doctors, nurses, hospice aides, social workers, chaplains or spiritual counselors, bereavement counselors, and trained volunteers.

Importantly, hospice care treats the family as the unit of care. Typically, a family member serves as the primary caregiver for the patient, with hospice staff making regular visits to provide medical care, pain management, and additional support. Hospice nurses might visit a few times a week (or more, if needed) to monitor symptoms and adjust medications. Social workers and chaplains offer counseling, help with practical needs, and guide difficult conversations. Hospice aides can assist with personal care like bathing or changing bed linens, although usually only for short visits a few times per week. Hospice staff are on-call 24/7 for urgent needs – meaning if a crisis or question arises at 3 AM, help is just a phone call away.

The impact of hospice on end-of-life care is profound. Research has shown that hospice involvement is associated with better pain control and symptom management, greater family satisfaction with care, and even improved mental health for caregivers. Hospice teams often help families with advance care planning and honoring the patient’s wishes, which can prevent unwanted aggressive interventions in the final days. In fact, patients receiving hospice are less likely to die in a hospital and less likely to undergo burdensome end-of-life procedures, compared to those who don’t receive hospice. One California health report noted that hospice patients receive better symptom control and their families are more satisfied with care. Hospice care has also been linked to a lower risk of emergency room visits or rehospitalizations near the end of life. All of this means more peace and dignity for the patient, and less stress on the family.

Despite these benefits, hospice remains underutilized, especially in California. Many families enroll in hospice only in the last days of life or not at all. As of 2020, only 42.3% of Medicare beneficiaries in California who passed away were enrolled in hospice at the time of death, compared to roughly half nationwide. This suggests that many Californians may not be accessing hospice support early enough. Common misconceptions (like “hospice means giving up hope” or that it’s only for the last 48 hours of life) can prevent timely hospice enrollment. In reality, hospice is most effective when introduced early in the final stage of illness, so that patients and families have time to build relationships with the care team and fully benefit from services such as counseling and respite care.

Cost and eligibility: Hospice care in the U.S. is covered by Medicare, Medi-Cal (Medicaid in California), and most private insurance, with little to no cost to the patient. The Medicare Hospice Benefit covers all hospice services, including medications, medical equipment (like a hospital bed for home), nursing care, social services, spiritual support, and short respite stays if needed. This generous coverage means families usually do not pay out of pocket for hospice itself. (However, Medicare does not cover around-the-clock caregiving at home – which is where home care agencies can play a pivotal role, as we’ll discuss.)

What Is Home Care (In-Home Care) Services?

Home care refers to non-medical assistance provided to individuals in their own home to help with daily activities and personal needs. Home care agencies in California employ caregivers – often called home care aides, home health aides, or personal care attendants – who can come to the home for extended hours, even 24/7 if necessary, to ensure a person is safe and cared for. Unlike hospice (which is medically focused and time-limited to terminal illness), home care is available to anyone who needs extra help at home due to age, disability, or serious illness, and it can continue for as long as needed.

Typical services provided by home care aides include: assisting with activities of daily living such as bathing, dressing, grooming, toileting, and feeding; helping the person move safely around the house or transfer from bed to chair; preparing meals and ensuring the patient eats and stays hydrated; light housekeeping and laundry; running errands or driving the client to appointments; and simply providing companionship and supervision. In end-of-life situations, a home care aide can also remind the patient to take medications on schedule (or even administer certain medications if trained and allowed), perform comfort measures like repositioning the patient to prevent bedsores, and observe for any changes in condition that should be reported. Essentially, home care aides act as an extension of the family caregiver, handling many time-consuming or strenuous tasks. This gives family members a chance to rest and spend more quality time with their loved one, rather than constantly scrambling to meet basic care needs.

It’s important to note that home care services in California (often called “personal care” or “custodial care”) are not covered by Medicare and generally not covered by standard health insurance. They are typically paid out-of-pocket or by long-term care insurance, though some low-income individuals may receive limited in-home support through Medi-Cal or local programs. Because of this, families might hesitate to hire home care due to cost. However, even a few hours of help per day can make a huge difference in a caregiver’s stress level and a patient’s safety. Agencies usually allow flexible scheduling – for example, you might hire an aide for an 8-hour overnight shift so the family can sleep, or for a couple of short shifts throughout the week to assist with baths. Respite grants or veterans’ benefits can sometimes help cover costs, and California’s Paid Family Leave law allows family caregivers to take some paid time off work, which can ease financial strain.

Many home care agencies specialize in senior care and are very familiar with working alongside hospice. In California, reputable home care organizations often train their staff in hospice-sensitive care, meaning the aides understand how to handle end-of-life situations compassionately and when to involve the hospice nurses. Some agencies are even directly affiliated with hospice programs (for example, a hospice might have a sister home care agency, or a company might offer both home health, hospice, and non-medical home care under one umbrella). Whether affiliated or separate, the goal of home care is to keep the patient comfortable at home by providing continuous, personalized assistance that hospice staff, due to their visit-based model, cannot supply on a constant basis.

Complementary Roles: How Hospice and Home Care Work Together

Because hospice and home care services address different needs, they truly complement each other. Think of hospice as the expert medical and psychosocial support – the nurses, doctors, and counselors who create a care plan, manage pain and symptoms, and guide the family through end-of-life decisions. Home care, on the other hand, provides the hands-on presence and practical help to implement that care plan on a day-to-day (and hour-to-hour) basis. Neither service can replace the other; rather, using both creates a more complete circle of care around the patient and family.

Here are some key ways that hospice and home care partner to improve outcomes:

Coverage Across Time: Hospice teams visit patients intermittently (e.g. a nurse might visit 2-3 times a week, an aide 2-3 times, etc.) and are available on-call for urgent issues. However, hospice is not designed to provide continuous caregiving or monitor the patient hour by hour. In fact, even though hospice agencies strive to support families, a study found that U.S. home hospice patients receive a median of only 1.3 hours of paid hospice aide care per week. The rest of the care is provided by family or other caregivers. Home care aides can fill in these gaps, staying with the patient for longer stretches each day. For example, while hospice might send an aide to bathe the patient in the morning, a hired home care aide could stay through the afternoon and evening to assist with meals, toileting, and mobility. This ensures the patient isn’t left alone or at risk when hospice staff are not scheduled to be there.
Medical Expertise + Personal Care: The hospice nurse and doctor manage medical aspects – adjusting medications to control pain, nausea, breathing difficulty, etc. They also can order equipment (like oxygen or special mattresses) and teach the family how to use them. Meanwhile, the home care aide focuses on the personal care and comfort – keeping the patient clean, dry, and turned; making sure they’re repositioned comfortably with pillows; offering sips of water or help with eating; and observing their condition in between nurse visits. If the aide notices, for instance, that the patient’s pain seems worse at night or they’re too weak to walk to the bathroom, they can communicate this to the hospice nurse. The hospice team can then adjust the care plan (perhaps increasing pain medication or providing a bedside commode). In this way, constant feedback between home care aides and hospice nurses leads to proactive care adjustments, preventing small issues from becoming big crises.
Relief for Family Caregivers: When both hospice and home care are in place, the family caregiver is no longer on duty 24/7 without backup. Hospice professionals provide knowledge and emotional support, while home care aides provide respite and practical relief. For example, a hospice social worker might counsel a spouse on coping with anticipatory grief, and a chaplain might pray with the family or help facilitate meaningful rituals. At the same time, a home care aide can be caring for the patient in the next room, so the spouse can focus on those conversations or simply take a break. Many caregivers say that having an aide even a few hours a day significantly reduces their stress – they can run an errand, take a shower, or get a full night’s sleep, knowing someone experienced is with their loved one. This support directly addresses caregiver burnout. As one expert put it, “The number one misunderstanding is that hospice care is around the clock… In reality, family members are routinely tasked with providing intimate personal care and managing distressing symptoms”. Home care aides step in to share that load, so that “the wife can be a wife instead of playing the role of nurse,” as another caregiver observed in a hospice facility context. In the home setting, a paid caregiver can allow a spouse or child to spend more quality time with the patient (reading, reminiscing, just being present) rather than constantly worrying about the next diaper change or repositioning.
Continuity and Consistency: If a patient has been receiving home care services even before hospice (as is often the case for seniors with chronic illness), those same trusted caregivers can continue caring for them after hospice enrollment – now in partnership with the hospice team. This provides continuity of care: the patient sees familiar faces and keeps a consistent routine, which can be very comforting amid the changes of advanced illness. Meanwhile, the hospice team brings in specialized resources without disrupting the support system already in place. Even when home care is started at the same time as hospice, the goal is to keep a consistent schedule and caregiving approach. Hospice and home care staff will often hold joint care conferences with the family – for instance, the hospice nurse might meet with the home care aide when they are both in the home during an overlapping hour, to go over the care plan together. Such coordination ensures everyone is on the same page. Specific tasks can even be done together for safety, such as two people turning a patient in bed or changing bed sheets while the patient is in it; one hospice blog noted that having some overlap between a private caregiver and the hospice aide is beneficial for heavier care tasks, since “changing linens, bathing, and cleaning a patient are safer… when two aides provide assistance rather than one.”
Avoiding Hospitalizations and Crises: With the combined vigilance of hospice professionals and round-the-clock caregivers, problems are addressed quickly. If a patient on hospice has no one with them for many hours, a spike in pain, a fall, or difficulty breathing might go unnoticed until it becomes an emergency. But if a home care aide is present, they can respond immediately and also call the hospice 24/7 line for guidance. This rapid response can often prevent a 911 call or ER visit. In fact, home-based palliative care models (which include hospice and supportive services at home) have been shown to reduce unwanted hospitalizations and medical crises at end of life. The hospice-home care partnership thus keeps the patient in the comfortable home setting and out of the hospital, which is typically one of the main goals families have for hospice care. As one physician stated, “If you want hospice to be able to take sicker patients who want to die at home, we can’t do that without providing them additional support.”In other words, additional in-home caregiving support is often the critical factor that makes dying at home possible for patients with intensive needs.

In summary, hospice provides the clinical direction and holistic care plan, while home care provides the dedicated caregiving manpower to carry out that plan day-to-day and likely add to the holistic plan as they are experts in providing care. Together, they offer a much more robust support system than either could alone. For the family, this means fewer gaps in care, fewer worries about “what if something happens when I’m alone with Mom?”, and a greater sense of security and comfort.

Benefits of Hospice–Home Care Partnerships for Families

When families leverage both hospice and home care, the benefits cascade in many areas. Here are some of the most important advantages for family caregivers and their loved ones during end-of-life care:

Reduced Stress and Burnout: Having a team on your side dramatically eases the mental and physical strain on family caregivers. You are no longer the only person responsible for every aspect of your loved one’s care. The hospice team gives you expert guidance and someone to call with questions, and home care aides give you the chance to rest. Studies have found that hospice involvement can improve caregiver mental health and adjustment. Families consistently report feeling relief once hospice is in place, and even more so if a reliable home caregiver is also helping. You can sleep at night knowing your loved one is attended to, or simply regain a few hours in the day to recharge. This respite leads to better patience and emotional availability when you are with your loved one, improving the quality of the time you spend together.
Better Symptom Management and Comfort: With hospice’s medical expertise, patients have their pain and symptoms managed far more effectively than a typical family could achieve alone. The nurse can prescribe higher-level pain medications, breathing treatments, or other therapies to keep the patient comfortable. For example, if Dad is winching in pain or struggling to breathe, a hospice nurse can quickly adjust morphine or anxiety medication and teach you positioning techniques to ease discomfort. Meanwhile, the home care aide ensures physical comfort – keeping Dad clean, dry, and turned, which prevents sores and adds to his ease. This one-two punch of medical management and attentive personal care means the patient experiences far less suffering. Research shows hospice care is associated with better pain control and meeting patients’ comfort goals. And when the patient is more comfortable, the entire family experiences less distress. It is incredibly reassuring to see your loved one peaceful rather than in agony.
Enhanced Emotional and Spiritual Support: End-of-life is not just a physical experience – it’s an emotional and spiritual journey for both the patient and their family. Hospice services place a big emphasis on counseling, legacy work (reminiscing and life review), grief support, and even helping mend family conflicts or facilitate meaningful goodbyes. Social workers might help children or grandchildren understand what is happening; chaplains can perform rituals or simply lend an ear to the patient’s existential concerns. This kind of support can be a huge weight off of family caregivers, who often feel responsible for keeping everyone’s spirits up. Home care aides contribute here as well: by taking over mundane tasks, they free up family members to be emotionally present. You can sit and hold your loved one’s hand without interruption, or step outside for a breather to collect yourself, trusting that the aide will alert you if needed. Some home caregivers form close bonds with families, offering compassion and a listening ear to the caregiver too. All of this creates a more emotionally supportive environment. As one California caregiver, Bernie, described after hospice helped her care for her husband at home, “Hospice lets you take care of your loved one at home, keep them comfortable, and have a normal life as long as possible… That’s what it’s all about.”
Continuity and Peace of Mind: The partnership of hospice and home care provides a seamless continuity of care that is hard to achieve otherwise. The patient is watched over around the clock, either by a professional or a trained family member, with experts on-call to assist. This continuity means there is always someone who knows the patient’s baseline condition and can note changes. Peace of mind is one of the greatest gifts to families – knowing that at no point will you be left scrambling alone in a crisis. Little concerns can be addressed before they escalate. And if a true crisis does occur (for example, sudden severe pain or a new troubling symptom), you have immediate help: the aide can call the hospice nurse, who might come out to the house even in the middle of the night. Many caregivers say this knowledge – that they are not alone and help is available 24/7 – greatly reduces their anxiety. It allows them to focus on simply loving their family member. Additionally, because care is coordinated, there is less confusion about medications or routines. The hospice team typically keeps detailed notes and communicates any changes to the family and any home caregivers. This continuity of information prevents errors like double-dosing medicine or missing a dose. Overall, the household functions more smoothly, almost like an extended family all working together: the real family and the “professional family” united in care.
Honoring Final Wishes (Staying Home and Maintaining Dignity): Most people, if given the choice, would prefer to spend their final days at home in familiar surroundings rather than in a hospital. They’d also prefer to avoid futile, invasive treatments when comfort is the priority. By partnering with hospice and home care, families greatly increase the likelihood of honoring those wishes. Hospice involvement has been linked to a higher chance of dying at home rather than in a medical facility. With adequate support in place, patients can remain in their own bed, with loved ones and even pets beside them, right up until the end. Home care aides contribute by making the home environment safe (helping prevent falls or accidents that could force a hospitalization) and by providing the continuous presence needed for someone to be cared for at home. In Bernie’s case below, she knew she could not keep her husband home by herself without extra help – hospice made it possible. For many families, being able to fulfill their loved one’s wish of “I want to die at home” is an immense source of comfort and closure. The partnership ensures that in those final moments, the focus can be on love and togetherness, not medical chaos. And even after the patient passes, hospice continues to support the family with bereavement counseling and grief resources for up to a year, helping them navigate the loss.

Real-World Example: A California Family’s Story

To truly appreciate how hospice and home care work hand-in-hand, it helps to hear a story from a family who’s experienced it. Bernadette “Bernie” Mellott, a Peninsula native in California and an expert in senior care herself, became the primary caregiver for her husband Tom when he was battling terminal cancer. Tom was a proud, private person who initially “was reluctant to have anyone in his house.” Bernie did her best to care for him alone, learning to manage his feeding tube and taking him to repeated hospital visits. But as his illness advanced, it became overwhelming. Bernie recalls telling Tom: “Honey, we either need hospice in the house or we need to find a place for you to go, because I can’t do this by myself.” They both wanted him to stay at home, so they agreed to enroll in hospice care through Mission Hospice & Home Care in San Mateo.

Once hospice came on board, everything changed for the better. The hospice team brought in a hospital bed and taught Bernie how to keep Tom comfortable. A nurse visited regularly to adjust Tom’s medications and tend to any medical issues, and a hospice aide helped with personal care. Bernie also had access to a 24/7 phone line; knowing she could call for help any time allowed her to sleep again at night. Most importantly, hospice provided emotional and spiritual support. Bernie developed great trust in their hospice nurse and was able to just be a loving wife in Tom’s final days, rather than only his exhausted caregiver. Tom was able to remain at home, surrounded by his family and his beloved dog, right until he peacefully passed in his own bed. Moments after he died, their dog hopped on the bed and licked his cheek – a tender goodbye that could only happen at home, not in a hospital.

Looking back, Bernie is immensely grateful for the partnership that made Tom’s peaceful home passing possible. “I could never have kept him at home with his dog and everyone without the help of Mission Hospice,” she says. “As hard as that time was for all of us, hospice was really a wonderful experience. It was the best way I could send Tom off.” Bernie now advocates for others to use hospice, believing no one should struggle alone at end of life. Her story shows how a family’s wish to keep a loved one at home – safe, comfortable, and dignified – can be achieved when hospice steps in to guide care and support the caregiver.

While Bernie’s story highlights hospice’s role, many families add private home care aides to this picture for even more support. For instance, another family in Los Angeles had an elderly mother on hospice who grew very weak in her final weeks. The devoted daughter caring for her was exhausted from waking every hour at night to check on her mom. The family decided to hire a professional caregiver through a home care agency to cover overnight shifts. That caregiver worked closely with the hospice nurse, keeping a log of the mother’s symptoms and making sure she was turned and medicated on schedule through the night. Thanks to this added help, the daughter could sleep and had energy during the day to spend precious moments with her mom. The hospice nurse noted that with the caregiver’s observations, they were able to promptly adjust medications (for example, giving an extra dose of morphine at 2 AM when the aide noticed increased pain), and they avoided any emergency hospital trips. The mother passed peacefully at home one morning, with her family rested enough to be fully present at her side. This kind of outcome – a calm death at home, with family at peace – is exactly what the partnership of hospice and home care can facilitate.

Conclusion: Compassionate Partners in Care

End-of-life caregiving will never be easy, but it can be made more manageable, meaningful, and loving with the right support. Home care agencies and hospice providers in California are increasingly partnering to ensure that families have a complete safety net during this challenging time. Hospice brings medical excellence, pain relief, and emotional/spiritual counseling; home care brings time, hands-on help, and respite for the weary caregiver. Together, they provide continuity from day to night, weekday to weekend, so that the care does not stop when the doctor leaves or when the family member needs to rest.

For California families, this partnership means better outcomes in the ways that matter most – less stress, more quality time, fulfillment of end-of-life wishes, and a peaceful environment for the final journey. As a caregiver, accepting help is not a sign of weakness but of love: by assembling a team (both hospice professionals and in-home caregivers), you are doing everything possible to give your loved one comfort and dignity. You are also caring for yourself, which enables you to be the steady, loving presence your loved one needs.

If you’re a family caregiver in California facing a terminal illness in your family, consider reaching out to hospice early and discussing in-home care options as part of the care plan. Many hospice providers can connect you with trusted home care agencies, or vice versa. You do not have to carry this alone. As Bernie discovered, hospice and home care can truly be “a wonderful experience” even in the hardest of times, leaving you with memories of compassion and togetherness rather than chaos. By partnering with these services, you give your family the gift of support – and that can make all the difference on the journey of saying goodbye.

(Stay tuned for part two of this series, which will focus on how hospice and clinical professionals can collaborate with home care agencies to enhance patient care.)

Sources

National Hospice and Palliative Care Organization (NHPCO). NHPCO Facts and Figures, 2022 – Hospice care overview and team structure. nhpco.org.
Let’s Get Healthy California, End-of-Life Goal – Increasing Use of Hospice Care (2022). Benefits of hospice for symptom control and family satisfaction. letsgethealthy.ca.gov.
Ornstein KA, et al. “Family caregiving at the end of life and hospice use: A national study of Medicare beneficiaries.” Journals of Gerontology: Series B. 2020. – Hospice associated with better pain management, family satisfaction, and reduced caregiver burden. pmc.ncbi.nlm.nih.govpmc.ncbi.nlm.nih.gov.
National Alliance for Caregiving & AARP. Caregiving in the U.S. 2020 – Statistics on caregiver stress (84% report high stress). morningstar-senior-living.com.
Minute Women Home Care Blog (Ryan McEniff). “How Do Hospice and Home Care Collaborate?” (May 24, 2021) – Explanation of hospice vs. home care roles and the need for both. mwhomecare.com
Alma Awad, MD, et al. “Home-Based Palliative Care: Benefits and Future Directions.” Current Oncology Reports (2021) – Home-based palliative (including hospice) reduces hospitalizations and supports patients and caregivers. pmc.ncbi.nlm.nih.gov.
AAMC News (Patrick Boyle). “When home is not the best place to die” (2022) – Discussion of family caregiver burdens in home hospice and need for additional support. aamc.orgaamc.org.
Mission Hospice & Home Care (San Mateo, CA). “Bernie Mellott’s story – Senior care expert learns benefits of hospice first-hand.” (Patient story, 2025) – California case study of hospice enabling home death with family testimonial. missionhospice.orgmissionhospice.org.
Institute on Aging (ioaging.org). “Who Pays for Hospice Care at Home in California?” – Information on Medicare coverage of hospice and services provided (e.g. homemaker aide, equipment). ioaging.org
California Health Care Foundation (CHCF). “Dying in California: A Status Report on End-of-Life Care” – Data on hospice utilization in CA (hospice used by 43% of decedents in 2014). letsgethealthy.ca.govamericashealthrankings.org.