13.4 Caregiver Skills, DME, Supplies, and Services
Key Takeaways
- Related hospital beds, oxygen concentrators, commodes, mechanical lifts, and wound supplies on the hospice plan of care are provided by the hospice; the family should not open a separate Medicare Part B DME claim for those related items while elected.
- Household groceries, rent or mortgage, and utilities — including electricity the concentrator uses — remain family costs; room and board in a nursing facility on routine home care is not a hospice room-and-board payment.
- A hospice aide provides RN-supervised intermittent personal care; a homemaker supports a safe environment under IDG direction; a volunteer offers companionship and sitting, not unsupervised Hoyer lifts or opioid administration.
- Mechanical (Hoyer) lifts are used only by people the hospice has trained; hospice may issue a lift when it is reasonable and necessary for palliation of the terminal illness and related conditions.
- Oxygen concentrator teaching includes no smoking, distance from open flame, tubing safety, and a backup plan if power fails when tanks are on the plan of care.
13.4 Caregiver Skills, DME, Supplies, and Services
HPCC task 4H Teach caregiver to provide patient care and 4K Provide education about access and use of services, medications, supplies, and durable medical equipment (DME) are one visit in real life. A hospital bed that nobody knows how to lower is not comfort. An oxygen concentrator the family is afraid to switch on is not dyspnea care.
What hospice covers when it is related
42 CFR 418.106 and 418.202 require the hospice to provide medical supplies, appliances, drugs, and DME that are reasonable and necessary for palliation and management of the terminal illness and related conditions and that appear on the plan of care. Equipment is supplied for use in the patient's home while the patient is under hospice care. Once the patient elects hospice, the hospice — not a separate Part B DME supplier the family calls from a television advertisement — is responsible for related hospital beds, wheelchairs, walkers, oxygen concentrators, commodes, over-bed tables, and, when indicated, a mechanical (Hoyer) lift.
Related wound supplies (gauze, border dressings, barrier cream ordered for a pressure injury tied to declining mobility) are hospice medical supplies when they are on the plan of care. Do not send the family to a retail pharmacy to buy those dressings out of pocket as if hospice had no duty. If a wound is unrelated (for example a longstanding venous ulcer the IDG has documented as unrelated), coverage follows the unrelated-condition pathway, not a silent denial of related skin care.
Unrelated drugs may still run through Medicare Part D. Related morphine, lorazepam, and bowel regimens for opioid constipation are hospice drugs. Teach the family not to fill a second, conflicting opioid at a community pharmacy "just in case" while hospice is already dispensing.
What the family still buys
Hospice does not pay household groceries, rent or mortgage, ordinary clothing, or utilities. The concentrator plugs into the family's electricity. That power bill stays a household cost. Room and board where the patient lives — private home, assisted living, or a nursing facility on routine home care — is not converted into a hospice hotel benefit. (Inpatient GIP or respite days are facility care under those levels; they are not a way to make hospice pay a long-term nursing-home rent.)
Families may still pay for private overnight sitters, extra incontinence products they prefer beyond the plan, and comfort items not on the plan of care. Those purchases are optional and do not replace hospice DME or aide services the plan already requires.
Caregiver skills the CHPN must teach
Hospital bed. Teach height for safe transfers (caregiver hips, not a low guest mattress), head-of-bed elevation for dyspnea, and side rails as enablers with entrapment teaching. Rails are not a restraint shortcut. Show how to lock wheels before a transfer.
Oxygen concentrator. Related dyspnea or hypoxemia on the plan of care. Teach no smoking, keep tubing out of walk paths, stay away from open flames, and do not drape cloth over the intake. If portable tanks are on the plan for power failure or trips to appointments, show the regulator and a tank-duration estimate. Concentrators fail in blackouts; "we will just wait" is not a backup plan if the patient is oxygen-dependent.
Commode. Place it at the bedside for fall-risk toileting. Teach a gait belt if ordered, a second person for weak stand-pivot, and emptying/cleaning so the hospice aide is not the only person who can handle waste.
Hoyer / mechanical lift. Use only after hands-on training. Two-person technique when policy requires it. Never ask a volunteer to run the lift alone. If the family cannot lift safely even with a device, that is an IDG problem (more aide time, different equipment, or a different level of care), not a volunteer problem.
Wound supplies. Clean technique the RN demonstrates and the caregiver return-demonstrates. Photograph or describe the wound per agency policy; caregivers do not improvise household disinfectant on open tissue.
Aide, homemaker, volunteer — and hired help
| Role | Typical CMS-aligned work | Not this role |
|---|---|---|
| Hospice aide | Intermittent personal care under RN assignment: bath, dressing, toileting, skin care help, linen change and light cleaning in the patient's area | 24-hour live-in routine home care; independent opioid dose changes |
| Homemaker | IDG-directed help maintaining a safe, healthy environment and tasks that enable the treatment plan | Skilled nursing; unsupervised mechanical lifts; replacing aide personal care if not aide-competent |
| Volunteer | Companionship, errands, sitting so the caregiver can eat or sleep a defined window | Administering morphine or lorazepam; independent Hoyer operation |
| Privately hired aide | Family-paid presence, often overnight; follows the written plan | Replacing the hospice nurse or inventing extra oxycodone |
Home health aide under a Medicare home health episode is a different benefit. After a hospice election, related personal care is the hospice aide, not a second home-health company billing for the terminal illness. Unrelated home-health services, if any, require a clean relatedness decision — not duplicate bathing for the same hospice diagnosis.
| Need | Typical hospice-related DME or supply | Caregiver skill to verify |
|---|---|---|
| Cannot get out of a low home mattress; caregiver back strain | Hospital bed with rails used as enablers | Height, locks, head elevation, entrapment awareness |
| Exertional or rest dyspnea related to the terminal illness | Oxygen concentrator; tubing; tanks if ordered for outages | No smoking, tubing safety, backup power plan |
| Falls on the way to a distant bathroom | Bedside commode | Transfer method, emptying, infection control |
| Cannot boost or transfer even with a bed | Mechanical (Hoyer) lift if reasonable and necessary | Trained operators only; never volunteer-only lifts |
| Pressure injury or malignant wound on the plan of care | Dressings and barrier products on the plan | Return-demonstration of the dressing; when to call for odor, bleeding, or fever |
| Caregiver cannot bathe the patient | Hospice aide visits under the RN | Aide does personal care; family still uses the commode plan between visits |
Exam trap: Related DME is a hospice duty while the patient is elected. The family still buys food, housing, and electricity. Volunteers do not become lift operators or opioid nurses. If the home cannot use the equipment safely, change the plan or the level of care — do not leave a Hoyer in the corner as decoration.
A home hospice patient needs a hospital bed and an oxygen concentrator for dyspnea related to the hospice terminal diagnosis. Who is responsible for those items under the Medicare hospice benefit?
Which expense usually remains a family or household cost even when hospice is covering related DME and wound supplies?
A family asks the hospice volunteer to operate the Hoyer lift alone so the spouse can rest. What should the CHPN teach?