What Is Hospice

What is hospice?

Hospice is an approach to end-of-life care that allows people with terminal illnesses and their families to live as comfortably as possible during the last stages of life.

How does hospice work?

• People who choose hospice care stop treatment for their illness to focus on end-of-life care. This means managing uncomfortable symptoms, such as pain, while keeping dignity and quality of life.
• A hospice team is made up of nurses, doctors, chaplains, social workers and volunteers. These people work together to assure the dying process is dignified and emotionally supportive for all involved.
• Hospice care emphasizes the role of family members in daily activities. They are central to making decisions and surrounding their loved ones when they pass.
• Hospice care is broken into benefit periods listed below. After each period, a hospice physician must re-certify that the patient is still eligible for hospice care.
  • Period 1: 90 days
  • Period 2: 90 days
  • Unlimited 60-day periods following the second 90-day period

What services does hospice provide?

As part of admission to hospice, the provider discusses the patient’s needs and how the hospice team can personalize care. All hospice care should follow the Medicare guidelines for hospice below.

Different hospice providers offer varying levels of these services and take different approaches to fulfilling these requirements:

• Symptom and Pain Relief: All medications and other Medicare-covered services to provide relief from suffering.
• Medical Supplies: Bandages, bedpans, gauze, catheters and the like.
• Medical Equipment: Lifts, wheelchairs, walkers, hospital beds, oxygen equipment, etc.
• Physician Care: Is coordinated by the primary care physician working with the hospice physician.
• Case Manager Nurse: A registered nurse visits every 14 days at a minimum to assess the quality of care and services your loved one is getting. Hospices have nurses on call every day around the clock to respond to calls from patients’ families.
• Home Health-aide: To help with activities of daily living (ADLs).
• Medical Social Worker: Will make regular visits to make sure individuals are getting everything they need, both medically and emotionally.
• Homemaker Services: To assist with cleaning and cooking.
• Chaplain: To provide emotional support and spiritual counseling for families and their loved one.
• Therapy: This includes physical, occupational, and speech therapy options.
• Short-term Respite Care: Focused on caregivers who help with home hospice. Short-term respite care offers a much needed break for a caregiver’s self-care.
• Dietary Counseling and Information: A dietician is available when the patient has a dietary need. This includes education for the family.
• Bereavement/Grief Counseling: For the patient and family during the end-of-life care and for the family after their loved one passes.

Some hospice providers will offer services beyond the ones required by Medicare including:

• Palliative Chemotherapy/Radiation: That focuses on easing a person’s pain.
• Volunteer Activities: Some hospice providers have trained volunteers who visit the patient and family. A volunteer may provide support or help out in ways that will help the family unit.
• Art, Music, Massage and Animal Therapy: These are typically associated in some way with a hospice provider. The goal is to offer care that focuses on quality of life.

Common misunderstandings about hospice

Misunderstandings about hospice limit the specialized services available to people who are dying and their families. It’s important to address those so that you and your family are guided with accurate information to help you with the end-of-life decisions you are making.

• Hospice is not about a person giving up
  • It’s about making the most of the time that is left. It’s about having as good a quality of life as possible as one prepares to pass.
  • It’s about your loved one knowing that their family and friends are rallying around them to show love and kindness.
  • Read more about dispelling hospice myths.
• The doctor does not need to be the one to bring up hospice
  • You and your loved one can bring up your interest in hospice care at any point. In fact, this is the best way to advocate for your loved one being as comfortable as possible as they near the end of life.
  • Let the doctor know of your interest at the time of diagnosis.
  • The doctor is responsible for deciding if your loved one meets hospice eligibility by diagnosis and life expectancy.
• Hospice is not only for people who will die very soon
  • The earlier one enters hospice care, the longer services are there to support their care.
  • The care and attention paid to your loved one and family can extend life for certain people.
  • The focus is on quality of life and comfort, whether one’s remaining life is measured in weeks or months.
• You do not have to use the hospice provider recommended by a hospital
  • Often families will use the hospice provider first recommended by the hospital or physician overseeing care for their loved one.
  • This is an emotional and stressful time as you decide if hospice is the next best step for your loved one. It may be in the best interest of your loved one and family to compare the recommended hospice provider with others in the area. Doing so means you’ve made a well informed decision.
• All hospice providers are not the same
  • One could say that hospice providers are as varied as the communities they serve.
    • Some are non-profit agencies while others are for-profit.
    • Some have a hospice house as part of their care options.
    • There are hospices associated with hospitals or health networks.
    • They offer different methods for abiding to Medicare requirements.
  • All hospices do have one thing in common. They are Medicare-certified, meaning they have met federal requirements associated with hospice care.
• Hospice is not only for people who are at the final stages of cancer
  • Certainly, there are people living with cancer who are in hospice because of this disease.
  • People in hospice care are dying from many other illnesses. These include various forms of dementia, degenerative diseases, and end-stage diseases of major organs such as lungs, heart, and kidneys.

Where is hospice care provided?

Hospice is provided in 3 possible settings:

1. In the recipient’s home (or family member’s home).
2. In a long-term-care facility or hospital.
3. In an in-patient specialized hospice center often called a hospice house.

Home Hospice vs In-Patient Hospice

Hospice is not a place but an approach to make end-of-life care manageable and as supportive as possible for individuals and their families. For most individuals, hospice care happens in whatever setting they consider home. That could be:

• Their personal residence
• A nursing home
• An assisted living community
• A family member’s home

Sometimes a hospice patient needs to move from their “residence” to an in-patient medical facility. This usually happens when an individual’s pain or discomfort cannot be treated at home.

There are also specialized hospice facilities or homes. These have progressive approaches to hospice care that patients and families can choose, often when close to life’s end.

Note: Medicare does not cover room and board when you receive hospice care in your home or another facility where you live (like a nursing home). Learn more on the Medicare hospice page.

What are the four levels of hospice care?

The Centers for Medicare and Medicaid Services detail the four levels of hospice care that all Medicare-approved hospice providers must offer. They include:

• Home Hospice Care
• Continuous Hospice Care
• In-Patient Hospice care
• Respite Care

What is the difference between palliative care and hospice care?

Palliative Care

Aims to provide comfort and symptom management when an individual is diagnosed with a serious illness and is going through treatments.

Hospice Care

Aims to provide comfort and symptom management once the patient is no longer receiving curative treatments and likely has less than 6 months to live. Hospice also focuses on emotional and spiritual comfort in addition to physical comfort.