What is hospice care?

Frequently Asked Questions

Hospice combines specialized nursing care at home with compassionate, supportive services for people at the end of life. Under some circumstances, care is also provided in a short-term inpatient setting.

The focus of hospice care is on managing pain and symptoms in a highly sensitive, compassionate approach to ensure the patient’s comfort, dignity and privacy.  The goal of hospice is to enhance the patient’s quality of life at the end of life.

Hospice involves a team of healthcare professionals and volunteers who work closely with the family to support their decision to care for their loved one at home.

The patient’s care is managed by a registered nurse, under the direction of the hospice physician/medical director and the patient’s doctor.  The nurse visits the patient’s home as often as needed to check on his or her condition and well-being, and teaches the family how to manage their loved one’s care between these visits.  If questions or problems arise, help is available by phone 24/7 or a nurse will come to the home, if needed, even in the middle of the night.

Depending upon the needs of the patient and family, other team members may include:

• home health aide for patient’s personal care
• medical social worker to help with emotional issues
• chaplain for spiritual care
• trained volunteer to help with a family’s more practical needs, such as sitting with the patient while the caregiver goes to an appointment
• physical or occupational therapist to help with the patient’s bed-bound or mobility issues.

As the registered nurse coordinates the patient’s care and team services, he/she is in regular contact with the patient’s physician and the hospice medical director, also a physician.

How is hospice care different from other types of care?
Hospice care is provided mostly in a home-setting but in certain cases can be provided in an inpatient setting, such as a licensed skilled nursing facility.   In addition to its team approach, it is also a philosophy of care that honors the choices of the patient and family over the decisions that affect the end of life process. In a hospital, where 75 percent of deaths occur, everything—the environment, the equipment, the food, the nurse, the doctor—is institutionally managed. In hospice care, the dying loved one and his family have more control over the process of care.  The hospice team honors the patient and family’s wishes for care at home, where most people want to be at the end of life.

How is hospice care paid for?
Medicare, the Federal government health care reimbursement program for those age 65 or older, has a benefit that covers hospice care nearly 100 percent for the patient, including medications and equipment that are related to the terminal illness. Most private insurance companies mirror the Medicare Hospice Benefit. There is usually little or no out-of-pocket expenses for the family. Medicaid coverage varies by state.

What if patients have another condition, such as diabetes, that requires a variety of medications and equipment? Are these covered too?
If the condition is the reason the patient has come on to hospice care, it most likely will be covered. In some cases, for people 65 or older, needs caused by secondary conditions can be justified for coverage under the Medicare Hospice Benefit or under other Medicare benefit coverage. Other insurances may vary.  The hospice care provider (see grant recipients) and the patient’s physician can help determine eligibility for coverage.

How is someone eligible for hospice care?
Under the rules of Medicare and many private insurance plans, a physician first must certify that the patient’s death is expected within the next 180 days, or six months. In addition, the patient is no longer seeking active, curative therapies, opting instead for hospice care that addresses pain and symptoms and other comfort measures.

For more information and resources, including books, CDs, and other materials, check out these websites from the National Hospice and Palliative Care Organization: nhpco.org and www.caringinfo.org.