What Is Hospice Care?
Hospice is specialized end-of-life care for people who have a terminal disease and are no longer seeking a cure. It provides symptom management and support for the patient, caregivers, family and friends. More than 98% of hospice care is provided in patients’ homes, which includes private dwellings, skilled nursing facilities or assisted living facilities.
- Written by Terry Turner
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Terry Turner has more than 30 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education (AFCPE®).Read More
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- Reviewed By Bart Astor
- Published: June 13, 2022
- Updated: October 10, 2022
- 8 min read time
- This page features 7 Cited Research Articles
- Edited By
What Is Hospice?
Hospice provides comprehensive end-of-life comfort care for terminally ill patients. It also provides comfort and support to family members.
Planning ahead for the possible need for hospice care — knowing agencies in your community, discussing your wishes with family members and friends — can be one of the most important parts of planning for your retirement life. Advance planning may be much easier than handling it near your end of life.
Hospice care can begin when your doctor determines that a patient only has six months or less to live if their condition takes its natural course.
If you receive a diagnosis of a terminal condition, it’s wise to ask your doctor about hospice. In some cases a doctor may not mention it as an option, so you should bring it up.
Four Levels of Hospice Care
Medicare recognizes four levels of hospice care. A patient may experience only one level, any combination of the four levels or all four levels while in hospice care.
- Routine Home Care
- This is hospice care at home without continuous home care. The home may be defined as the person’s house or apartment, a skilled nursing facility or an assisted living facility — whatever place the patient calls home.
- Continuous Home Care
- Continuous home care is in a home setting that is not an inpatient facility such as a hospital, skilled nursing facility, hospice inpatient unit or similar setting. The care consists of continuous care in the home. Patients can only get continuous home care during brief times of crisis as needed to keep the patient in their home.
- Inpatient Respite Care
- Inpatient respite care occurs when the hospice patient chooses to go to an approved inpatient setting for up to five consecutive days, allowing their caregiver some time to rest and recover.
- General Inpatient Care
- This is any time a hospice patient chooses to go to an inpatient unit for pain control or to manage chronic or acute symptoms that can’t be performed in the home or other settings.
What Does Hospice Do?
Hospice focuses on the comfort, care and quality of life for someone with a serious, terminal illness. It is designed to help a patient nearing the end of their life — and the patient’s family — through this time when it is no longer possible to cure the patient.
Hospice Care Services
- Coordination of Care
- A hospice team will coordinate and supervise your care, round the clock, seven days a week. This will include your doctor, nurses and other health care providers. But it may also include your clergy person, funeral directors and other members of your community.
- Family Meetings
- Hospice care includes regular meetings for the patient’s family. These are usually led by a hospice nurse or other team member or a social worker. The meetings keep family members updated on the patient’s condition, provide support, help members deal with stress and understand the process of death.
- Home Care and Inpatient Hospice Care
- Ideally, hospice care is delivered in the home. The hospice team will arrange for inpatient care if certain pain or symptom management care must be temporarily provided in an inpatient facility.
- Respite Care
- Respite care allows family or other constant caregivers some time to rest and recover. Respite care allows the patient to receive care in a hospice unit, hospital or nursing home for up to five days.
- Spiritual Care
- Your hospice team can set up spiritual care based on your specific religious needs. This can include discussions of life and death in a spiritual context, religious ceremonies or rituals and discussions with clergy.
- Bereavement Care
- After your death, hospice care still continues for your family. The hospice team will provide bereavement care to your survivors. The team can connect family members with trained volunteers, professional counselors, support groups and/or clergy to help them deal with grief for up to a year after your death.
When Is Hospice Recommended?
Hospice is recommended when an illness or condition reaches a point at which doctors can no longer control or cure it. Typically, hospice services can begin when you are expected to live just six months or less.
When you reach this point, it’s important to discuss your hospice options with your doctor to make sure you take full advantage of hospice care while you can. Starting hospice care as soon as possible may give you a better quality of life at the end of life, and give you more time to spend with your loved ones.
Anyone, including a family member, friend, doctor or your clergy member may recommend that you seek hospice care.
You may also decide to choose hospice care when your health has rapidly declined over the previous six months despite aggressive medical treatments or if you choose to focus on your quality of life rather than pursuing treatments that may prolong but not save your life.
How Long Is Hospice Recommended?
About half of the people entering hospice died within three weeks, and 35.7% died within one week, according to a 2014 study in the Journal of Palliative Medicine. Only about 12% to 15% of the patients in the study survived six months or longer.
The American Cancer Society recommends entering hospice as soon as you are eligible if you wish to focus on quality of life.
You can always leave hospice care if you change your mind or recover. Hospice programs will also allow you to renew care if you live longer than six months after enrolling in hospice.
Palliative Care vs. Hospice Care
Hospice care often includes palliative care, but they are two different types of care. While hospice care focuses on end-of-life care, palliative care focuses on relief of symptoms and stress of a serious illness while patients may or may not still be receiving treatment for the condition.
|Hospice Care||Palliative Care|
|Patient treated||Anyone with a serious, terminal illness diagnosed with a short time to live (six months or less)||Anyone with a serious illness|
|Care team||Coordinates majority of care for the patient; communicates with the patient’s medical team||Provides only palliative care services; communicates with the patient’s medical team that provides and manages treatment for the illness|
|Continue to receive treatment to cure your condition||No; you will only receive symptom relief||Yes, if you choose to|
|How long you will receive care||As long as you meet the hospice team’s criteria of a short life expectancy, you’ll be covered; you can stop at any time||Depends on the type of care you require and your insurance coverage|
|Medicare coverage||Yes, but you may still have some associated out-of-pocket costs||Depends on your Medicare plan|
|Private insurance coverage||Depends on your plan||Depends on your plan|
|Where you can receive care|
Hospice Care at Home
Most often, hospice services provide care in the patient’s home. Hospice care may be provided 24 hours a day, seven days a week, even if provided in your home.
In-home hospice care includes any type of senior housing situation. If you live in a nursing home, an assisted living facility or other senior living facility, you can receive hospice care there. It is considered in-home care as long as the facility is your home.
If you receive home hospice care, you will have services provided by doctors, nurses and other health care professionals. But a family member or friend is typically the primary caregiver who will be responsible for your around-the-clock supervision.
If you are a primary caregiver for a friend or family member receiving home hospice care, the hospice agency will train you on what you need to know and do. You will have to make sure that you — or another caregiver — are with the hospice patient around the clock, seven days a week.
Hospice professionals will check in routinely to make sure the patient’s symptoms are managed and to see how the family and caregivers are doing.
If there is a special need or the patient experiences a crisis, the hospice agency will have an on-call nurse who can take calls 24 hours a day or who can make visits or send someone if needed between regular visits.
Is Hospice Care Covered by Medicare?
If you are enrolled in Original Medicare, you will pay nothing for hospice care — but you may have to pay a portion of associated costs.
Medicare hospice coverage pays hospice agencies a daily rate as long as you are enrolled in hospice, regardless of the types and number of services performed on any given day. This same rate is paid even if the agency performs no services.
For example, you may have to pay 5% of the Medicare-approved amount for inpatient respite care.
You may have to continue paying room and board if you live in a nursing home or other facility. And you may have a copayment of up to $5 for each outpatient drug prescribed for symptom and pain management.
7 Cited Research Articles
- National Institute on Aging. (2021, May 14). What Are Palliative Care and Hospice Care? Retrieved from https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care
- Mayo Clinic. (2021, March 2). Hospice care: Comforting the terminally ill. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/end-of-life/in-depth/hospice-care/art-20048050
- National Hospice and Palliative Care Organization. (2020, August 17). NHPCO Releases New Facts and Figures Report on Hospice Care in America. Retrieved from https://www.nhpco.org/hospice-facts-figures/
- Centers for Disease Control and Prevention. (2020, May 20). Hospice Care. Retrieved from https://www.cdc.gov/nchs/fastats/hospice-care.htm
- American Cancer Society. (2019, May 10). What Is Hospice Care? Retrieved from https://www.cancer.org/treatment/end-of-life-care/hospice-care/what-is-hospice-care.html
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Hospice care. Retrieved from https://www.medicare.gov/coverage/hospice-care
- U.S. Department of Health and Human Services. Eldercare locator. Retrieved from https://eldercare.acl.gov/Public/Resources/Factsheets/Hospice_Care.aspx