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What is hospice care?

what is hospice care

Hospice is a type of end-of-life care geared towards keeping a patient comfortable and improving their quality of life, rather than seeking to cure them of disease. More than 1.4 million Medicare beneficiaries were enrolled in hospice care for one day or more in 2016, according to the National Hospice and Palliative Care Organization, and research shows it may help alleviate suffering and possibly even allow you to live longer.

In hospice, the focus shifts from treatments aimed at a cure to medical care aimed at comfort and support for patients and their families. A fundamental belief in hospice care is that everyone has the right to die pain-free and with dignity.

Care is provided by an interdisciplinary team that includes a hospice doctor or medical director, as well as nurses, social workers, bereavement counselors, home health aides, clergy and volunteers. All of these people are specially trained in hospice care and management and all the unique issues that surround death and dying.

How hospice works

The vast majority of all hospice care is provided where the patient currently lives, whether it’s their home (56 percent) or a nursing home (42 percent). Less than 2 percent receive care at a freestanding hospice facility or in a hospital, according to NHPCO.

Generally, a family member serves as the primary caregiver, with members of the hospice staff visiting regularly (perhaps two or three times a week, or more or less often depending on your specific needs) to check in on the patient, adjust medication, and provide any other services needed. The hospice team develops a care plan to address a patient’s needs for pain management and symptom relief, and remains on-call 24/7 and available in case of emergencies.

Services provided can include:

  • Medical care to manage symptoms like pain. This can include palliative treatments such as radiation (for example, to reduce pain caused by cancer), removing excess fluid, or even blood transfusions.
  • Counseling and social support to help you and your family come to terms with the emotional, psychological, and spiritual aspects of dying
  • Medications, medical supplies and equipment
  • Instructing caregivers on how to administer medication and provide other types of care
  • Short-term inpatient care when pain or other symptoms can’t be managed at home
  • Services like speech and physical therapy
  • After death, grief support and counseling for the family

Sometimes, a person will need continuous home care (CHC), which is nursing care for eight to 24 hours a day to manage pain and other symptoms, or even temporary inpatient care if CHC isn’t sufficient. Respite care may also be available for several days at a hospital or hospice facility if the primary caregiver needs a break.

When hospice is appropriate

Hospice is available for anyone who gets physician certification that they have a terminal illness and have less than six months to live. You can leave hospice at any time — for example, if your disease improves, or you decide that you once again want to pursue a curative treatment.

Research shows that many people put off hospice care for too long. A Yale study published in 2017 in the Journal of the American Geriatrics Society found that the average stay in hospice was just 12.5 days, suggesting that physicians may need to discuss the possibility sooner.

Benefits of hospice

Patients who opt for hospice generally live longer and experience a better quality of life. One 2007 study published in the Journal of Pain and Symptom Management found that terminally ill patients with either congestive heart failure or cancer who received hospice services lived, on average, 29 days longer than those who did not. And debilitating symptoms — like fatigue, pain, shortness of breath, depression and anxiety — all decrease substantially after hospice begins, according to a 2016 study published in the American Journal of Medicine.

Read more: 7 benefits of hospice care

How to pay for hospice

Medicare, Medicaid, and most private health plans cover hospice services. If you want to receive benefits through Medicare, the provider you choose must be Medicare-certified. While Medicare requires that a patient has a prognosis of less than six months, you can still receive care after six months is up. A physician just needs to recertify every 60 days that you still meet eligibility requirements. There is no limit to the number of 60-day recertification periods.

The hospice benefit will cover everything related to the terminal diagnosis, though specific coverage can vary by hospice and your insurance plan. Medications and treatments for other conditions not related to that diagnosis can still be covered by health insurance outside of the hospice benefit.

How to find a hospice provider

Your doctor or local hospital can provide recommendations, as can friends. The National Hospice and Palliative Care Organization (NHPCO) can help you find a provider in your community. Most states also have a state hospice society or network. You can check the website for your state’s department of health to see if a hospice has received any citations, and Medicare’s Hospice Compare site allows you to see quality ratings for every Medicare-certified hospice.

Written by Hallie Levine and reviewed by Keith Lagnese, MD

Read next: What's the difference between palliative care and hospice care?

Jan. 23, 2014

Nancy C. that is correct.. Service companies charge 15 to 18 dollars an hour and the caregivers get 8 dollars an hour on the average maybe 9 if you really talk to your boss. So there for like myself I prefer to work on my own at 10 or 12 dollars an hour depending on the client and the situation. But I am with a company now because its hard to find private pay jobs because all of these companies are already getting ahold of them. And they don't realize we as caregivers don't receive the money we make minimum wage from 7.50 to 8.00 an hour. I worked for myself for several years until my client died in 2010. And had to go with a company because I had to find a job ASAP. Just alittle info for people looking for caregivers that think we get paid all the money you pay to companies.

Jan. 17, 2014

I learned that many agencies charge outrageous amounts with the person providing the care only getting about 25% of the amount charged. I would consider interviewing on my own. You might need two or more caregivers sharing the time between them. 24/7 is very difficult for anyone, family or employee. I understand how difficult and challenging full time care is and hope you are able to find competent and caring individuals to provide a safe and caring environment for your family.

Dec. 5, 2013

I have been caring for my grandmother for 7 years. She is 94 years old and has been living on her own up until 2 months ago when she was admitted into the hospital for dehydration (due to her prescriptions/water pills etc) she was stabilized in the hospital after 2 weeks and I continued her care in a skilled nursing facility. As grandma ALWAYS BOUNCED BACK after some time, this was different. Once I brought her home I realized that she could NOT live on her own. It required even much more care than I could provide. I placed her into a private home that is better equipped to care for her. Today I was suggested \

Nov. 23, 2013

Can you please tell us what we need to do !! My mother has alzheimers and now has been diagnoised with Lung Cancer. She is in a nursing facility, should we bring in hospice or let them take care of her till the end?

Jan. 10, 2013

My mom passed away 12-28-12, she was under hospice they made my life easier and made her comfortable...yes it's hard to hear that your loved can't go to the doctors or hospital it took me a few days to accept what they told me..anything I needed I had the next day or the same day..all her meds were taken care of....when the time came of her passing..they took care of everything....I love hospice.

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