Hospice offers medical care toward a different goal: maintaining or improving quality of life for someone whose illness, disease or condition is unlikely to be cured. Each patient’s individualized care plan is updated as needed to address the physical, emotional and spiritual pain that often accompanies terminal illness. Hospice care also offers practical support for the caregiver(s) during the illness and grief support after the death. Hospice is something more that is available to the patient and the entire family when curative measures have been exhausted and life prognosis is six months or less.
List of services
The vast majority of hospices follow Medicare requirements to provide the following, as necessary, to manage the illness for which someone receives hospice care:
- Time and services of the care team, including visits to the patient’s location by the hospice physician, nurse, medical social worker, home-health aide and chaplain/spiritual adviser
- Medication for symptom control or pain relief
- Medical equipment like wheelchairs or walkers and medical supplies like bandages and catheters
- Physical and occupational therapy
- Speech-language pathology services
- Dietary counseling
- Any other Medicare-covered services needed to manage pain and other symptoms related to the terminal illness, as recommended by the hospice team
- Short-term inpatient care (e.g. when adequate pain and symptom management cannot be achieved in the home setting)
- Short-term respite care (e.g. temporary relief from caregiving to avoid or address “caregiver burnout”)
- Grief and loss counseling for patient and loved ones
What's Not Covered
Not all services provided to patients enrolled in hospice care are covered by the Medicare Hospice Benefit. The benefit will not pay for:
- Treatment intended to cure your terminal illness or unrelated to that illness
- Prescription drugs to cure your illness or unrelated to that illness
- Room and board in a nursing home or hospice residential facility
- Care in an emergency room, inpatient facility care or ambulance transportation, unless it is either arranged by the hospice team or is unrelated to the terminal illness
Not just for cancer (or adults) anymore
It is not surprising that people often associate hospice with cancer. In the mid-1970s when hospice came to the U.S., most hospice patients had cancer. Today, more than half of hospice patients have other illnesses for which they are medically eligible for hospice services, such as late-stage heart, lung or kidney disease, and advanced Alzheimer's disease or dementia. Hospice also once was exclusively for adults but today many hospice programs accept infants, children and adolescents.
In order to receive hospice services, a hospice physician and a second physician (often the individual’s attending physician or specialist) must certify that the patient meets specific medical eligibility criteria; generally, the patient’s life expectancy is 6 months or less if the illness, disease or condition runs its typical course. However, if the individual lives longer than six months and their condition continues to decline, they may be recertified by a physician or nurse practitioner for additional time in hospice care. Similarly, if a hospice patient's condition improves, they may be discharged from hospice care. The patient is eligible for hospice again if his or her condition begins to decline.
Care comes to the patient
Hospice services are provided in the setting that the patient calls home, which may be their private residence or that of a loved one, a hospital, assisted living center, or nursing home. Some hospices have their own long-term residential center where they provide hospice care.