Hospice is:

 

• Medical care to help someone with a terminal illness live as well as possible for as long as possible, increasing quality of life.
• An interdisciplinary team of professionals who address physical, psychosocial, and spiritual distress focused on both the dying person and their entire family.
• Care that addresses symptom management, coordination of care, communication and decision making, clarification of goals of care, and quality of life.

​Read how hospice is a family affair.

When is it time for hospice?

Deciding when it's time for hospice is difficult and should be discussed with loved ones and a physician. It is generally time for hospice when:
 

• The patient has 6 months or less to live, according to a physician.
• The patient is rapidly declining despite medical treatment (weight loss, mental status decline, inability perform activities of daily living).
• The patient is ready to live more comfortably and forego treatments aimed at prolonging life.

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.

Medical eligibility 

 

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.
 

Facing tough decisions near the end of life

When determining if hospice is the right decision, these questions will guide the conversation. Do you/your loved one want:
 

• artificial nutrition and hydration (whether or not to have a feeding tube or intravenous fluids)?
• cardiopulmonary Resuscitation (CPR) (whether or not to restart the heart if it stops beating)?
• mechanical ventilation (intubation) (whether or not to use a breathing machine to breathe for a person whose lungs have stopped working)?
• to discontinue treatment aimed at curing the disease in order to pursue comfort care?

 

Hospice seems like the right decision? Here are some next steps:

 

Learn about accessing hospice care.
Learn about paying for hospice.
Learn about choosing a hospice provider.
Learn about preparing for hospice care.

​Is your loved one in a nursing home? Learn more about receiving hospice in a nursing home here.