Hospice provides something more for patients when a cure is not an option. It is a medical care model focused on comfort.
Hospice care aims to manage the patient’s symptoms while supporting their quality of life. It provides support for family caregivers, too.
Understanding what hospice is — and isn’t — can help patients and families decide whether to choose this type of care.
About hospice care
Hospice is medical care for people who are expected to live six months or less. It is provided primarily where a person lives — at home or in a nursing home or community living arrangement — so the patient can be near family, friends, pets, and valued possessions.
Hospice care is provided by an interdisciplinary team of professionals trained to address the patient’s medical, physical, spiritual, and psychosocial needs. The team focuses on the person, not the illness, as they coordinate patient care, clarify the goals of care, and foster communication.
Members of the hospice team visit the patient periodically. Hospice providers are available around the clock to respond to patient or caregiver concerns.
The team also supports family members and other close caregivers. Hospice provides bereavement care for the patient’s family and caregivers during the illness and for more than a year after their loved one’s death.
Importantly, hospice care is a covered benefit for anyone enrolled in Medicare or Medicare Advantage. This specialty care also is covered at varying levels by most healthcare insurers and, in almost every state, by Medicaid. Read more about paying for hospice care.
What hospice is not
Hospice care is not focused on curative therapies or medical treatments designed to prolong life.
In most cases, hospice does not provide around-the-clock bedside care. It does not replace caregiving provided by family members, a nursing home, or other residential care.
Hospice care does not hasten death. Instead, it focuses on providing comfort at the end of life and supporting the dying person and their family caregivers.
Who can receive hospice care?
To qualify for hospice services, a hospice physician and a second doctor (often the person’s attending physician or specialist) must certify that the patient meets specific medical eligibility criteria.
These criteria vary by illness and condition. But in general, those eligible for hospice care are adults with a terminal illness who are expected to live six months or less if their illness/condition follows its typical course. Those who do not qualify for hospice care may benefit from palliative care. Read about the differences between hospice and palliative care here.
Common diagnoses for hospice patients include (but are not limited to) cancer, heart disease, dementia, Parkinson’s disease, lung disease, stroke, chronic kidney disease, cirrhosis, and amyotrophic lateral sclerosis (ALS).
Children and teens also can receive hospice care, but the regulations governing hospice services and coverage for minors are different from those for adults.
Read more about hospice eligibility.
When is it time for hospice?
Hospice care is not just for people who are bedridden or in their last days of life. Patients and their families can benefit from hospice for months, so long as the patient is medically eligible.
Consider starting hospice care when:
- The patient’s physical and/or cognitive status declines significantly despite medical treatment. Signs may include increased pain or other symptoms, substantial weight loss, extreme fatigue, weakness, or shortness of breath.
- Doctors estimate that life expectancy is six months or less.
- The patient is in the end stage of Alzheimer’s disease or dementia.
- The goal is to live more comfortably rather than continuing treatments that take a physical toll and have been unsuccessful in halting or curing a life-threatening illness.
Hospice services
Most hospices follow Medicare requirements and provide these services, as necessary, to manage the primary illness that qualifies the patient for hospice care:
- The hospice team’s time and services, including visits by the hospice physician, nurse, medical social worker, home health aide, and chaplain/spiritual counselor.
- Medication for symptom control, including pain relief.
- Medical equipment such as a hospital bed, wheelchair, or walker, and medical supplies such as oxygen, bandages, and catheters.
- Any other Medicare-covered services needed to manage pain and other symptoms related to the terminal illness, as recommended by the hospice team.
- Volunteer services to assist with a variety of patient and caregiver needs.
- Short-term inpatient care (for example, when pain and other symptoms cannot be managed adequately in a home setting).
- Short-term respite care that gives family caregivers temporary relief from caregiving. This helps to avoid or relieve “caregiver burnout.”
- Grief and loss support for the patient and their loved ones, who may experience “anticipatory grief” as they think about the future. Grief support is provided to family members for up to 13 months after their loved one’s death. It may also be provided to patients and families experiencing anticipatory grief.
In addition, physical and occupational therapy, dietary counseling, and speech-language pathology services may be provided based on the hospice team’s assessment and goals of care, and the patient’s disease progression and symptoms.
Services not included
Hospice care does not provide treatment or prescription drugs intended to cure a terminal illness, or any other illness unrelated to the terminal diagnosis, unless the other illness is adding to the patient’s symptom burden.
These services are not included in hospice care:
- Prescription drugs and supplies prescribed to treat an illness or condition unrelated to the diagnosis that qualifies the person for hospice.
- Room and board in a nursing home, residential hospice facility, or other care facility.
- Care in an emergency room, inpatient facility care, or transportation by ambulance, unless it is ordered/arranged by the hospice team.
Locations for care
Hospice services are provided wherever the patient lives. This may be a private residence, such as the patient’s home or the home of a loved one. When services are provided at home, hospice generally requires one or more caregivers who may be family members, friends, or paid caregivers.
Hospice care also can be provided in an assisted living center, nursing home, or hospital.
If the patient needs 24/7 care, hospice may arrange to transport them to a special inpatient facility for a short time, with the goal of bringing the patient home again after symptoms have been managed.
Read more about preparing for hospice care and hospice caregiving.
Length of care
Hospices must abide by strict federal rules that address who is eligible and how long a patient may stay in hospice care. Changes to care may occur due to:
- Extensions. Hospice care is provided in “benefit periods” — two 90-day periods followed by an unlimited number of 60-day periods. Although medical eligibility generally relies on a doctor’s opinion that the patient’s life expectancy is six months or less, it is common for patients to outlive that prognosis. If this happens, the patient can be re-certified for hospice care, so long as they are still medically eligible.
- Discharge. If a patient’s condition stabilizes or improves sufficiently, federal rules may require a hospice to discharge the patient from care. The patient’s Medicare benefits then revert to the coverage they had before entering hospice care.
- Revocation. Sometimes hospice patients choose to pursue therapies, such as entering a clinical study of a new medication or procedure, or decide they no longer want hospice services. In these cases, the patient must withdraw from (“revoke”) hospice care.
Patients who are discharged, as well as those who choose to leave hospice care, can re-enroll at any time provided they meet the medical eligibility criteria.
