Hospice care, a form of palliative care, is intended for people with a life-limiting illness who have a life expectancy of less than six months and have decided to forgo ongoing [qtip:curative treatment|Treatment that is meant to cure the disease itself as opposed to masking the symptoms; in the case of lung cancer, killing or removing all lung cancer cells].

The overall goal of hospice care is to provide comfort, both physical and spiritual, for the patient and the patient's family and caregiver(s). Hospice care aims to improve the quality of time that the patient has left to live.1,2,3

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Hospice services help a patient and their family and caregiver(s) identify what is most important to the patient in living his/her remaining time to the fullest. Hospice care is characterized by compassion for the patient, as well as the patient's family and caregiver(s), and maximizing quality time. Hospice care also focuses on meeting the patient’s and the patient's family’s goals and wishes around the patient's death.1,2

It is a good idea for patients and their families to learn about all available treatment options, including hospice care, early in the treatment process. This will allow a smoother transition from curative treatment to hospice care if hospice should be needed in the future.

Note that the decision to go into hospice care can be reversed at any time, for any reason, without penalty.4

Hospice care may be provided in various locations, including the patient’s home, free-standing hospice centers, hospitals, nursing homes, and other long-term care facilities.1,2,5

What services does hospice provide?

Hospice services may include, as appropriate and needed, these services:1,2,6,7

  • Visits by members of the hospice care team to wherever the patient is
  • Medications to manage pain or other symptoms
  • Necessary medical equipment (e.g., wheelchairs), supplies (e.g., catheters,) and drugs
  • Services such as physical, occupational, and speech therapy
  • Short-term inpatient care if:
    • symptoms orpain are too difficult to manage if patient is at home or
    • if the caregiver needs a respite (temporary break from caregiving)
  • Nutrition counseling
  • Guidance to loved ones on caring for the patient
  • Grief and loss counseling to the patient and to loved ones

Referral to hospice care

A patient must be referred to hospice. This can be done by any member of the patient's healthcare team, but it is usually done together with the primary care physician or the specialist managing the [qtip:terminal illness|Disease that cannot be cured and will cause death]. A doctor must make the official determination that the patient meets qualifications for the hospice benefit, usually using clinical guidelines. A hospice doctor must also certify the patient's terminal illness. No matter when or how the decision is made, it is never too late to consider or request hospice care.1,2

Who is on the hospice care team?

Usually, the patient has a primary caregiver, such as a family member or friend, who works with the hospice care team. The hospice care team itself includes the patient's own doctor, the hospice doctor, nurses, social workers, home health attendants, clergy members, trained volunteers, and possibly physical, speech, and occupational therapists. The focus of the care is symptom management and ensuring that pain is well controlled. The delivery of hospice care is ultimately a combination of professional services provided by the hospice care team, together with the support of friends and family.1,56,7

Who pays for hospice care?

Hospice is covered by Medicare, Medicaid, the Veteran's Health Administration, and most insurance providers. Before choosing to enter hospice care, patients and their families need to have a full understanding of what their insurance benefit provides and what services would be available. There are some options for those not covered by insurance as well. A thoughtful discussion involving the patient, the family, and members of the patient’s healthcare team will be helpful in making the hospice care decision.1,5,7,8

Resources for more information about hospice care 

National Hospice and Palliative Care Organization:  https://www.nhpco.org/
Hospice Foundation of America: https://hospicefoundation.org

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Updated March 18, 2021

References

  1. Choices for Care When Treatment May Not Be an Option. National Cancer Institute website. https://www.cancer.gov/about-cancer/advanced-cancer/care-choices. Updated February 26, 2021. Accessed March 17, 2021.
  2. What is Hospice? Hospice Foundation of America website. https://hospicefoundation.org/Hospice-Care/Hospice-Services. Accessed March 17, 2021.
  3. How to Access Care. Hospice Foundation of America website. https://hospicefoundation.org/End-of-Life-Support-and-Resources/Coping-with-Terminal-Illness/How-to-Access-Care. Accessed March 17, 2021.
  4. Dispelling Hospice Myths. Hospice Foundation of America website. https://hospicefoundation.org/Hospice-Care/Dispelling-Hospice-Myths. Accessed March 17, 2021.
  5. How and Where is Hospice Care Provided and How Is It Paid For? American Cancer Society website. https://www.cancer.org/treatment/end-of-life-care/hospice-care/who-provides-hospice-care.html. Revised May 10, 2019. Accessed March 17, 2021.
  6. Hospice FAQs. National Hospice and Palliative Care Organization website. https://www.nhpco.org/hospice-care-overview/hospice-faqs/. Copyright 2021. Accessed March 17, 2021.
  7. Geriatrics and Extended Care: Hospice Care. U.S. Department of Veterans Affairs website. https://www.va.gov/GERIATRICS/Guide/LongTermCare/Hospice_Care.asp. Accessed March 17, 2021.
  8. Is my test, item, or service covered? Hospice care. Medicare.gov website. https://www.medicare.gov/coverage/hospice-care. Accessed March 21, 2021.