Hospice Care: The Basics

The use of hospice care (end-of-life comfort care) -- services that focus on keeping a dying patient as comfortable and pain-free as possible during their last days -- is becoming more and more popular. Many elderly folks and terminally ill people choose this low-fuss, low-frills medical care as their lives come to an end. If you are considering hospice care for yourself or a loved one, take the time to learn what it is, how to pay for it, when it starts, and how to find hospice care services that work for your particular situation.

What is Hospice Care?

Hospice provides an alternative to the traditional medical care that hospitals and nursing facilities commonly deliver toward the end of a patient's life. In hospice, the goal is shifted from attempting to cure an illness or performing life-saving measures to keeping a patient as comfortable and free of pain as possible. In addition to providing a seriously ill patient with care and comfort, hospice services often extend to his or her family members and friends -- involving and training them in giving care, and providing breaks and counseling services to those who need them.

Hospice care has been growing in popularity in recent years. The National Hospice and Palliative Care Organization estimates that 1.49 million patients received services from hospice in 2017, up from 1.27 million patients in 2012. And it noted that 48.2% of Medicare beneficiaries in the United States who died in 2017 were under the care of a hospice program.

Provided the patient meets certain criteria, Medicare and most insurance plans cover hospice care.

Where hospice care is provided. Many people think of hospice as care provided at home, and that is generally the case. But it may also be given in a hospital, nursing home, or separate hospice facility. Because hospice care is focused on easing pain rather than radical medical intervention, it usually does not require sophisticated or cumbersome machinery, such as life-support systems or dialysis devices.

Types of care included. The specific type of hospice care provided may depend on which people or what agency provides it, as well as what care is most fitting. But hospice services are generally provided by a team of caregivers and may include:

• medical care -- a hospice doctor generally oversees and coordinates the care, sometimes working in tandem with a patient's primary care physician
• nursing care -- provided either around-the-clock, if needed, or sporadically for check-ups or special services, such as administering injections
• help with daily needs, such as bathing, cooking, or cleaning
• visits from a religious counselor, if requested
• counseling services, both for the patient and for family members
• social services support, such as help with insurance and financial matters
• respite care to provide breaks and rest time for caregivers, especially family members
• medical supplies and equipment -- such as hospital beds, bedside commodes, wheelchairs, and oxygen
• medications to help control pain and symptoms
• physical, speech, dietary, and occupational therapists, and
• bereavement care following a death.

What is the difference between Palliative Care and Hospice Care?

Palliative care is specialized medical care provided during a patient's treatment of serious illness or disability. It focuses on providing relief from the symptoms of illness to improve the quality of life of the patient and their family. It is often provided in combination with curative treatment and begins at the time of diagnosis, rather than at the end of the illness, like hospice care. Palliative care is provided during the treatment of the illness while hospice care is usually provided when medical treatment stops.

When Does Hospice Care Start?

Before hospice care can begin, a doctor must certify that a patient has a terminal illness and will probably have six months or less to live.

In reality, of course, it is often difficult or impossible for doctors to put a specific timeline on a patient's life. But most insurers and all Medicare administrators will require this diagnosis before they will cover the cost of hospice care, as discussed below.

Patients may also switch in and out of hospice care as a medical condition worsens or improves. For example, a person whose cancer goes into remission may switch out of hospice care, but enter it again if symptoms recur. It's also acceptable for a patient to move in or out of hospice care simply because he or she has a change of heart or is anxious to try a new type of medical treatment.

Finding Hospice Care Providers

There are several Internet sources available to help locate hospice care in your area. The National Hospice and Palliative Care Organization at www.nhpco.org and the National Association for Home Care & Hospice at www.nahc.org/ are good starting points for a search.

Friends, neighbors, and relatives who have had good experiences with a particular hospice provider may also be invaluable resources. Or, you can check with your local Office on Aging. Staff members may be able to direct you to reputable hospice care providers. To find your local Office on Aging, do an Internet search using your state name and "office on aging" as the search words.

However, for older people who are already enmeshed in the medical system or who are receiving care through a hospital or skilled nursing facility, often the best way to find appropriate hospice care is to talk with medical and other personnel who are already involved with the patient, including:

Treating physicians. A doctor who has practiced medicine in one place for a while will likely be familiar with one or more hospice agencies in the locale. One caveat is that primary care physicians often bow out of the caretaking picture once hospice care begins. So if a treating physician recommends an agency, ask for a description of the experience behind that recommendation.

Discharge planners. If a patient is in a hospital or skilled nursing facility, the hospital or facility discharge planner should have contact information for area hospice services. Some medical facilities have a contract with and refer to only one hospice service, so find out whether this is the case.

Long-term care facilities. Assisted living and other types of long-term care facilities usually have relationships with one or more hospice providers. A person who is a resident in such a facility will often experience the smoothest transition in care by taking up with a familiar hospice, because the staffs at both spots most likely have an established working relationship.

Whatever method you use to find hospice service, be sure to investigate a few and comparison shop before making a final decision. For more information on paying for hospice and Medicare coverage, see our article, Medicare Coverage of Hospice Care.