What Is Hospice Care?
“You matter because of who you are. You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully but also to live until you die.
—Dame Cicely Saunders, founder of the first modern hospice
When former President Jimmy Carter announced he was entering hospice care, our primary care doctors in Delray Beach noticed that some of our patients didn’t fully understand the concept of hospice, or had some misconceptions surrounding the concept.
So we thought we’d explain what it is and what to expect if you or a loved one decides to choose hospice for end-of-life care.
What is Hospice Care?
The National Institute on Aging (NIA), a branch of the National Institute of Health (NIH), defines hospice care as a service that focuses on the care, comfort, and quality of life of a person with a serious illness that is approaching the end of life.
“Hospice care is a service for people with serious illnesses who choose not to get (or continue) treatment to cure or control their illness,” the NIA says. “People may choose to enroll in hospice if the treatment is unlikely to be effective or if continuing it has become too burdensome.
“Hospice aims to provide comfort and peace to help improve the quality of life for the person nearing death. It also helps family members cope with their loved one’s illness and can also provide support to the family after the person dies, including help with grieving, sometimes called bereavement care.”
To receive hospice care, your doctor or a hospice-care physician must certify that you have a life expectancy of six months or less if the illness runs its normal course.
Some people, however, unexpectedly do so well in hospice care that they end up living longer than that. In that case, you can remain in hospice indefinitely, as long as the hospice medical director or other hospice doctor recertifies that you are terminally ill.
Where is it Administered?
Many people are surprised to find that “hospice” isn’t necessarily a place to go, although hospice services can be provided anywhere: home, assisted living facility, nursing home, hospital, or even dedicated hospice facilities.
There are four levels of hospice care:
- Routine Home Care (RHC)—your family or loved ones care for you at home, and you receive regular visits from hospice care providers
- General Inpatient Care (GIP)—you receive hospice care in a facility because your pain or other symptoms are too difficult to manage at home
- Continuous home care (CHC)—a combination of GIP and care in your home
- Inpatient Respite Care (IRC)—a brief type of care in a facility to give your caregivers a break
What Services are Provided?
According to the Hospice Foundation of America (HAF), hospice includes an interdisciplinary team of professionals who are trained to address the physical, psychosocial, and spiritual needs of the person. The hospice team also supports family members and other intimate unpaid caregivers.
Hospice care can include visits to the patient’s location by the hospice physician, nurse, medical social worker, home health aide, and a chaplain or spiritual advisor.
Those in hospice will receive medication for symptom control, including pain relief (but not to hasten death), necessary medical equipment, physical and occupational therapy, speech-language pathology services, dietary counseling, and other necessary services to help the person live more comfortably.
It does not provide direct, hands-on, 24/7 care, or the types of daily care such as would occur in an assisted care facility, nursing home, or hospital. Hospice care professionals, however, will be on call 24/7 to provide guidance.
Hospice is about keeping you as comfortable as possible and having the best possible quality of life in your remaining days, weeks, or months. While you won’t receive any alternative therapies or any type of treatment meant to cure your disease or prolong life, you can continue to receive other necessary medications.
Does Medicare Cover it?
If your hospice provider is Medicare-approved, then Original Medicare will cover the cost.
According to Medicare, “Once your hospice benefit starts, Original Medicare will cover everything you need related to your terminal illness. Original Medicare will cover these services even if you choose to remain in a Medicare Advantage Plan or other Medicare health plan.
“If you’re in a Medicare Advantage Plan (like an HMO or PPO) and want to start hospice care, ask your plan to help find a hospice provider in your area. Your plan must help you locate a Medicare-approved hospice provider in your area.”
For more information on what is covered, see the Medicare website (https://www.medicare.gov/what-medicare-covers/what-part-a-covers/how-hospice-works), or call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, seven days a week (except some federal holidays).
One final word: You may have heard the term “palliative care” in connection with end-of-life care. Hospice care is not the same as palliative care, although they can overlap.
Palliative care is specialized medical care for those living with a serious illness such as cancer, dementia, or heart failure. It is care provided to enhance the quality of life (e.g., relieve pain, improve functioning, and so on), along with treatment intended to cure their illness.
People in hospice care receive palliative care, but without additional treatment intended as a cure.