Hospice care: Overview of a compassionate approach to end-of-life care

Hospice supports a person's comfort and dignity as they near the end of their life. It is for people who are seriously ill and no longer receiving or continuing treatment to cure their illness.

What is hospice care and what role does it play in end-of-life care?

Hospice is compassionate medical care for people who are expected to live six months or less due to an illness or condition. The focus of this end-of-life care shifts from trying to cure the illness to keeping a person comfortable and pain free so they can live their last months with the highest quality of life possible.

Hospice does not hasten death, nor does it prolong life. Rather, it allows an illness to take its natural course while supporting an individual and their family through the process of dying.

At the core of hospice is the belief that everyone has a right to die with dignity and without pain.

Hospice versus palliative care: What's the difference?

Both hospice care and palliative care focus on comfort and symptom management for people with a serious illness. Both aim to relieve suffering and help provide for an individual's physical comfort and emotional well-being.

The difference is that hospice care is provided to people during their last months of life, while palliative care can be given at any time during a serious illness. The major focus of palliative care is to manage pain and discomfort from an illness or from the side effects of treating a condition.

People in hospice, on the other hand, are no longer receiving curative treatment, but rather receive remedies to help ease pain and other symptoms caused by the illness.

Key services offered in hospice care

The hospice team is available around the clock to provide services, advice, or even reassurance for individuals and families and to respond to their ongoing needs. The services provided by most hospices follow Medicare requirements and include:

• regular visits to an individual and family by hospice team members
• medication to relieve pain and control symptoms
• medical equipment such as a hospital bed, wheelchair, or shower chair
• medical supplies such as oxygen, bandages, and catheters
• physical, occupational, and speech therapy, depending on symptoms and disease progression
• short-term respite care for family caregivers, to help avoid caregiver burnout
• grief counseling and bereavement support for the individual and family.

It's important to note that while hospices will provide the supports described above, a family member typically serves as the primary caregiver and has day-to-day responsibility for the person in hospice.

Where does hospice take place?

Hospice caregivers come to people wherever they may live, allowing them to be with family members and to remain in a place surrounded by important objects and memories. This may be a private home, independent or assisted living facility, nursing home, hospital, or prison.

Some hospice providers have residential centers where an individual can move when they are near the end of their life. In some cases, hospice caregivers may suggest that an individual move to a hospital for a short time to manage their symptoms and then return to their residence.

Who is eligible for hospice care?

People of any age with a terminal illness who are expected to live for six months or less are eligible for hospice care. If a person lives beyond six months, they can continue to get hospice care as long as the hospice doctor recertifies that they are still terminally ill.

Some common conditions of those who receive hospice care include cancer, heart disease, dementia, Parkinson's disease, stroke, chronic kidney or liver disease, lung disease, and incurable conditions such as Lou Gehrig's disease (amyotrophic lateral sclerosis, or ALS).

When to consider hospice care

An individual does not have to be bedridden or on the verge of death to receive hospice care. In fact, it is better for both the person and family to receive hospice services earlier, to take advantage of all that hospice care can offer.

Hospice care may be considered if medical treatment of an illness is no longer effective and a person's physical health or cognitive abilities are declining. Some signs of this can include increased pain, significant weight loss, shortness of breath, and extreme fatigue or weakness.

The hospice care team: Who provides support?

A family member typically serves as the primary caregiver. A loved one who is not a relative; a close friend; or a paid caregiver may also serve in this role. The hospice care team supports both the person in hospice and the caregiver. Hospice caregivers are an interdisciplinary team of professionals who are trained to address the physical, emotional, and spiritual needs of people nearing the end of their life, while also supporting family members.

The hospice team includes the hospice physician, nurses, medical social worker, home health aides, counselors, and a chaplain or spiritual adviser. The team will coordinate the services needed and will set a schedule of visits by various hospice caregivers. The team also will provide any medications needed to keep the individual pain-free. (Administering those medications may fall to the primary caregiver.)

Planning for hospice care: What you need to know

To qualify for hospice services, a doctor must certify that an individual's life expectancy is six months or less if the illness or condition runs its typical course. A hospice physician needs to confirm that assessment.

Families can request hospice services themselves, either through an individual's doctor or by contacting a hospice provider. Medicare.gov offers a website you can use to find a Medicare-certified hospice closest to you.

Medicare covers all aspects of hospice care and services. There is no deductible for hospice services, although there may be a small copayment for prescriptions and for respite care. Hospice care also is covered by most private health insurance at varying levels and by Medicaid in almost every state.