- Hospice refers to a philosophy of care rendered to a person with limited life expectancy
- Medicare pays for hospice services and defines limited life expectancy as six months or less
- It is most commonly provided at home, but can also be provided in a health care building or other location
- The decision to enter hospice is usually made with a physician
What Is Hospice?
The term “Hospice” or “Hospice Care'' refers to a philosophy of care rendered to a person with limited life expectancy. It focuses on providing care and comfort as one approaches end of life. Medicare pays for hospice services and defines limited life expectancy as six months or less.
Hospice provides support to both patients and families. It accepts the dying process as a natural part of life, and aims to support people through it.
Where Is It Delivered?
Hospice care can be delivered in many places: in health care buildings specifically designated as a hospice, at home, in nursing homes or assisted living facilities, and even sometimes in the hospital. It is most commonly provided at home.
How Do You Enroll?
To enroll in hospice, a physician must certify that a patient has a prognosis of fewer than six months. Hospice patients are always followed by a physician. In some cases, this is a physician who works for the hospice, but many physicians (and especially geriatricians) follow their patients into hospice.
Many patients in hospice live longer than their six-month certification. This presents no problem in that patients can be recertified or even taken off hospice if their condition or prognosis improves.
How Is It Paid For?
In the U.S., “Hospice Care” is included in Part A of Medicare’s benefits. Most private insurers have adopted similar policies.
Enrolling in a hospice program brings a variety of services to the patient that may not normally be covered by Medicare, like visiting nurses and social workers. In general, patients who elect to use Medicare’s hospice benefit forgo being covered for subsequent hospitalizations, although this can be overriden if circumstances warrant it (like a hip fracture).
What’s the Difference Between Hospice and Palliative Care?
Much of the work of hospice involves palliative care, but specifically for patients with a limited prognosis. The goal of focusing on symptom relief and providing comfort is very similar in both. In hospice, there is a greater focus on helping families, including bereavement services.
How Do You Find The Right Program?
If you’re already in the hospital or a system of home care (like a local visiting nurse service), those entities likely have strong relationships with hospices, and many will offer hospice care as part of their larger program.
Physicians generally have knowledge of local hospices and may have a hospice they recommend and can introduce you to, so it’s always a good idea to ask them.
The decision to enter hospice is usually made with a physician. In the same way that a palliative care consultation should be considered sooner rather than later, it's never a bad idea to learn about hospice services, even if the patient and family are not ready to use them.
