What is Hospice Care?

Hospice is end of life holistic medical care that focuses on managing a patient’s pain and symptoms of their conditions.  The hospice care team aims to improve a patient’s quality of life and provide them with dignity rather than treating any conditions.

Key Points

  • Hospice care provides holistic end of life care focused on symptom and pain management to help patients improve their quality of life.
  • Hospice provides a range of services including hospice physicians, hospice nurses, counselors and social workers, respite care, and durable medical equipment.
  • Generally to be considered for hospice care a patient must have a terminal medical condition and must have a life expectancy of less than 6 months.
  • Medicare covers hospice care.

What is Hospice Care?

Hospice care is specialized care for people approaching the end of their life. It focuses on improving the quality of life for patients and their families by addressing their physical, emotional, and spiritual needs at this stage.

Hospice care is most often provided at a patient’s home or in residential care facilities such as assisted living facilities or skilled nursing facilities. 

What Are the Benefits of Hospice Care? 

While hospice care can be administered in a hospital, typically patients will receive care in their own home or residential care facility – this provides patients with a comfortable setting while they recieve care to alleviate symptoms and manage pain.

Additionally, because hospice care is holistic, the patient is surrounded by friends, family members, and  staff who are able to help the patient with emotional and spiritual needs alongside managing symptoms associated with their conditions.

What Services Does Hospice Provide?

Hospice care is a combination of services provided to patients with an advanced stage of the disease. 

Pain & Symptom Management 

Pain & symptom management is a primary component of  hospice and palliative care. The goal is to improve a patient’s quality of life, but unlike palliative care, does provide any treatment of a patient’s condition – only their symptoms.

Medical Equipment 

While receiving hospice care, patients can qualify for access to medical supplies and equipment.l. Specifically, durable medical equipment that helps improve a patient’s quality of life can be provided via hospice. Examples of medical equipment that can be provided to hospice patients are:

  • Wheelchairs
  • Hospital beds (and beds with rails)
  • Blood pressure monitors
  • Walkers
  • Crutches
  • Kidney machines
  • Bi-Pap and C-Pap machines
  • Oxygen equipment (including ventilators)
  • Chair and stair lifts 

Spiritual Care & Grief Counseling 

In addition to managing a patient’s physical symptoms and pain, hospice aims to provide support for a patient’s whole being. As such, hospice care often includes spiritual and emotional care.

Oftentimes, a patient will work with spiritual leaders who are trained to help hospice patients and their loved ones. These professionals are trained to listen and comfort their patients and families through the hospice process.

Aide & Homemaker services 

Hospice may provide personal / custodial care services to assist with activities of daily living viva home health aides or personal care aides.

A registered nurse on the patient’s hospice care team can assign hospice assistants to help a patient with ADLs. The nurse in charge of a hospice assistant’s activities will create written patient care instructions that the  hospice aides will carry out.

Family Meetings 

Facilitating family meetings is another part of hospice’s holistic approach to care. These meetings are usually set up to determine a patient’s preferences, direct decision-making, and establish patient-centered goals, and determine care plans. A hospice care family conference can assist patients and their families make difficult decisions, clarifying misunderstandings and smoothe out care transitions.

Respite Care

Patients receiving hospice care are eligible for “respite care,” which provides relief for family / non-paid caregivers. . While the patient is receiving care in a Medicare certified inpatient facility a family caregiver can take a break from their caregiving responsibilities to recharge and rest.

Following admission to the care facility, the hospice team keeps moving forward with the patient’s care plan while the facility staff takes over the care the family caregiver would typically provide. The hospice benefit allows routine inpatient respite care for up to five days and nights.

Physical Therapy & Occupational Therapy 

Hospice patients qualify for physical and occupational therapy which helps  with skills and strength to accomplish activities of daily living, such as bathing,eating, toileting, and mobility.

Speech-Language Pathology Services 

Speech-Language Pathology Services are also available to hospice patients . At this phase, the goal of therapy is facilitative rather than rehabilitative intervention. 

For instance, the Speech-Language Pathology Services collaborate with the patient and their caregivers to establish compensatory methods that will enable the patient to eat orally for as long as feasible if they have swallowing difficulties. 

When a patient has trouble speaking due to poor breath support or deconditioning, the SLP works with them to develop an alternative communication method to help them express their requirements and wants clearly.

Dietary Counseling 

As the patient’s body slows down, the need for nutrition also decelerates. A registered dietitian organizes, plans, and delivers dietetic plans and education to nursing staff and other staff members. 

What is Not Included in Hospice Care?

While hospice covers a wide variety of therapies for end of life care, hospice does not cover many things including:

  • Senior living facilities’ room and board costs.
  • Curative treatments or prescriptions (though patients may receive treatment for conditions outside of their terminal illness). 
  • Primary caregivers or household services
  • Hospital or ambulance costs

Who Qualifies for Hospice Care?  

While there are no age requirements for hospice, guidelines for hospice qualification are that a patient must:

  • Be diagnosed with a terminal illness and have a prognosis of 6 months or less
  • Have decreasing functional capabilities
    • Need help with at least 3 of 6 ADLs
    • Have a palliative performance rating of less than the 50%-60% range
  • Have deterioration in condition over the last 4-6 months
    • Hospitalized 3+ times in the last 6 months
    •  Increased fatigue 
    • Decrease in cognitive abilities 
  • Have frequent infections
  • Have significant weight loss

Additionally, for patients with the following diagnoses, there are additional disease specific qualifications:

  • ALS
  • Alzheimer’s
  • COPD and Lung Disease
  • Dementia
  • Heart Disease
  • HIV and AIDS
  • Liver Disease
  • Neurological Disease
  • Oncology
  • Renal Disease
  • Sepsis and Concomitant End-Stage Disease

Does Medicare Cover Hospice Care?

Medicare does cover hospice expenses including:

  • medical services
  • nursing care
  • durable medical supplies (e.g., wheelchairs, walkers)
  • medical equipment (e.g., bandages, catheters)
  • prescription medications for pain alleviation or symptom control
  • counseling on diet and nutrition
  • Homemaker and aide services
  • Services in physical and occupational therapy
  • social work assistance
  • counseling for patients and their families in times of loss
  • short-term inpatient treatment for the control of symptoms and pain
  • inpatient short-term respite care
  • any further Medicare-covered services that the hospice staff may advise

Even if a patient is enrolled in a Medicare Advantage Plan (Part C) or has Medigap (Medicare Supplement Insurance) insurance, Original Medicare (Parts A and B) will cover all of their requirements regarding their terminal disease.

A senior on hospice must continue paying their premiums if they want to stay enrolled in their Advantage Plan and enjoy medical benefits and services unrelated to their terminal illness. Prescription medicines and respite care for patients while they are getting hospice care are two standard extras covered by Medigap policies.

How to Start Hospice Care  (h2)

Once you and your loved one have decided to learn more about hospice; the best place to start is with your primary care physician. Ask if you or your loved one qualifies for hospice and what that could look like. You should also ask your physician for referrals to hospice care providers in your area.

Hospice Care FAQs 

When Should Someone Start Hospice? 

While many families wait until the last few days or weeks of their loved one’s life before starting hospice, you can start hospice when you have a terminal illness and life expectancy of 6 months or less.

Is Hospice the Same as Palliative Care?

While both hospice and palliative care aim to relieve pain and symptoms, hospice is comfort care without the purpose of curing; while palliative care provides concurrent treatment of the underlying condition.

Where is Hospice Care Provided? 

Most hospice care is given at home or in a residential care facility (such as an assisted living facility, skilled nursing facility, or group home), but hospice can also be provided in hospitals.

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