Hospice Care Frequently Asked Questions

What is hospice?

Hospice is a way to care for people who are terminally ill by focusing on pain relief and symptom management.

Instead of trying to cure the disease, hospice intends to provide comfort to the patient and the family. It provides support for emotional and spiritual end-of-life issues and focuses on giving seriously ill patients and their loved ones meaningful time together.

What does it mean when it’s time to call hospice?

Calling hospice means deciding that the patient and family no longer want to pursue curative care.

Generally, a physician determines that a patient’s life expectancy is six months or less; most medical treatments and interventions are no longer effective, will not cure the disease, and/or will prolong suffering.

Calling hospice takes a patient’s care away from disease specialists and surgeons and gives it to an interdisciplinary team trained in comfort care, pain relief, psychosocial support, and quality of life at the end of life.

What’s the first step to getting started with hospice care?

Anyone can request a hospice evaluation at no cost. Sometimes the physician makes the referral or provides several options and lets the patient/family decide.

The physician must certify to the hospice provider that the patient is eligible and has a prognosis of 6 months or less.

When a referral is made, the hospice provider makes an appointment (the same day or on a date convenient for the family) to meet with the patient and family. The admissions nurse evaluates the patient, answers the family’s questions, and creates a plan of care that reflects the patient/family’s wishes.

If the discussion goes well and the family is ready to decide, they sign admissions paperwork and the hospice team begins to visit.

Who is on the hospice team? Who is responsible for care?

Hospice patients receive services from an “interdisciplinary” team, meaning members come from different disciplines or fields.

They may include a physician, registered nurse, hospice aide, social worker, chaplain, bereavement services manager, volunteer, and other healthcare professionals.

Where do patients receive hospice services?

Hospice services are typically brought to wherever the patient calls home.

Home could be a private residence, assisted living community, or nursing home. Patients can also receive hospice services while in the hospital, or in an inpatient hospice unit.

What are hospice “levels of care?”

Levels of care are specific types of hospice care to address different needs of patients and families.

Medicare requires all hospice providers to offer four distinct levels of care. They are:

• Routine hospice care in the home
• Shifts of acute symptom management in the home when medically necessary.
• Round-the-clock inpatient care when symptoms cannot be managed at home
• Respite inpatient care for the patient when the family caregiver is away 1−5 days

If hospice is for dying, does choosing a hospice mean giving up on my loved one?

No. When treatment options for a disease have been exhausted or no longer work, hospice provides a way for people to live in comfort, peace and dignity without curative care.

Hospice isn’t about giving up, but about improving the quality of the patient’s life by being free of pain, surrounded by family and in the comfort of home.

When is it time for hospice?

Hospice services is ready when you are, and can begin when a doctor gives a prognosis of six months or less.

Patients should consider hospice services when medical treatments can no longer cure their disease and/or symptom burden outweighs the benefits of treatment.

What is the difference between diagnosis and prognosis?

A diagnosis is when the cause of the illness is identified (e.g., the common cold, pneumonia, lung cancer, etc.). A prognosis is a prediction about how the illness will develop.

In the case of people who are terminally ill, the prognosis is often the physician’s estimate of how long the illness will take to run its course before the patient dies.

Are there signs that a patient might be ready for hospice services?

When the burden of treatment outweighs the benefits and/or the patient has had multiple hospitalizations over the last several months, he or she might be ready for hospice.

Other indications include:

• Repeat trips to the emergency department
• Unrelieved pain
• Frequent infections
• Sudden or progressive decline in physical functioning and eating
• Weight loss/difficulty swallowing
• Shortness of breath/oxygen dependence

What are the qualifications for hospice care?

A patient is eligible to receive hospice services when their illness is terminal, meaning a physician has determined that they could die within six months if the disease continues as expected.

There are medical guidelines that accord with the patient’s disease and help a physician make a hospice referral.