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What Is Hospice Care?

What Is Hospice Care?

Hospice provides comfort care when curative treatment may no longer be the best option.

The end of life can be an emotionally and physically difficult time. Most adults say they’d prefer to die at home, pain free and surrounded by friends and family. The concept behind hospice is that compassionate, quality care at the end of life is a fundamental right for all of us.

Hospice is a type of medical care that supports patients and their families during this important life transition. It provides physical, emotional, spiritual and social support from a multidisciplinary team of care providers and volunteers. According to the National Hospice and Palliative Care Organization (NHPCO), at least 1.6 million American families take advantage of hospice care annually.

If you’re considering hospice care, here’s what you need to know.

What’s the difference between hospice and palliative care?
Both hospice and palliative care provide comfort care, such as pain and symptom management, to people with serious illnesses. You can receive palliative care while simultaneously undergoing curative treatment for cancer and other serious diseases.

Hospice care begins when curative efforts end. If your physician believes you have six months or less left to live, he or she can refer you to hospice. However, hospice care does not end if you live longer than six months. In that case, your physician can continue to certify that you are still eligible to receive hospice care.

What are the benefits of hospice?
Above all, hospice helps keep patients comfortable at the end of their lives so they can focus on the things that matter most.

Your hospice care team may include physicians, nurses, social workers, therapists, home health professionals, spiritual advisors, bereavement counselors and trained volunteers. Hospice care providers are specially trained to deal with terminally ill patients’ physical and emotional symptoms.

The first step in hospice is to develop a care plan to meet individual patient and family needs. This may include any of the following:

  • Pain and symptom management
  • Teaching families how to care for patients at home
  • Providing home equipment and medications
  • Spiritual counseling
  • Emotional support
  • Companionship
  • Logistical help, such as running errands, helping with meals and giving family caretakers a break (also known as respite care)

Hospice also provides grief support to loved ones leading up to and following the death of the patient.

Members of the hospice care team meet with patients and their families on an agreed-upon schedule, which can change as the patient’s needs change. Most hospice providers offer on-call support outside of normal business hours.

Evidence suggests that hospice care may increase how long some patients live. For example, in one study published in 2007 in the Journal of Pain and Symptom Management, those patients in hospice care lived an adjusted average of 29 days longer than those who didn’t receive hospice. The study authors noted that the extra time that hospice might provide can be especially valuable to some patients and their families because it may help them “use the end of life as a time of resolution and closure.”

Furthermore, patients who receive end-of-life care at home may be more likely to die at home, which aligns with most patients’ wishes.

Researchers have several hypotheses for why hospice may increase longevity. Many patients, especially those with cancer who are already weakened by their disease, undergo intensive treatment late in the course of their illness. These treatments can actually increase mortality. In hospice care, the focus is instead on comfort care and quality of life. Hospice patients are also closely monitored and receive psychosocial support, which is important in end-of-life care.

Hospice may even lower healthcare costs at the end of life. A 2007 study found Medicare expenditures were about $2,300 lower in the last year of life for patients in hospice.

Where can I receive hospice care?
Hospice is not necessarily a place—although it can be. Patients may receive hospice at home, in a nursing home, in the hospital or in a freestanding hospice program. In 2014, nearly 60 percent of hospice patients received care in the place they were living, most often their own residence or a nursing home, assisted living or other residential facility. If your medical care needs change and you move from one setting to another, hospice moves with you.

Do I have to pay for hospice?
Medicare established a hospice benefit in 1983 and since patients’ needs often change, it offers four levels of care. The majority of patients receive routine home care. The Veteran’s Health Administration and most insurance companies also offer a hospice benefit. According to NHPCO, Medicare and Medicaid may not cover care in some hospice centers, so check with your provider before you need care.

How can I find a hospice program?
Medicare certifies hospice programs, so a good place to start is the online Medicare hospice finder. Choose a hospice provider that is accredited and is a member of NHPCO. While neither is required, both indicate a commitment to quality and an adherence to established standards.

NHPCO offers a list of questions to consider when evaluating community hospice providers. For example, you might want to ask if staff are certified or credentialed and who might handle a crisis at night or on the weekends.

If you or a loved one has a life-limiting illness and your physician does not recommend hospice, ask about it. Many people who are eligible don’t receive hospice until very close to end of life. Although anyone with a prognosis of six months or less can receive hospice, in 2014, only half of eligible patients were in hospice for two weeks or longer and more than one-third were in hospice for less than a week.

Hospice is a service that many patients and their families don’t access fully, but it may be potentially valuable—and meaningful.

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