What is Hospice?

  • Hospice is an insurance benefit. Congress established the Medicare Hospice Benefit in 1983 to ensure that all Medicare beneficiaries could access high-quality end-of-life care. Also covered by most private insurance companies, the hospice benefit ensures that patients are provided comfort and that loved ones receive the support they need. The hospice benefit covers medical equipment and medications related to the terminal diagnosis.
  • Hospice is a philosophy. It is a program of care for the terminally ill. Interdisciplinary teams made up of physicians, nurses, home health aides, social workers, chaplains and volunteers work together with patients and families to establish goals of care unique to each patient that emphasize quality of life.

Hospice care includes:

  • Symptom management
  • Medical equipment and supplies related to the terminal illness
  • Medications for the management of pain and other symptoms related to the terminal illness
  • Respite care and acute care for severe symptoms can be provided in a hospice inpatient unit, a hospital or a nursing facility. Home visits by nurses, home health aides, chaplains, social workers, bereavement counselors, volunteers
  • Crisis management for severe symptoms
  • Bereavement follow-up for up to 13 months following the death of the individual
  • Hospice is not a place; hospice cares for people wherever they call home. Although there are inpatient hospice facilities and some hospice care is provided in hospitals, the vast majority of hospice patients are cared for in their home – wherever that may be. Care may be provided in private residences as well as long term care and assisted living facilities.

Who qualifies for hospice?

To be admitted to hospice care, the patient must be certified by two physicians as having a terminal illness and a life expectancy of six months or less. In electing hospice care, the patient is choosing to seek comfort rather than cure.

However, hospice care doesn’t necessarily end after six months. Some patients live well beyond their original six-month prognosis, and hospice care may continue as long as the physician continues to certify the patient and the patient wishes to continue comfort and not curative treatment.
Hospices now care for about 40% of Americans who die from cancer and a growing number of patients with other chronic, life-threatening illnesses, such as end-stage heart or lung disease. According to actual patient counts supplied by National Hospice and Palliative Care Organization (NHPCO) member hospices, and conservative estimates for other hospice programs, NHPCO estimates that hospices provided care to 1.72 million people in 2020. NHPCO estimates than more than 51.6% percent of all Americans who died in 2020 were in hospice care.

How is Hospice Care Reimbursed?

Hospice care is reimbursed on a per diem basis. The Medicare and Medicaid reimbursement for hospice care is a set rate per day. There are four hospice rates each linked to one of the four levels of hospice care: routine home care, general inpatient care, respite care, and continuous care. 95% of Medicare hospice patients are billed as routine home care.

How does hospice care begin?

Hospice can evaluate a patient to determine eligibility after receiving an order from a physician. Once eligibility is determined goals of care will be discussed and the interdisciplinary team will work with the patient and family to put a care plan in place.

What if the patient changes their mind about hospice?

A patient can stop hospice at any time – it only requires a signature. Notify the hospice to begin the revocation process.

Patients may also be discharged from hospice for several reasons including a stable condition.

How do I find a hospice?

Click here to see a list of hospice providers

What is Palliative Care?

  • Palliative care follows the same philosophies as hospice, but can coincide with curative treatment.
  • Palliative care teams work collaboratively to meet the patient’s goals of care. An interdisciplinary palliative team will coordinate with current physicians, family and the patient to ensure the patient’s wants are clear and the goals of care meet the patient’s needs.
  • Palliative care can teams can help evaluate choices and treatments and make decisions that align with the patient’s goals.

What’s the difference between hospice and palliative care?

Palliative care is an option for anyone with a serious illness – at any age and at any stage of disease. It is not dependent upon a patient’s prognosis. Palliative care can accompany curative treatment.

Hospice is a piece of palliative care offered to the terminally ill – those who only have months to live. People who receive hospice care have decided to stop all curative treatments for their terminal illness.

Does insurance cover palliative care?

Most insurance plans cover all or part of the palliative care treatment a patient receives, just as with other hospital and medical services. This is also true of Medicare and Medicaid. Palliative care teams can help patients determine payment options.

Can curative treatment continue on palliative care?

Yes. Palliative care focuses on symptom management. Symptoms may come from a serious illness, curative treatments.

Who provides palliative Care?

A palliative team typically includes palliative care doctors, nurses and social workers. Other specialists including massage therapists, pharmacists and nutritionists might also be part of the team.