What is hospice care?

Hospice care is end of life comfort care that is offered to those with a terminal illness. Proof of a 6 month life expectancy from a doctor is required before initiating hospice care, as it is only given to terminally ill patients. Hospice care focuses on the quality of life for the patient, giving pain relief from symptoms, emotional support, social services, and helping the family; under hospice care, no attempts to treat or cure the underlying illness or condition can be made.

Hospice care can be both an inpatient and an outpatient system of care, whichever system is more comfortable for the patient. If the patient does not have a suitable place to stay with family members, or their condition is serious enough to merit constant medical care and attention, they will stay in an inpatient facility. This can be in a hospital, nursing home, or other facility dedicated to hospice and inpatient care. Many patients going into hospice care prefer to do so in the comfort of their own home, surrounded by their family. They will stay in their own home or move into a close family member’s home, and will be visited periodically by their hospice team. 

A hospice team is the group of people dedicated to ensuring both the patient’s and their family’s comfort and well-being throughout the hospice process. It usually consists of nurses, social workers, emotional counselors, religious leaders, and of course, the doctor in charge of the patient who signed off on the hospice care. At least one member of the team will be available by phone every day, and at least one member of the team will visit outpatient hospice patients at their homes, or make the rounds of an inpatient facility. 

The point of the hospice team is to check up on the patient and provide medical, emotional, and spiritual assistance whenever necessary. They are also working to help the family members (who are the primary caretakers) with any difficult emotions and stress that may arise from taking care of their loved one during a difficult period. The counselors and spiritual advisors particularly spend much of their time with the family members.

The idea of hospice care is to make the patient as comfortable as possible and to allow them to feel ready to pass in a place they feel safe and happy. If treatment is no longer a viable option for your loved one, whether from their condition resisting it, or they are too tired to continue, it may be time to consider hospice care. Stopping uncomfortable treatments that are not even working can be a hard decision, but ultimately allow the sick person to feel comfortable as they prepare to leave this life, rather than dying in pain.


Who can receive hospice care?

Hospice care is offered to anyone who is facing a terminal illness and wants to cease attempts to cure their condition. There is no age requirement, only proof from your doctor that you are expected to have 6 months or less to live. While you can choose to decline treatment and enter hospice care if diagnosed with a terminal illness, many will only enter hospice if it is recommended after several failed attempts at treating the condition. If there is another option for curing their illness, most patients will opt to do whatever they can, as hospice care does not attempt to cure the condition, even if it is possible. 

While it is possible to stop hospice care at any time and resume treatments for their condition or disease, the patient and family must understand the commitment they make to stop all attempts at finding a cure when they enter hospice care.


Who makes up a hospice team?

A hospice team is made up of the patient’s primary doctors, their nurses, social workers, emotional counsellors, spiritual advisors, and any other people who periodically volunteer efforts in helping the patient.

The hospice care team works closely with the family to ensure that the patient’s needs are being met: physical or medical needs, emotional needs, and spiritual needs. They will check in at least once daily with the patient and offer their service whenever necessary.

For an inpatient facility, the hospice team is at the forefront of the patient’s care, and will include general caregivers as well as nurses, emotional counselors, spiritual advisors, and social workers. Since the patient is not at home with family to care for them, the hospice team will spend extra time with the patient to help them feel safe and comfortable.

For someone in outpatient care at home, the hospice team is not the primary caregiver. The family is in charge of taking care of their loved one’s basic needs. For an outpatient setup, the hospice care team is helping the family members a great deal as well as the patient. The hospice team will check in at least once a day, and at least one member will always be available by phone. The team will help teach the family how to provide basic care to their loved one, and will guide and support them through taking care of their loved one.

In outpatient care, the family is the primary caregiver to the patient. This can be very stressful and taxing on the family members, and so the hospice team will provide respite care. This allows the patient to receive the specialized service of the hospice team, as well as providing a much needed break for the family. This can last anywhere between a few hours to a few days. If for some reason the family can no longer take care of the patient, or should the patient’s condition require more serious care for pain management, then they can be transferred to an inpatient facility.

In the event of the patient’s death, the social worker of the team will ensure that all their legal affairs are in order, while the emotional counselor and spiritual advisor will provide bereavement support and grief counseling to the family. The hospice team is there to provide support and comfort to the patient, but they can also provide support to the family and help them through this difficult time.


Inpatient versus outpatient hospice care

When considering inpatient versus outpatient care for your loved one in hospice, the first thing you should consider is how capable you or other family members are of taking on a full-time job as a caretaker to your loved one.

The biggest downside to outpatient care is the strain it places on the family as the primary caretakers. This can be an incredibly stressful position. It will be time consuming and emotionally exhausting. Of course, the reward is how much more comfortable your loved one will be, surrounded by people they know and love, in a familiar place. Staying at home is the ideal situation for anyone going into hospice care, as the whole goal is to make sure they are happy and comfortable. However, some families are not in the financial or emotional state to be able to take in a sick family member.

The other factor to consider is the level of care the patient requires. Some patients on hospice just need to take pain medication to handle painful symptoms, and some require some expensive equipment that is only in hospitals or nursing homes. If you are going to end up shuttling your loved one back and forth from the hospital, or have to spend days at a time in a temporary inpatient situation, maybe you should look at a long term care facility.


Does Medicare insurance cover hospice care?

Medicare will completely cover the costs of hospice or palliative care. Their website explains how hospice is covered by original Medicare. Medicare part A, which covers any inpatient care at a hospital charges, skilled nursing facility care charges, nursing home care charges, home health care charges, and hospice charges, will cover inpatient treatment you receive. Medicare part B covers outpatient service, including home visits from your hospice team, and any medical equipment or prescription medications you receive.

Medicare won’t pay for long term room and board, so for an inpatient facility you will be responsible for paying for the rent and the meals. Any and all medical charges will be covered so long as they have been ordered from your official hospice team. Short term respite care or emergency hospitalizations will be covered by Medicare part A.

Any unrelated health care issues you need treated will still be covered by Medicare part C as long as you continue to pay your premiums. If you don’t have any conditions unrelated to your terminal illness, you may want to cancel Medicare part C so you don’t have to continue paying for it, but if you are receiving treatments for health care unrelated to your terminal condition, Medicare part C will still cover those.


What is palliative care?

Palliative care is an alternative to hospice care. Should your loved one want to prioritize their comfort, but still be receiving treatments intended to cure their serious illness, they can receive palliative care.

Unlike hospice, palliative care does not require a 6 month life expectancy. Any serious or chronic illness or condition is enough to merit palliative care. The main focus of doctors and nurses will still be on curing the underlying condition, but an added emphasis will be placed on treating painful symptoms and increasing the comfort of the patient. Palliative care can transfer into hospice care, should the patient stop responding well to treatment attempts, or if the patient decides they would like to focus wholly on being out of pain for their last few months.


When should you consider hospice or palliative care?

Palliative care is often considered first, as there are still attempts made to save the patient’s life. If palliative care is unsuccessful, or if it is too late for attempts to be made on saving the patient’s life, then they will be placed in hospice care and a whole team of people will be dedicated to addressing any pain or discomfort, so they can be happy and comfortable for their last few months of life.