Hospice care provides medical care, pain management, and emotional and spiritual support for people who are terminally ill. The goal of hospice is to help people who are nearing the end of life have peace, comfort and dignity. It’s normal to feel anxious or resistant when hospice is first recommended. Some people equate hospice with giving up hope. However, hospice care does not speed up or slow down the dying process. The hospice team will work to ensure quality of life in a patient’s final weeks or months.
What is hospice care?
Hospice provides comprehensive comfort care and support services for the terminally ill. The goal is to allow patients to live their last weeks or months as fully and comfortably as possible. Hospice care is available when a doctor certifies that a patient has 6 months or less to live if the illness runs its normal course. However, some people live longer than expected in hospice care.
Hospice services include:
- Medical care with a focus on comfort, not cure
- Pain and symptom management
- Spiritual and grief counseling
- Medications, medical supplies and equipment related to the terminal illness
- Physical, occupational and speech therapies
- Companionship and respite care
- Short-term inpatient care to manage symptoms
- Bereavement services for family after death
Hospice care is usually provided in the patient’s home, but can also be provided in freestanding hospice centers, hospitals, nursing homes or other long-term care facilities. Medicare, Medicaid, most private insurance plans, HMOs, and other managed care organizations may cover all or a portion of hospice care costs.
Who is eligible for hospice care?
To qualify for hospice care under Medicare rules, an individual must:
- Be entitled to Medicare Part A (hospital insurance)
- Be certified as terminally ill by a physician, which means having a life expectancy of 6 months or less
- Accept palliative, comfort-focused care instead of curative treatment for the terminal illness
Some private insurance plans have similar requirements. Medicaid hospice eligibility varies by state. Most hospice organizations also serve people who do not meet the strict Medicare criteria, such as individuals with potentially terminal illnesses who are still pursuing active treatment. These people pay out-of-pocket for hospice care.
Does entering hospice mean giving up all medical treatment?
Hospice focuses on comfort care and relieving pain and symptoms, not trying to cure the underlying terminal illness. However, it does not mean you must deny all care. For example:
- You can continue to receive primary medical care and other services aimed at quality of life.
- Medications, equipment and therapies related to symptom control are covered by hospice.
- Treatments needed for unrelated medical conditions are permitted.
- You can be transferred out of hospice care if your condition improves and you are no longer considered terminally ill.
The hospice care team will work with you and your family to determine the best course of care. The emphasis is on comfort and dignity, but that doesn’t preclude basic medical treatment for secondary issues.
Is entering hospice the same as stopping medical treatment?
Hospice focuses on providing comfort measures and relieving symptoms, not continuing aggressive medical interventions that may prolong life but not provide symptom relief or quality of life. However, entering hospice does not mean you must deny all medical evaluation and treatment. For example:
- You can continue to receive primary care from your regular physician.
- Medications, medical equipment and therapies aimed at symptom control will continue.
- Treatments for unrelated conditions are allowed.
- You can be transferred out of hospice if your condition improves.
The hospice team will work with you and your family to determine which treatments provide the most benefit aligned with your values and priorities. The emphasis is on comfort and quality of life, but basic medical care can continue.
How long can you stay in hospice?
There are no strict limits on how long you can continue to receive hospice care. Under Medicare rules, hospice benefit periods are:
- First 90-day period
- Second 90-day period
- Unlimited subsequent 60-day periods, as long as recertification requirements are met
To enter another benefit period, your hospice provider must obtain written certification from the medical director that you have 6 months or less to live, if the terminal illness runs its normal course. Some private insurers have different requirements for hospice benefit periods.
Can hospice care be stopped and restarted?
Yes, hospice care can be stopped and restarted if needed. For example:
- If your condition improves or stabilizes, you can be discharged from hospice care.
- If the illness progresses again, you can resume hospice care, after obtaining recertification of terminal illness.
- Discharging and readmitting is allowed an unlimited number of times, as long as certification requirements are met.
Stopping aggressive treatments while enrolled in hospice does not mean you can never seek medical care again. Hospice can be turned on and off as your situation changes.
Can you leave hospice care?
Yes, a patient can leave hospice care at any time for any reason. Discharging from hospice care typically happens for a few reasons:
- The patient’s condition improves and life expectancy extends beyond 6 months.
- The patient seeks aggressive curative treatment not covered by hospice.
- The patient decides to move to a different hospice provider.
- The patient no longer believes hospice care is the right choice.
If discharged from hospice, Medicare will resume covering regular medical care related to your terminal illness. You can also re-enter hospice care at a later point if you again meet eligibility requirements.
What happens if you live longer than 6 months in hospice?
Some patients live longer than the 6 months predicted when they entered hospice care. This is not cause for automatic discharge from hospice. For hospice under Medicare:
- Benefit periods can be recertified if life expectancy remains 6 months or less.
- There is no limit on how many benefit periods an individual can have.
- Patients can go on and off hospice care as their condition changes.
Living longer than expected is not a bad thing. It means you are continuing to receive expert medical and comfort care tailored to your needs as your disease runs its course.
Can you recover and leave hospice?
Yes, it is possible to recover to the point of exceeding a 6-month life expectancy while enrolled in hospice care. Reasons this could happen include:
- An unexpected positive response to palliative treatments
- Misdiagnosis of terminal illness
- Advancement in curative treatments
- Remission of cancer
In these cases, you would be discharged from hospice. Medicare coverage of regular medical care would resume. You can always re-enter hospice later on if the terminal prognosis returns.
Does hospice mean you will die sooner?
No, hospice care does not cause patients to die sooner than expected. In fact:
- Many studies show hospice patients tend to live longer than those with similar diagnoses who do not receive hospice care.
- Focusing on quality of life and aggressive comfort care measures can sometimes prolong life.
- Hospice provides close medical supervision, possibly extending life for some.
The relief of pain, anxiousness, loneliness and other stresses may actually allow some hospice patients to live longer than if these symptoms went untreated. Hospice care neither hastens nor postpones death.
Can hospice be considered giving up?
Some view entering hospice as “giving up” on treating a disease. However, it does not mean you are giving up on life. Hospice focuses on living fully in the time you have left. Benefits of hospice include:
- Making the most ofremaining time by setting life goals and priorities.
- Enjoying life with improved symptom management and support.
- Feeling empowered by taking charge of end-of-life care choices.
- Spending quality time with loved ones.
With hospice you are not giving up, but refocusing your efforts to make the most of each day you have left.
Does hospice mean refusing food and drink?
No, hospice does not mean refusing food and drink in order to hasten death. In fact:
- Hospice team members work with patients and families to meet nutritional needs and hydration goals.
- As conditions progress, some patients have reduced hunger and thirst sensations.
- Your care team can provide assisted feeding or IV fluids if needed for comfort.
- The choice to stop eating and drinking is up to the patient and family.
Hospice aims to support quality of life and meet basic needs. There is no requirement to refuse food and fluids. These choices are personal decisions.
Is entering hospice giving up all hope?
No. Hospice is not about giving up hope, but about redefining what you hope for. Hospice hopes and aims to provide:
- A sense of life meaning and completion.
- Time for quality moments with loved ones.
- Expert caregiving and comfort measures.
- Emotional and spiritual support.
- Symptom relief and peace.
- Assistance creating positive end-of-life plans.
The hope of hospice care is to improve remaining days by focusing on overall well-being, quality of life, and enhanced relationships – not just length of life.
Is hospice the end of the road?
Hospice is not necessarily the absolute final step before death. Hospice care can actually be stopped and restarted. For example:
- If your condition stabilizes or improves, you can leave hospice care.
- Medical treatments for the terminal illness can be resumed.
- If illness progresses again, hospice care can be reinstated.
For some, hospice marks the final chapter. For others, it is one stage in a longer journey. Either way, expert hospice staff help make the most of this moment.
Conclusion
Hospice care is a philosophy of comfort, dignity and support for terminally ill patients and families. It is not a place to go to die, but to embrace the life you have left. Hospice affirms life by focusing on comfort measures and family support. While hospice signals the final phase of illness, it is not necessarily the end of the road. With flexibility to leave and re-enter hospice as health dictates, many see their condition stabilize or even improve with hospice support. Above all, hospice provides expert medical care aimed at optimizing quality of life each day.