Hospice care shifts the focus to comfort and quality of life, not on treating or curing the illness.
Approximately 1.7 to 1.8 million people use hospice care annually in the United States. Despite these numbers, many people have misconceptions about what hospice care is, what services it includes, and who qualifies.
Learn more about what you can expect from hospice care and what resources are available to Veterans, Service members, and their families.
What Is Hospice Care?
Hospice care focuses on the care of a person with a serious illness who is approaching the end of life and no longer seeks treatment to cure or control their illness. Examples of serious illnesses include dementia, cancer, or heart failure.
Palliative care can be provided at any stage of serious illness, alongside curative treatment, with no prognosis requirement. Hospice is a specific type of palliative care for the last months of life.
Palliative care consultation can help with symptom management and advance care planning before patients are ready for hospice.
When serious illness strikes, most patients and families initially focus on treatment in an attempt to cure the illness or alter its course. When treatment is unlikely to be effective, or if it becomes too burdensome to continue, people often turn to hospice care. Hospice care shifts the focus to comfort and quality of life, not on treating or curing the illness. Hospice care helps manage a person’s pain and symptoms, allowing them to live as fully and comfortably as possible, and for natural death to occur.
What Services Does Hospice Care Provide?
Hospice care can provide a range of different services, depending on the patient’s symptoms and care wishes. A hospice team, which can consist of members such as a registered nurse, hospice aid, social worker, chaplain or spiritual counselor, nurse practitioner, medical provider, and hospice volunteers, works with the patient and their family to develop a personalized care plan to meet the patient’s needs.
- Emotional and spiritual support for both the patient and their loved ones
- Pain and symptom management
- Help with advance care planning
- Therapy, such as physical or occupational therapy
- Education and instructions for providing care properly and safely
- Help ordering equipment, supplies, and medications
- Routine visits by the team, such as a registered nurse and a hospice aid
- Support for the family after their loved one dies, including help with grieving
Although hospice care provides a lot of support to patients and their families, it rarely provides 24/7 bedside care. Most day-to-day care is still provided by family and friends.
Where Is Hospice Care Given?
Some people have the misconception that “hospice” is a place, but hospice care can be given in a number of places. Many people choose to receive hospice care at home, but hospice care can also be provided in a nursing home, an assisted living facility, or a hospital. The decision about where to receive hospice care often considers factors like cost, the stability of the patient’s condition, the level of care required, and more.
Research shows that hospice care improves symptom management, increases patient and family satisfaction, and helps patients achieve their end-of-life goals. Studies suggest that earlier enrollment in hospice—ideally several weeks to months before death rather than days—allows hospice teams to provide maximum benefit to patients and families.
Who Qualifies for Hospice Care?
Anyone with a serious illness
whose health care providers certify has a prognosis of six months or less if the disease follows its normal course usually qualifies for hospice care. Patients can remain in hospice beyond six months if they continue to meet eligibility criteria and can enroll and disenroll as their condition changes.
- TRICARE covers hospice care in the United States, the District of Columbia, and U.S. territories when you, your primary physician, or authorized family initiates hospice care. TRICARE offers different levels of hospice care, which may include physician services, nursing care, counseling, medications, physical and occupational therapy, short-term inpatient care, and more.
- The Department of Veterans Affairs (VA) offers hospice care to qualified Veterans who are in the final phase of their lives, typically six months or less. VA helps Veterans live fully until death and works closely with community and home hospice agencies to provide care in the home with a multidisciplinary team.
- Most Medicaid, Medicare, and private insurance providers cover some of the services provided by hospice. Often, for insurance to pay for hospice, a physician has to determine that a patient has a life expectancy of six months or less. Under traditional Medicare, patients typically agree to forgo treatments aimed at curing their illness, although some insurance programs (including Medicaid for children and VA benefits) allow hospice care alongside disease-directed treatments. This does not mean “giving up,” rather hospice focuses on living as fully as possible while managing symptoms.
Is Hospice Care Right for Me or My Loved One?
According to the AARP, 70% of Americans say the topic of death and dying is generally avoided in their families. Although talking about end-of-life care can be uncomfortable, it’s important to talk about it before significant health impairments prevent the conversation from happening. Earlier conversations about end-of-life preferences often lead to better outcomes and care that aligns with patient wishes.
Deciding whether and when to start hospice care can be a very difficult decision for patients and families. Here are some resources that may help:
- The National Institute on Aging offers answers to several frequently asked questions regarding hospice care.
- U.S. News & World Report shares guidance for how to determine if hospice care is a good fit for you or a loved one.
- VA has several resources to help patients determine what matters most to them in terms of health priorities and care preferences at the end of life.
- AARP provides tips for how to start a conversation about end-of-life care, including specific questions you can discuss with your loved ones.
- The Hospice Foundation of America has a wide range of resources, including information on becoming a caregiver, deciding if hospice is a good fit, and more.
Understanding what to expect from hospice care and taking the time to have end-of-life care conversations with your loved ones is important. It is an essential start to ensure your wishes and care preferences are put into place when the time comes.