Hospice is Not a Place

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Hospice and Palliative Care combine pain control, symptom management, and emotional and spiritual support.

Both care methods can offer relief from the symptoms of a serious illness, but have slight differences that most people are not aware of. It is important to understand what those differences are so you can determine which care plan is right for you.

What is the difference between Hospice and Palliative care?

Hospice is traditionally an option for people whose life expectancy is six months or less, and involves palliative care (pain and symptom relief) rather than ongoing curative measures, enabling you to live your last days to the fullest, with purpose, dignity, grace, and support. While some hospitals, nursing homes, and other health care facilities provide hospice care onsite, in most cases hospice is provided in the patient’s own home. This enables you to spend your final days in a familiar, comfortable environment, surrounded by your loved ones who can focus more fully on you with the support of hospice staff.

Palliative Care refers to any care that alleviates symptoms, even if there is hope of a cure by other means. Both palliative care and hospice care provide comfort. Palliative care focuses on easing pain and discomfort, reducing stress, and helping people have the highest quality of life possible.  It is appropriate at any age and any stage of a serious illness, not just end-of-life. It is an ‘extra layer of support’—treating the symptoms of an illness and supporting the entire family.

Your disease doesn’t have to be terminal for you to qualify for palliative care and, in the U.S., many palliative treatments are covered by Medicare. In some cases, palliative treatments may be used to alleviate the side effects of curative treatment, such as relieving the nausea associated with chemotherapy, which may help you tolerate more aggressive or longer-term treatment.

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When is it Time for Hospice Care?

There isn’t a single specific point in an illness when a person should ask about hospice and palliative care; it very much depends on the individual.

Typically, it is NOT time for hospice care if you are currently benefiting from treatments intended to cure your illness. For some terminally ill patients, though, there comes a point when treatment is no longer working. Continued attempts at treatment may even be harmful, or in some cases treatment might provide another few weeks or months of life, but will make you feel too ill to enjoy that time. While hope for a full recovery may be gone, there is still hope for as much quality time as possible to spend with loved ones, as well as hope for a dignified, pain-free death.

It depends almost as much on the patient’s philosophy of living and spiritual beliefs as it does on his or her physical condition and the concerns of family members.

Signs you may want to explore hospice care:

  • You’ve made multiple trips to the emergency room, your condition has been stabilized, but your illness continues to progress significantly, affecting your quality of life.
  • You’ve been admitted to the hospital several times within the last year with the same or worsening symptoms.
  • You wish to remain at home, rather than spend time in the hospital.
  • You have decided to stop receiving treatments for your disease.

How and Where is Hospice Care Delivered?

Hospice care is usually provided in the person’s home. It also can be made available at a special hospice residence. Hospice is a combination of services designed to address not only the physical needs of patients, but also the psychosocial needs of patients and their loved ones.

Hospice is primarily a concept of care and not a specific place of care.

Hospice combines pain control, symptom management and emotional and spiritual support. Seniors and their families participate fully in the health care provided. The hospice team develops a care plan to address each patient’s individual needs.

The hospice care team usually includes:

  • The terminally ill patient and family
  • Doctor
  • Nurses
  • Home health aides
  • Clergy or other spiritual counselors
  • Social workers
  • Volunteers (if needed, and trained to  perform specific tasks)
  • Occupational, physical, and/or speech therapists (if needed)
  • Other Counseling & Support Services

Seniors and family caregivers facing end-of-life decisions often must deal with very difficult issues of grief and loss both before and after their loved one dies. In addition, they may have practical concerns about their legal rights and how to pay the bills now that an important member of the household is gone.

female-doctor-comforting-older-patient

What Care Levels Can Hospice Care Include?

Hospice care can include four levels of care: routine home care, continuous care, general inpatient care, and respite care.

Routine home care is a starting point for most patients in hospice because it allows the patient to live wherever they call home while receiving the care they need to help them feel comfortable.

Continuous care is provided for brief periods when the patient has high needs. Hospice nurses or aids care for these patients round-the-clock to avoid hospitalization.

General inpatient care includes any needs that can’t be managed at home. Patients needing this type of care are sent to a hospital or inpatient care unit until their symptoms are alleviated enough to be able to return to their home.

Respite care is temporary care provided to give family caregivers a break.

How Long Does Hospice Care Last?

Your loved one is welcome to remain in hospice care as long as they meet the criteria. Some patients remain on hospice longer than six months and some improve and graduate from hospice care, moving on to independent living or home health. Others remain in hospice care and receive help and comfort as they and their families prepare.

old-man-in-nursing-home-smiling-to-female-doctor

How Can I Pay for Hospice Care?

Medicare, private health insurance, and Medicaid (in 43 states) covers hospice care for patients who meet eligibility criteria.

Private insurance and veterans’ benefits may also cover hospice care under certain conditions. In addition, some hospice programs offer healthcare services on a sliding fee scale basis for patients with limited income and resources. To get help with your Medicare questions call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov. Additional information about how to pay for hospice care can be found at the Public Policy Institute of the AARP.

Who Pays for Palliative Care?

Medicare, Medicaid, many insurers, and healthcare plans will cover the medical portions—physician and nurse services—of palliative care.

Veterans may be eligible for palliative care through the Department of Veterans Affairs. Check with your doctor and healthcare plan to see what insurance will cover in your particular situation. Unlike the comprehensive hospice benefit, there is no comprehensive palliative care benefit.

My Family Member Is Ready For Hospice. Where Do I Begin?

People who qualify for hospice have a life expectancy of six months or less.

To determine if your loved one is ready for hospice, he or she needs recommendations from their physicians. They will determine the life expectancy based on a physical assessment, medical history, and other diagnoses.

A Case Study of Hospice Care

The following case study shows how one patient decided that hospice care was what she wanted and why it was right for her:

Lynda was 57 years old when she was diagnosed with liver cancer. In spite of the best medical treatment her doctors could provide, her cancer proved incurable. Although the prospect of dying frightened her, Lynda wanted to receive professional assistance to prepare herself and her family for her death.

She realized that she wanted to be cared for at home by her sister, Sara. The local hospice service made the arrangements so that this would be possible. Hospice staff made sure that Lynda’s family would have the equipment they needed, and trained Sara in how to administer medications to relieve Lynda’s pain.

The hospice program also sent a registered nurse to the house to oversee Lynda’s care, and the nurse consulted with a doctor to make sure Lynda was as comfortable as she could be during her final weeks. In addition, the hospice service sent a personal care attendant to bathe Lynda twice a week, and a social worker and a clergyman to provide spiritual and grief counseling for Lynda and Sara.

Lynda lived the last six weeks of her life at home before she passed away surrounded by Sara and the rest of her family.

Want to Learn More About Hospice Care? Visit: 

National Hospice and Palliative Care Organization  https://www.nhpco.org/

Hospice Foundation of America https://hospicefoundation.org/

Resources and credits for this article: National Hospice and Palliative Care Organization and US Dept of Health and Human Services, Administration on Aging

Care Availability

Care Availability

Written by The Care Availability Team
Experts in the senior care & retirement living industries

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