Hospice Care for Seniors

What Is Hospice?

Hospice provides end-of-life care for an individual with a terminal condition who has six months or less to live. Using a holistic approach, a team of professionals that includes physicians, nurse practitioners, home health providers, social workers, spiritual leaders, and family members coordinates the necessary care.

Determining the right time and the right way to transition an older loved one to end-of-life care isn’t always clear. Technically, anybody of any age with a qualifying prognosis is eligible for hospice care. But seniors make up over 83 percent of hospice care recipients.1

Hospice relieves suffering and helps end-of-life patients in many aspects of their lives. Usually provided at home, hospice is designed to help your loved ones live their remaining days as comfortably and fully as possible.

Hospice Care vs. Comfort Care

Comfort care is just another term for hospice care that may be used by a medical doctor or nurse. They may refer to end-of-life care as comfort care because that is essentially what hospice does — offer comfort for the individual rather than treatment for their illness.

Hospice Care vs. Palliative Care

Hospice care is often confused with palliative care. Both types of care involve a team working together to support the well-being of someone with a serious illness. With palliative care, however, the goal is to provide comfort using a holistic approach while the patient continues with their treatment. Palliative care ideally begins when a patient starts receiving treatment for a condition, such as cancer or kidney failure, to alleviate discomfort.

In hospice care, someone has a terminal illness and a prognosis of only six months left if the disease were to run its course naturally. Therefore, it’s understood that the patient will not recover. Hospice care begins only when treatment stops. Hospice care provides comprehensive comfort care and pain relief as well as a range of support to the senior as well as the senior’s family.4

Types of Hospice Care

There are four levels of hospice care depending on your loved one’s circumstances, needs, and preferences. Any given patient may go through one or all levels. These are the four levels as defined by Medicare.5

Level One: Routine Home Care

This is the basic hospice care level seniors can receive within their home or assisted living facility. Covered by Medicare Part A (hospital insurance) and Part B (medical insurance), routine home care is occasional or intermittent. But a doctor (usually the patient’s or a hospice doctor) has to certify that it’s necessary. With routine home care, the primary doctor partners with a group of health care professionals to jointly assess and serve the patient’s needs.

Many seniors prefer to remain at home and receive in-home hospice services. Not having to move into a hospice care facility can be a great comfort to these older adults. In fact, trying to transfer an individual at the end of their life from their home to a facility is typically the last resort. Hospice nurses often work with home care providers to give the senior comfort in their home environment.

Level Two: Continuous Home Care

In this level, a nurse or other medical professional stays with the patient for a long period of time to handle a particular situation. Seniors may need this level of care if they have a critical condition or severe symptoms that need to be monitored.

Be Aware: Your medical practitioner can decide to move your loved one to level three if they require better or more appropriate care in a medical facility.

Level Three: General Inpatient Care

General inpatient care involves temporary treatment in a hospital or hospice-approved facility. If a patient has acute pain, for example, your doctor could recommend this level. The goal is still to get patients back home if possible once the pain is under control.

Level Four: Respite Care

Respite care is short-term relief for primary family caregivers who need a break. Respite caregivers come to a patient’s home or health care facility for scheduled visits that can last from a few hours up to a few weeks. Most private insurance doesn’t cover respite care, but Medicare will pay for a large portion of respite care (up to a certain amount of time) if your loved one is in a hospital or approved nursing facility.6

What Services Does Hospice Care Provide?

Hospice is a holistic approach to senior care that also supports families and primary caregivers, so the service options can be extensive. Usually, a team of hospice staff partners with the patient and their advocates to develop a major plan. These are some of the most common services hospice provides:

• Doctor services
• Nursing care
• Medical equipment (wheelchairs, walkers)
• Medical supplies (catheters)
• Prescription drugs (to manage symptoms or pain)
• Hospice aide and homemaker services
• Physical therapy services
• Occupational therapy services
• Speech-language pathology services
• Social work services
• Dietary counseling
• Bereavement (grief and loss) counseling
• Short-term inpatient care (must be in a Medicare-approved facility)
• Short-term respite care within a Medicare-approved facility (up to five days per stay; occasional basis only)

You can request additional Medicare-covered services to manage related conditions, but they must be recommended by your hospice team.

What Services Does Hospice Care Not Provide?

If you are like the majority of hospice patients using Medicare to cover care, it’s helpful to know the services Medicare won’t cover:

• Treatment to cure the terminal illness
• Curative prescription drugs (versus drugs for pain or symptom relief)
• Hospice care from a different hospice provider (Medicare will cover services from only one provider unless you officially switch providers with approval. Patients can still see their primary physician as long as they’re designated part of the hospice team.)
• Room and board, except for short-term inpatient or respite care in an approved facility (Co-payments may apply.)
• Hospital inpatient or outpatient care (emergency room, ambulance), unless arranged by the hospice team or unrelated to the terminal illness

What Are the Benefits of Hospice?

Hospice care offers an array of services to patients. Hospice can provide 24/7 on-call medical directors and nurses able to meet patients in their own home and aides trained to help your loved one with activities of daily living. Families can get valuable equipment delivered in the form of hospital beds and wheelchairs. A hospice social worker can also guide the family with emotional support and community resources. And a hospice-trained counselor can help the patient, caregivers, and family members process their grief.

When Should I Consider Hospice?

Many hospice providers can start care within a day or two as long as the staff is available. But this depends on the area you live in and specific provider. Keep in mind businesses in the care industry are suffering from severe staffing shortages.

Signs it may be time to enlist the help of hospice:

• A prognosis from the doctor of six months or less
• Multiple hospitalizations or ambulance calls in the past six months
• Severe, recurring pain that requires medication
• Inability to perform normal daily tasks independently (eating, dressing, bathing, using the bathroom, walking, or getting out of bed)
• Significant and/or rapid weight loss
• Shortness of breath while at rest
• Inability for family or caregiver to continue to provide adequate care

Admission Criteria for Hospice

Currently, only a medical provider may certify that a patient meets the criteria for hospice care. The patient must have a terminal medical condition (and not be seeking treatment) and have six months or less to live.

Depending on the health insurance provider, such as Medicare or private health insurance companies, you might need to adhere to additional requirements to place your loved one in hospice care. Check your policy and reach out to insurers because following requirements is mandatory; otherwise, the patient may lose coverage for their care.

How Does Hospice Work?

When a senior is placed in hospice, the facility will typically assemble a team that includes a hospice nurse and a medical doctor, both of whom are available 24/7 for questions or assistance. They usually assign someone to be with the patient at home. For example, a home care nurse may be with the patient from 8 a.m. to 8 p.m., after which a family member spends the night with the patient. Seniors living in a nursing home or hospice facility will probably be under the constant supervision of the organization’s staff.

The hospice team members will do whatever they can to help the individual manage their pain and concerns. For example, if your loved one is struggling with their spirituality or worried about what will happen when they pass on, a clergy leader can be invited over to answer their questions and provide spiritual guidance.

If the patient wants to see all of their family members before they die, the team will try to make it happen. For instance, they may set up video conferencing or facilitate telephone calls with those out of town or unable to visit. The hospice team is tasked with meeting the patient’s needs to ensure they are peaceful and able to die with dignity.

How Long Do Patients Usually Remain in Hospice?

Because everyone’s circumstances are different, the typical time frame for patients to remain in hospice can vary anywhere from one day to six months. On average, people stay in hospice fewer than 60 days.8 Keep in mind that hospice care can last as long as a physician feels it’s necessary. Some doctors will extend hospice for longer than six months. Medicare allows an unlimited number of renewal requests in 60-day increments.

Can a Patient be Released From Hospice Care?

In some instances, patients placed in hospice unexpectedly improve. If so, they might be released from hospice care. At that point, they should report to their insurance provider that they’re no longer receiving hospice care. Depending on their health situation, they may return to receiving treatment that is covered by their insurance.

The Cost of Hospice

Though hard to believe, most seniors pay nothing for hospice care! Most older adults who use hospice care are covered by Medicare or Medicaid, or the Veterans Administration. There are exceptions, of course. In addition, private health insurance benefits typically cover hospice services.

Paying for Hospice

Roughly 90 percent of hospice patients use Medicare or Medicaid to cover hospice. But seniors need to meet certain criteria to get the full benefit (Medicare Part A and Part B). To get Medicare Part A benefits, seniors must be 65 or older and meet the minimum criteria.

Does Medicare Cover Hospice?

Medicare does cover all hospice care costs if the senior meets the requirements. Seniors must be at least 65 years old to qualify for Medicare, and they need to be enrolled to use benefits for hospice care.

Be sure to check hospice care under your Medicare policy. For example, if your hospice provider determines you need to go to the hospital, the hospice care nurse or doctor has to contact the hospital to arrange for care. Then the hospice provider works with the hospital to receive its payment via a contract. If you go to the hospital without alerting the hospice administrator, you may have to pay for care out of pocket. Find out the details about your Medicare plan before you finalize medical decisions.

Does Medicaid Cover Hospice?

Medicaid does cover the costs of hospice care. Medicaid is a social health insurance benefit that is available to low-income seniors who would otherwise be unable to afford health insurance, such as Medicare. When using Medicaid, benefits pay for hospice care according to various levels of care.

These include:

• Routine home care
• Continuous home care for nursing care during a medical crisis
• Inpatient respite care for short-term care that provides relief to family members or loved ones taking care of the individual
• General inpatient care, which includes short-term care and covers pain management services not covered by other insurance benefits

Medicaid also pays for a hospice service intensity add-on (SIA), which was introduced in 2016. This service recognizes that patients and families need more intensive services at the very end of life.

To determine if Medicaid covers the costs of the hospice you select, ask the hospice how much the care costs per day through the maximum six-month period. If Medicaid doesn’t cover all costs, request financial assistance for the remaining amount from the hospice facility.

For those without adequate benefits or health care coverage, you have options. Contact the hospice care providers in your area to see if they will offer discounted or no-cost care. It’s common for hospice care facilities to offer charitable funds or a sliding scale to reduce the financial burden on their patients’ families.

How Do I Choose a Hospice Provider?

Hospice is often a last-minute decision dictated by which providers are available nearby. Start by determining a few basic parameters:

• Does the hospice need to be local?
• Do you need Medicare to cover the bulk of the bill? (Some private hospices offer different services through private insurance.)
• Whom does the doctor recommend?

Questions to Ask Hospice Providers

If possible, visit and interview a few hospices. Get your most important questions answered so you know if their service is a good fit. Here are some of the most frequently asked questions:

• Are you licensed and certified by Medicare?
• When can hospice service begin?
• What services do you provide for each level of care?
• What are the out-of-pocket costs?
• What family services do you have?
• How will the team determine pain management?
• Will medical staff make home visits?
• Do you provide 24-hour care?
• Are services available seven days a week?
• What are your after-hours crisis services?
• What is the usual response time?
• Do you offer inpatient services?
• Who are your hospital or inpatient partners?
• What are your policies around religious or spiritual needs?

How Do I Find Hospice Care Near Me?

Here are four reputable sites with hospice locator tools to aid you in your search:

• Medicare’s hospice locator and comparison tool
• The National Hospice Locator
• The Hospice Directory on the Hospice Foundation website
• The Find a Care Provider tool from the National Hospice and Palliative Care Organization (NHPCO)

You want to get an extensive profile of the one or two organizations that you are considering. This includes program information, staffing details, nonprofit or for-profit status, and ratings.

You can also search our directory to find hospice near you or your loved one. Call us on our senior helpline if you’d like to speak to someone about your options or ask questions.