What is Hospice?

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Many people think of hospice as “giving up,” or even that it hastens death. But in many cases, it can improve daily life physically, emotionally, and spiritually. Some studies suggest those who choose hospice can live longer than those who don't.

In this guide, we'll define the different types of hospice, how it works, who it's best for, and how to decide when it's time to call for hospice. Understanding the different levels of hospice and how they differ from other kinds of care can make it a little easier to navigate this difficult decision.

What is Hospice?

It can be hard to determine the right time and way to transition an older loved one to end-of-life care. There are different types of care to consider depending on the situation, including hospice. Hospice, also known as “comfort care,” focuses on maximizing a person's quality of life in the final stages rather than curing their illness. In other words, hospice care focuses on managing pain and allowing the person to live out their last days with dignity and minimal medical intervention. Usually provided at home, it is designed to help loved ones live their remaining days as comfortably and fully as possible.

What is Hospice

Good to Know: All hospices are not created equal. There are nearly 5,000 hospice providers in the U.S., over half of which are for-profit businesses. Research providers very carefully to ensure they have specific services, staff, and capacity your loved one needs.

Who Can Receive Hospice?

Technically, anybody with a qualifying prognosis is eligible for hospice care. But seniors make up 94 percent of recipients.1 Currently, two main criteria determine hospice eligibility, and only a doctor may certify that a patient meets them.

  • Terminal medical condition (and patient is not seeking treatment)
  • Prognosis of six months or fewer

Paying for Hospice

Roughly 90 percent of hospice patients use Medicare and Medicaid to cover hospice. But seniors need to meet certain criteria to get the full benefit (Medicare Parts A and B). To get Medicare Part A benefits, seniors must be 65 or older and meet the minimum criteria.2

Good to Know: To receive hospice care, patients (or their legal representative) must sign a statement choosing hospice care over other Medicare-covered treatments.

What Are the Four Levels of Hospice Care?

There are four different levels of hospice care depending on circumstances, needs, and preferences. Any given patient may go through one or all. These are the four levels as defined by Medicare3:

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 Parts A (hospital insurance) and 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 healthcare professionals to jointly assess and serve the patient's needs, which might include:

  • Hospice physician
  • Nurses
  • Home health aides
  • Social workers
  • Spiritual support
  • Bereavement counseling
  • Speech, physical, occupational, and other therapists
  • Medication
  • Medical equipment and supplies
  • Volunteer visits

Level Two: Continuous Home Care

Continuous home care means a nurse or other medical professional stays with the patient for a longer 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.

Good to Know: It's important to be aware that your practitioner can decide to move the patient to level three if they will receive better or more appropriate care in a medical facility.

Level Three: General Inpatient Care

General inpatient care means temporary treatment in a hospital or hospice-approved facility. If a patient has acute pain or other symptoms, level three might be recommended if it can better or more quickly ease symptoms. The goal is still to get patients back home if possible once the pain is under control.

Level Four: Respite Care

Hospice is a holistic concept that helps both patients and their families. Respite care is short-term relief for primary family caregivers who need a break. Respite caregivers come to a patient's home or healthcare 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 portion4 up to a certain amount of time if your loved one is in a hospital or approved nursing facility.

How Long Is Hospice?

Hospice is intended for people with only six months or fewer left to live. But because everyone's circumstances are different, there is no official minimum or maximum hospice time frame. On average, people stay in hospice less than 60 days, and 30 percent of hospice patients pass away within seven days.5 While these numbers may feel disheartening, it's important to remember hospice care can make your loved one's last days as comfortable and peaceful as possible. Without hospice care, they might not have that positive experience.

Ultimately, 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.

What Services Does Hospice Care Provide?

Hospice is a holistic approach to elder 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 comprehensive plan. These are some of the most common services hospice provides:

  • Doctor services
  • Nursing care
  • Medical equipment (ex: wheelchairs, walkers)
  • Medical supplies (ex: 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 it must be recommended by your hospice team.

What Services Hospice Does Not Provide through Medicare

If you are like the majority of hospice patients using Medicare to cover care, it's important to know what services Medicare won't cover.

  • Treatment to cure the terminal illness
  • Curative prescription drugs (vs. drugs for pain or symptom relief)
  • Hospice care from a different hospice provider. Medicare will only cover services from 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 (ex: emergency room, ambulance) unless arranged by the hospice team or is unrelated to the terminal illness.

When to Call Hospice Care

Ideally, research hospice options before you need them, so you're ready when your loved one is, and you know what they want.

Signs it may be time to consider hospice:

  • Doctor has given a fatal diagnosis or prognosis 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)
  • Family or caregiver can no longer provide adequate care
  • Significant and/or rapid weight loss
  • Shortness of breath while at rest

How long does it take to begin hospice care?

Many providers can start care within a day or two as long as the staff is available. But this depends on the area and specific provider.

How do I choose a hospice provider?

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

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

Good to Know: If there are numerous options, try comparing some through Hospice Compare. The federally funded online tool lets you see how different providers compare to national averages for things like pain and symptom management.

Questions to ask hospice providers:

If possible, interview and visit a few different hospices. But make sure you get the most important questions answered, so you know it's a good fit. These are just a few of the most frequently asked:

  • 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?

What Is the Difference Between Palliative Care and Hospice Care?

Like hospice, palliative care addresses comfort during an illness, but that illness doesn’t have to be terminal. Palliative care provides both symptom or pain management and curative treatment.

Where hospice requires a terminal prognosis, palliative care does not. Palliative care ideally begins at diagnosis and can continue for years as conditions and treatment plans evolve. Hospice only begins when treatment has stopped, and it's understood that the patient will not recover.

Final Thoughts on Hospice Care

The end-of-life process is never easy, including for caregivers. The most important part is determining your loved one's wishes and what the family needs. Hospice is often a good solution for seniors who want to remain at home focused on family and living their final days as comfortably as possible. It can also provide much-needed support for caregivers, from planning to respite care. Even if it's not time yet, it's okay to plan ahead and start researching early. Reducing stress by having a good-quality option in place is one of the kindest things you can do for yourself and those you love.

Written By

Jeff Hoyt

Editor in Chief

Since graduating from Harvard with an honors degree in Statistics, Jeff has been creating content in print, online, and on television. Much of his work has been dedicated to informing seniors on how to live better lives. As Editor-in-Chief of the personal… Learn More About Jeff Hoyt

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Citations
  1. CDC. (2021). Hospice Care.

  2. Medicare.gov. (2021). How do I get Parts A & B?

  3. Medicare.gov. (2021). Hospice care.

  4. National Institute on Aging. (2021). What Is Respite Care?

  5. PBS. (2015). Why hospice care could benefit your loved one sooner than you think.