ConditionWhole body & general
Hospice Care: Comfort and Support at the End of Life
Hospice care is specialized care for people with a serious illness who are expected to live 6 months or less and who choose to focus on comfort rather than treatments aimed at cure. A team of nurses, doctors, aides, social workers, chaplains and volunteers manages pain and symptoms and supports the family, usually at home. In the US, Medicare, Medicaid and most insurers cover it. Many families say they wish they had started hospice sooner.
Also called: End-of-life care, comfort care at end of life, hospice palliative care
At a glance
- What it is
- Comfort-focused care for a terminal illness, usually in the last 6 months of life.
- Where
- Mostly at home; also nursing homes, assisted living, hospice residences and hospitals.
- Who provides it
- A team: hospice doctor, nurses, aides, social worker, chaplain, volunteers, bereavement staff.
- What it covers
- Symptom control, medicines and equipment related to the illness, caregiver support, respite and grief support.
- Cost
- Covered by Medicare Part A, Medicaid and most private insurance.
When to get help
Call 911 or go to the ER
- Thoughts of suicide in the patient or a caregiver: call or text 988 (US), or call 911 or your local emergency number
See a doctor within a day or two
- For someone in hospice, call the hospice's 24-hour line first for severe pain, breathing distress, agitation, seizures, a fall, bleeding or vomiting that will not stop
- Uncontrolled pain or breathlessness in someone with a serious illness who is not yet in hospice
Book a routine appointment
- Frequent hospital visits, declining function, weight loss or a doctor saying treatment is no longer working: ask about hospice or palliative care
- Caregiver exhaustion or feeling unable to cope
- Wanting to record wishes in advance directives or a POLST form
What hospice care is
Hospice is a philosophy of care as much as a service. When a cure is no longer possible, or treatments are causing more burden than benefit, hospice focuses on:
- relieving pain and other symptoms
- supporting emotional, social and spiritual needs
- helping the person live as fully and comfortably as possible
- supporting family and caregivers, including after death
Choosing hospice does not mean giving up care. It means changing the goal of care.
Hospice vs palliative care
| Hospice | Palliative care | |
|---|---|---|
| When | Expected prognosis of 6 months or less | Any stage of serious illness |
| Curative treatment | Generally stopped for the terminal illness | Can continue alongside |
| Setting | Mostly at home | Hospital, clinic or home |
| Payment (US) | Medicare hospice benefit | Regular insurance benefits |
All hospice care is palliative, but not all palliative care is hospice.
Who qualifies
In the US, a person qualifies for the Medicare hospice benefit when:
- two doctors (usually the regular doctor and the hospice medical director) certify that life expectancy is 6 months or less if the illness runs its normal course
- the person chooses comfort care instead of curative treatment for the terminal illness
People can stay in hospice longer than 6 months if they continue to qualify; they are recertified at set intervals. They can also leave hospice at any time and return to curative treatment.
Common illnesses in hospice
- advanced cancer
- dementia, including Alzheimer's disease
- heart failure
- COPD and other lung diseases
- kidney or liver failure
- stroke and neurological diseases such as ALS and Parkinson's disease
Signs it may be time to consider hospice
- repeated emergency visits or hospital stays
- spending most of the day in bed or a chair
- needing help with most daily activities
- ongoing weight loss and poor appetite
- worsening symptoms despite treatment
- the person saying they want to stop aggressive treatment
What hospice provides
Under Medicare, hospice covers care related to the terminal illness:
- nursing visits and a nurse on call 24 hours a day, 7 days a week
- doctor services from the hospice medical team
- medicines for symptom control and pain
- medical equipment such as hospital beds, wheelchairs and oxygen
- supplies such as incontinence pads and dressings
- home health aides for bathing and personal care
- social workers for practical, financial and emotional support
- chaplains or spiritual care
- volunteers for companionship and errands
- short-term inpatient care for symptoms that cannot be managed at home
- respite care (up to 5 days at a time) to give caregivers a break
- bereavement support for the family for up to 13 months after death
Hospice usually does not provide round-the-clock caregivers at home; families or hired caregivers provide most day-to-day care.
Symptom control in hospice
Hospice teams are skilled in managing:
- pain, often with opioids at doses carefully adjusted to comfort
- breathlessness, with medicines, fans, positioning and oxygen if helpful
- nausea, constipation and loss of appetite
- anxiety, agitation and delirium
- mouth care, skin care and pressure sores
- changes as death approaches, such as noisy breathing, which the team explains and eases
Choosing a hospice
Questions to ask:
- Is it Medicare-certified?
- How quickly can they start, and how often will nurses visit?
- What happens after hours or in a crisis?
- Do they offer inpatient and respite care?
- What bereavement support is offered?
Your doctor, hospital discharge planner or local Area Agency on Aging can suggest options.
Support for families
Caring for someone at the end of life is demanding. Hospice teams teach caregivers practical skills, explain what to expect, and help with difficult conversations and decisions. After death, bereavement services offer counseling, support groups and check-ins. See grief for more on coping with loss.
Frequently asked questions
What does hospice care provide?
Hospice provides a team that manages pain and symptoms, nurse visits with 24-hour on-call support, medicines and equipment related to the terminal illness, personal care aides, social work, spiritual care, volunteers, respite care for caregivers and bereavement support for the family.
What is the difference between hospice and palliative care?
Palliative care can begin at any stage of a serious illness and can be given alongside curative treatment. Hospice is palliative care for people expected to live 6 months or less who have chosen to focus on comfort rather than cure.
Who qualifies for hospice?
In the US, people qualify when two doctors certify a life expectancy of 6 months or less if the illness follows its usual course, and the person chooses comfort-focused care. People can stay longer if they still qualify, and can leave hospice at any time.
Does Medicare pay for hospice?
Yes. Medicare Part A covers hospice care related to the terminal illness, including team visits, medicines for symptoms, equipment and supplies, respite and short inpatient stays, with little or no out-of-pocket cost. Medicaid and most private insurers also cover hospice.
Does going into hospice mean giving up?
No. Hospice shifts the goal from curing the illness to living as comfortably and fully as possible. Studies suggest many people in hospice have better symptom control, and some live as long as or longer than those who continue aggressive treatment.
Sources
This guide was written from current patient and clinical guidance, including:
- Centers for Medicare and Medicaid Services: Medicare Hospice Benefits
- National Institute on Aging: What Are Palliative Care and Hospice Care?
- National Hospice and Palliative Care Organization: Hospice Facts and Figures
- American Cancer Society: What Is Hospice Care?
- MedlinePlus: Hospice Care