hospice care

What is hospice care?

Hospice care provides comfort and pain relief and seeks to improve quality of life for people in the final stage of their life. Hospice care includes physical care as well as counseling, and can include help for both the patient and their family.¹ When a patient enters hospice care, the focus is no longer on trying to cure their terminal medical condition, but rather on providing comfort.²

What is the difference between hospice care and palliative care?

Palliative care is designed to provide comfort and improve quality of life for people living with serious illnesses, as well as their caretakers. Palliative care can be provided in conjunction with curative treatment. Hospice care is a form of palliative care, but curative treatment is no longer used once a patient begins hospice care.²

Why would a patient transition to hospice care?

Patients can transition to hospice care once the patient and their care team determine that curative treatment for a terminal condition is no longer working. This could be due to any terminal condition, although cancer and Alzheimer’s are the most common reasons people transition to hospice care. About a third of all hospice patients have either cancer or Alzheimer’s.³

Is hospice care covered by health insurance?

Most hospice patients are covered by Medicare,⁴ which pays almost all hospice care expenses. Roughly 90% of all hospice patients in the U.S. have Medicare, Medicaid, or both, according to one study.⁵ (Roughly 80% of all deaths in the U.S., regardless of whether hospice is involved, are among people enrolled in Medicare.)⁶

Medicare coverage of hospice care is uniform, nationwide.⁷ But hospice coverage is an optional benefit that states can provide via their Medicaid programs, so Medicaid coverage of hospice services can vary by state.⁸

Among the minority of hospice patients who do not have Medicare, Medicaid, or both, most have private health coverage, either obtained from an employer or purchased in the individual market. These plans do typically cover hospice care, but the specifics will vary from one plan to another.⁹

To qualify for Medicare hospice coverage, a patient’s doctor must certify that the patient’s life expectancy is six months or less. If the patient is still alive at the end of the six months, they can remain in hospice as long as their hospice doctor recertifies that they’re terminally ill.⁷

Hospice benefits under private health insurance policies vary, so they will have differing requirements in terms of qualifying for hospice benefits, prior authorization, provider networks, where hospice care can be provided, and out-of-pocket costs. If you or a loved one needs hospice care and have private health insurance, you’ll need to contact your plan to find out the details.¹⁰

Where is hospice care provided?

Hospice care is usually provided in the patient’s home or a facility where the patient lives, such as an assisted living facility or nursing home.¹⁰ Under the Medicare hospice benefit, this is known as routine home care (RHC).¹¹ The primary caregiver is typically a family member, but hospice staff members visit regularly and the patient and their caregiver also have 24-hour access to on-call hospice staff.⁴

If a patient receiving in-home hospice care is experiencing a pain or symptom crisis, the Medicare hospice benefit can cover continuous home care (CHC) in which nursing care can be provided for between eight and 24 hours per day.¹²

Hospice care can also be provided in a hospital or a freestanding hospice facility.¹⁰ Under the Medicare hospice benefit, this is referred to as general inpatient care (GIP), and is utilized when adequate pain relief or symptom management cannot be facilitated where the patient lives.¹³

And if a hospice patient is receiving in-home care, the Medicare hospice benefit also covers respite care. This allows the patient to be temporarily moved to a hospital or hospice facility to give the patient’s primary caregiver a break.⁴

The terminology and coverage specifics will differ if a hospice patient doesn’t have Medicare. For those with Medicaid or private insurance, it’s important to understand any restrictions on where covered hospice benefits can be received.

Who provides hospice care?

As noted above, most hospice patients’ primary caregiver is a family member. But they are supported by a team of medical professionals. This includes the patient’s primary doctor and hospice doctor, as well as nurses and home health aides. The care team can also include social workers, bereavement counselors, and spiritual counselors.⁴

What’s not covered by hospice care?

If a patient enters hospice care, they are no longer receiving curative treatment for their terminal illness. Symptom relief is a significant part of hospice care, as the goal is to make the patient as comfortable as possible. But efforts to cure the terminal illness will cease when a patient opts for hospice care.²