Hospice care is a program in local communities to help people with cancer who are coping with a limited life expectancy receive care by trained professionals. The emphasis of hospice care is on relieving pain and discomfort and assisting the person with cancer and his or her caregivers. Many people with cancer feel overwhelmed when their doctor tells them there is little chance that treatment will cure or reverse the disease. Hospice can help by focusing on individual needs and goals. Hospice care allows a person to approach the end of life with confidence in comfort, peace, and dignity.

According to the National Hospice and Palliative Care Organization, most hospice care takes place in the home, although there are some freestanding hospice centers, hospitals, nursing homes, and other long-term care facilities that provide hospice care.

Eligibility for hospice care

Hospice care is available for situations when all treatments to cure the disease no longer work and the patient and caregivers are comfortable with a treatment plan dedicated to maintaining comfort. In the United States, acceptance into a hospice requires a statement by a doctor that the person has a life expectancy of six months or less if the disease runs its natural course. If the condition improves or the disease goes into remission (temporary or permanent absence of symptoms), hospice care can be discontinued and active cancer treatment can resume. As necessary, hospice care can begin again at a later time.

The hospice team

For hospice to be successful in achieving its goals, it requires a discussion among the patient, his or her caregivers, and a variety of medical, nursing, and other health care professionals. Here is a list of professionals that may be a part of the hospice team. Not all hospices offer services by all of these professionals, so it is important to ask which members will be a part of the team.

• A doctor who serves as the medical director of the team
  
  
• Nurses who provide direct care and case management
  
  
• Home health aides, including bath aides, to assist with basic needs
  
  
• Social workers
  
  
• Chaplains and pastoral care counselors
  
  
• Physical, occupational, and rehabilitation therapists
  
  
• Dietitians
  
  
• Trained hospice volunteers
  
  
• Bereavement counselors

The hospice team works closely with the patient and the family or caregivers to develop a plan of care tailored to meet the unique needs of the situation. The hospice staff is also responsible for meeting with the patient and family to explain their approach to care and the types of services offered.

Working with the hospice team

The hospice staff regularly meets with the patient to evaluate his or her medical and comfort needs and provides any needed services under the supervision of a doctor. This plan of care will include measures to manage pain and other symptoms and support for the patient and family. The hospice staff is on call 24 hours a day, seven days a week. Consider discussing the following issues with the hospice staff:

• How will pain and other symptoms be managed?
  
  
• How will family members be involved in day-to-day care, such as eating, bathing, giving medication, and monitoring changes in condition?
  
  
• What services are provided to help with the emotional and spiritual aspects of death and dying?
  
  
• Who can my family members call if they have any questions, and what are the phone numbers?
  
  
• Can family and friends visit at any time? (this applies to inpatient hospice care only, since at home, the patient and caregivers have control over access)

Hospice at home

A family member or close friend serves as the primary caregiver in the home and should be prepared to assume the majority of the responsibility in caring for the patient. The hospice staff regularly meets with the patient and caregivers. Even at home, the hospice staff is on call 24 hours a day, seven days a week. The American Hospice Foundation developed a checklist to help patients and families learn what to expect from high-quality, in-home hospice care.

Hospice care outside the home

Hospice care is also delivered in hospitals and other inpatient facilities. If admitted to an inpatient hospice facility, the location and hours should be convenient for visits by family and friends; provide peace and quiet; and ensure privacy for the patient, family members, and other visitors.

Medicare hospice benefits

Medicare is a federal health insurance program for people age 65 years and older, some disabled people under age 65, and people of all ages with end-stage renal disease (permanent kidney failure treated with dialysis or a transplant). The cost of hospice care, whether at home or as an inpatient, is covered as a benefit under Medicare Hospital Insurance (Part A). The Medicare Hospice Benefit allows all Medicare beneficiaries to get the benefits of hospice care. To be eligible, a doctor must determine that the patient has a limited life expectancy of six months or less if the condition runs its natural course. The patient will be required to sign a statement choosing hospice care instead of other Medicare benefits to treat the illness. Under Medicare, hospice is primarily delivered in the home setting by a Medicare-approved hospice provider and covers:

• Services provided by the doctors
  
  
• Nursing visits to the home with 24-hour on-call services
  
  
• Medical appliances and supplies related to the life-limiting illness
  
  
• Medications to manage symptoms and relieve pain
  
  
• Short-term, acute care either in a hospital or nursing home, including respite care. Inpatient respite care is provided to give family caregivers temporary relief.
  
  
• Home health aide and homemaker services
  
  
• Supportive counseling
  
  
• Spiritual support and counseling
  
  
• Nutritional counseling
  
  
• Bereavement support for your family

What is not covered under Medicare

The following services are not covered under Medicare:

• Treatment for the life-limiting illness that is not for pain control and other symptom management
  
  
• Care given by another health care provider that was not arranged through the hospice program
  
  
• Care given by another health care provider that duplicates care the Medicare-approved hospice provider is required to provide

Learn more about the Medicare Hospice Benefit.

Finding a hospice facility or program in your area

The National Hospice and Palliative Care Organization provides a database of hospices that you can search by state and city.

More Information

End-of-Life Care

Coping

Additional Resources

Hospice Association of America

Lance Armstrong Foundation: What Hospice Care Means for Caregivers

Lance Armstrong Foundation: What Hospice Care Means for Survivors

National Cancer Institute: Hospice