Key Messages

• Hospice care is for people with cancer that cannot be cured who are expected to live six months or less. It is high-quality, compassionate care that focuses on relieving symptoms and helping patients and families cope with death and dying.
• Hospice care may take place in your home or a specialized facility and involves a team of doctors, nurses, therapists, and other professionals.
• The hospice care team will work with you to help develop a care plan that helps you meet your goals.

Hospice care is a form of palliative care [2] provided to patients with advanced cancer and other diseases who are expected to live six months or less. The goal of hospice care is to help patients who are no longer receiving disease-directed treatment and their families cope with the physical and emotional effects of death and dying. The focus is no longer a cure; rather, the focus is on ensuring compassionate care that allows for the highest quality of life possible. Hospice care can take place at home (home care) or in a specialized center or facility.

Many people with advanced cancer feel overwhelmed when they are told there is little chance of a cure. Hospice care works to ensure that you approach the end of life with confidence and in comfort, peace, and dignity.

Quality of hospice care

Some people worry that because they are reaching the end of life, they will not receive the same quality of care as other patients or that their death will occur quicker in hospice. Hospice care is humane and compassionate care, and it does not slow down or speed up the end of life. You will receive the same quality of care as patients undergoing curative treatment. The only difference is the focus of care is quality of life, not longevity. In fact, people who use hospice may actually live longer, either because they are more comfortable, or because they have fewer side effects from chemotherapy near the end of life.

Other patients worry that they will simply be medicated and unable to make choices or spend their last days as they wish. Your hospice care team will work with you to determine your goals for end of life care and develop a care plan that allows you to meet those goals while keeping you comfortable. Medication is only one part of that plan. Other therapies, such as music and art therapy, physical therapy, nutrition therapy, massage, and more, may be used.

Hospice care providers

Hospice care most often takes place at home and, in this instance, is referred to as home hospice. Hospice care is also delivered in hospitals and private inpatient facilities. The cost, availability of caregivers, and community resources are factors to consider when selecting where to receive hospice services. If you are 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 you, your family members, and other visitors.

Professionals that may be a part of your hospice care team include doctors, nurses, home health aides, social workers, chaplains, therapists (physical, occupational, and rehabilitation), dietitians, trained hospice volunteers, and grief and bereavement counselors. These professionals also act as a support system for your loved ones. Knowing your loved ones have these resources may help ease your worries about leaving them behind.

Your doctor, nurse, or social worker will help you find hospice care in your area. Other options include contacting your state or local department of health fort a list of licensed agencies or researching online hospice-related organizations (many are listed at the end of this article) that provide resources related to home hospice care.

Working with the hospice team

The hospice staff regularly meets with you to evaluate your 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 you and your family and caregivers. The hospice staff is on call 24 hours a day, seven days a week. During these meetings, you may wish to discuss these questions with the hospice staff:

• How will you help manage pain and my other symptoms?
• How will family members be involved in day-to-day care, such as eating, bathing, giving medication, and monitoring changes in my 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?
• May 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 care in the home

In home hospice care, a family member or close friend serves as the primary caregiver and is responsible for coordinating and/or overseeing most of the patient's care. Doctors, nurses, home health aides, and personal attendants will work with you and your caregivers to develop a plan tailored to meet the unique needs of your situation. They also regularly meet with you and your caregivers to evaluate your medical and comfort needs and provide any services - medical or day-to-day care, such as help with bathing and eating - that your primary caregiver is unable to provide. Hospice professionals are typically on call 24 hours a day, seven days a week.

Eligibility and costs of hospice care

Hospice care is available when all treatments to cure your cancer no longer work and you and your doctor are at ease with a treatment plan dedicated to maintaining comfort. In the United States, acceptance into hospice care requires a statement by a doctor that the person has a life expectancy of six months or less. (Hospice care can be continued, though, if you live longer than six months.)

If your condition improves or your cancer goes into remission (temporary or permanent absence of symptoms), hospice care is discontinued and disease-focused treatment may resume.

The Medicare [3] Hospice Benefit covers the costs of hospice care for people who receive Medicare if they are accepted into a Medicare-certified hospice program. 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; at most, patients are responsible for a $5 copayment.
• Short-term, acute care, including respite care, either in a hospital or nursing home. 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

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

Medicaid may also cover some home care services. Private health insurance policy benefits differ from insurer to insurer. A hospital social worker will help you understand your options. Learn more about the Medicare hospice benefit [4].

More Information

Advanced Cancer Care Planning [5]

End-of-Life Care [6]

Coping [7]

Additional Resources

American Hospice Foundation [8]

Hospice Association of America [9]

Hospice Education Institute [10]

International Association for Hospice and Palliative Care [11]

National Cancer Institute: Hospice [12]

National Hospice and Palliative Care Organization [13]