What Every Caregiver Should Know About Hospice

What you need to know and where to call about hospice.

How does hospice work?

Hospice care is for any person who has a life-threatening or terminal illness. Most reimbursement sources require a prognosis of six months or less if the illness runs its normal course. Patients with both cancer and non-cancer illnesses are eligible to receive hospice care. All hospices consider the patient and family together as the unit of care.

The majority of hospice patients are cared for in their own homes or the homes of a loved one. “Home” may also be broadly construed to include services provided in nursing homes, hospitals and prisons.

Typically, a family member serves as the primary caregiver and, when appropriate, helps make decisions for the terminally ill individual. Members of the hospice staff make regular visits to assess the patient and provide additional care or other services. Hospice staff is oncall 24 hours a day, seven days a week.

Who is the hospice team?

Hospice care is a family-centered approach that includes, at a minimum, a team of doctors, nurses, social workers, counselors, and trained volunteers. They work together focusing on the dying patient’s needs; physical, psychological, or spiritual. The goal is to help keep the patient as pain-free as possible, with loved ones nearby until death. The hospice team develops a care plan that meets each patient’s individual needs for pain management and symptom control.

How is hospice paid for?

Hospice is paid for through the Medicare Hospice Benefit, Medicaid Hospice Benefit, and most private insurers. If a person does not have coverage through Medicare, Medicaid or a private insurance company, hospices will work with the person and their family to ensure needed services can be provided.

Who is eligible for Medicare hospice benefits?

Hospice care is covered under Medicare Part A (Hospital Insurance). You are eligible for Medicare hospice benefits when you meet all of the following conditions:

  • You are eligible for Medicare Part A (Hospital Insurance), and
  • Your doctor and the hospice medical director certify that you are terminally ill and probably have less than six months to live, and
  • You sign a statement choosing hospice care instead of routine Medicare covered benefits for your terminal illness,* and
  • You receive care from a Medicare-approved hospice program.

Please note: Medicare will still pay for covered benefits for any health problems that aren’t related to your terminal illness.

What does Medicare cover?

Medicare covers these hospice services and pays nearly all of their costs:

  • Doctor services
  • Nursing care
  • Medical equipment (like wheelchairs or walkers)
  • Medical supplies (like bandages and catheters)
  • Drugs for symptom control and pain relief
  • Short-term care in the hospital, including respite and inpatient for pain and symptom management
  • Home health aide and homemaker services
  • Physical and occupational therapy
  • Speech therapy
  • Social work services
  • Dietary counseling
  • Grief support to help you and your family

Please note: You will only have to pay part of the cost for outpatient drugs and inpatient respite care.

Respite care and Medicare?

Respite care is care given to a hospice patient by another caregiver so that the usual caregiver can rest. As a hospice patient, you may have one person who takes care of you every day, like a family member. Sometimes your caregiver needs someone to take care of you for a short time while they do other things that need to be done. During a period of respite care, you will be cared for in a Medicare-approved facility, such as a hospice residential facility, hospital, or nursing home.

The Medicare Hospice Benefit does not cover the following:

Treatment intended to cure your terminal illness

As a hospice patient, you will receive comfort care to help manage symptoms related to your illness. Comfort care includes medications for symptom control and pain relief, physical care, counseling, and other hospice services. Medications not directly related to your hospice diagnosis are not covered under the Medicare Hospice Benefit.

Hospice team members will consult with the hospice physician and will inform you and your family which drugs and/or medications are covered and which ones are not covered under the Medicare Hospice Benefit. The Hospice uses medicine, equipment, and supplies to make you as comfortable and pain-free as possible. Under the hospice benefit, Medicare won’t pay for treatment to cure your illness.

You should talk with your doctor if you are thinking about potential treatment to cure your illness. As a hospice patient, you always have the right to stop getting hospice care and receive the “traditional” Medicare coverage you had before electing hospice.

Care from another provider that is the same care that you are getting from your hospice

All care that you receive for your illness must be given by your hospice team. You can’t get the same type of care from a different provider unless you change your hospice provider.

Nursing Home Room and Board

Room and board aren’t covered by Medicare. You may receive hospice services wherever you live, even in a nursing home, however, the Medicare Hospice Benefit does not pay for nursing home room and board.

How do I begin receiving hospice?

Anyone can inquire about hospice services. You or your loved one may call a local hospice and request services. The hospice staff will then contact your physician to determine if a referral to hospice is appropriate. Another way to inquire about hospice is to talk with your physician, and he or she can make a referral to hospice. Hospice can begin as soon as a ‘referral’ is made by the person’s doctor.

Questions to ask when choosing a hospice program.

Hospice care is a philosophy of care that accepts dying as a natural part of life. When death is inevitable, hospice seeks neither to hasten nor postpone it. Below is a list of questions you should consider when looking for a hospice program.

  • What services are provided?
  • What kind of support is available to the family/caregiver?
  • What roles do the attending physician and hospice play?
  • What does the hospice volunteer do?
  • How does hospice work to keep the patient comfortable?
  • How are services provided after hours?
  • How and where does hospice provide short-term inpatient care?
  • Can hospice be brought into a nursing home or long-term care facility?

For information and referral, or to locate a Medicare approved hospice in your area, call: