What Is Hospice, and When Can Someone Get It Under Medicare?

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What is hospice, and when can someone get it under Medicare?

What is hospice? Hospice is an alternative to regular medical care for people in the final months of life. Instead of continuing to try curing or delaying the fatal disease or condition, hospice ends treatment altogether. Instead, its goal is to control pain and other symptoms and make the patient's last stretch of life as comfortable as possible. Hospice can result in a significant improvement in the patient's quality of life, with a focus on her as a person rather than on her disease.

If someone chooses hospice, it means she can leave the hospital or nursing facility and spend her last weeks or months in her own home or in a family member's. Hospice caregivers are specially trained to carefully calibrate pain medication and other symptom relief so that a patient is as comfortable as possible and able to appreciate the time she has left with loved ones.

Because hospice caregivers work wherever a patient is staying, they can also bring relief to you or others who are providing most of her daily care. Hospice can even move a patient into a special hospice facility for a few days of what is called "respite care," giving you and other caregivers a short break from your duties.

When and how can a patient choose Medicare hospice? If she's enrolled in Medicare Part A and meets certain conditions, she may choose to receive Medicare-covered hospice care, which covers nearly the full cost. To qualify, her treating physician must certify that she has a terminal illness and that she probably has less than six months to live.

Of course, doctors usually can't predict exactly how long someone will live. And they are sometimes reluctant to say what they think about life expectancy. So Medicare builds in a protection in case the prediction proves wrong -- if a patient chooses hospice but lives longer than six months, hospice can be continued as long as she needs it. Or, if her condition stabilizes or even improves, she can give up hospice and return to regular Medicare coverage.

The other condition is that she must formally give up any further treatment of her terminal illness or condition. This "giving up" may be very difficult, both for caregivers and the patient. But recognizing the futility of further treatment is an essential part of the transition to hospice and is necessary for hospice to bring maximum relief and comfort to her.

Does choosing hospice mean someone gives up all medical treatment? By choosing hospice, a patient gives up all treatment of her terminal illness or condition . But that doesn't mean she gives up treatment -- and Medicare coverage -- for any other illness or condition that might trouble her during her last months of life. If she gets the flu or has trouble with her back or has any other medical problem, she can receive treatment from her doctors and have it covered by Medicare Part B in the normal way.

Is choosing Medicare hospice a decision a person is stuck with? There are several reasons why someone eventually might want to discontinue hospice care. She might simply change her mind about giving up treatment, or her doctors might advise her about a new treatment. Her condition might stabilize or even improve, changing the doctor's prognosis about how long she has to live. Or for some reason she might not like hospice care and prefer to return to regular Medicare coverage (which still allows her to refuse any specific treatment she doesn't want). For any of these reasons -- or for no reason at all -- a patient can end hospice care at any time and return to regular Medicare coverage.

What services does Medicare hospice offer?

Hospice is provided by a Medicare-certified agency that can offer a variety of services. These are carefully coordinated within a plan of care developed by the hospice agency in cooperation with the patient's doctor.

Do services include personnel and equipment?

The specific services provided depend on the patient's particular needs and preferences and can include:

  • Medical personnel. A hospice physician, in consultation with a patient's doctor, develops an initial hospice care plan. After the plan is in place, you and the person you're caring for won't see much of either doctor, except for problems other personnel cannot handle. Special hospice nurses are often involved in the initial period of adjustment to hospice care, along with a physical therapist, and a nurse is likely to oversee ongoing care.
  • Personal aides. Most of the care someone receives through hospice comes from specially trained hospice aides. Aides monitor her symptoms and perform tasks to make her comfortable, including administering pain relief and other medications. They can also help with simple household tasks, though they don't provide general housekeeping services. An aide comes as often as needed, and toward the end, an aide may spend several hours every day with a patient.
  • Counseling. Hospice makes various kinds of counseling available, not only to a patient but also to caregivers and family members. A social worker may be available to help with arrangements and paperwork regarding financial and estate matters and end-of-life decisions. Counselors and clergy are also available to help everyone -- patient and caregivers -- deal with emotional issues.
  • Medication and equipment. Hospice provides a patient with any drug she may need -- for pain and other symptom control, sleep, mobility, digestion -- to keep her as comfortable as possible. Hospice provides the medications directly, without the need to go to the pharmacy, get a special prescription, or use insurance coverage. The same is true for medical equipment such as a hospital bed, wheelchair, walker, or the like.

Does hospice provide any relief for caregivers?

Hospice attends not only to a patient but also to the needs of caregivers and family. The physical and emotional toll of caring for someone can become enormous, especially if only one or two people are doing most of the round-the-clock care giving. A special feature of hospice, called "respite care," gives caregivers a break by moving the patient to a special hospice facility where, for up to five days, she gets 24-hour daily care. There can be more than one of these respite periods during a patient's time with hospice. Respite care does not happen automatically; the caregiver or the patient's family must specifically request it from the hospice agency.

How does Medicare hospice actually work once someone chooses it?

If a patient and her doctor agree that hospice is the right choice, you can help her choose a hospice agency. Her doctor or a hospital or nursing facility discharge planner may recommend one. If the patient lives in a senior residence or an assisted living or long-term care facility, the facility can recommend one or more hospice agencies. You can also check our local guide to find out about all nearby hospice agencies or by contacting your state's hospice association; you can get the number from the Hospice Association of America .

  • Once a patient chooses a hospice agency, she must formally enroll in it. The agency handles all the paperwork. If she isn't physically or mentally able to give consent, enrollment must be made by the person who has power of attorney or other authority over the patient's healthcare decisions.
  • The hospice agency begins by setting up a care plan. This includes discussions with the patient and with any family members or others who will be regularly providing her with full-time care. It also involves a visit wherever she'll be staying. There's usually a flurry of activity when the hospice agency first gets involved, with various hospice staff visiting the patient and assessing her needs. Then a regular routine is established, with one or more aides visiting on a schedule. This schedule changes as the patient's needs change.
  • It's important to speak up about things you like and don't like about the care a patient is receiving, including asking the agency to send (or not send) one aide or another if the patient develops a strong preference. You may even switch to another agency altogether if you or the person you're caring for isn't satisfied with the hospice care she's receiving.
  • A patient's need for hospice is evaluated after 90 days to determine if it's still appropriate. It's evaluated again at the end of another 90 days and can be continued in 60-day segments after that. Although intended only for a six-month period, hospice often lasts longer than that because many people live longer than the original six-month prognosis.

How do hospice payments and medical coverage work?

Does a person have to pay anything for Medicare hospice?

Medicare-sponsored hospice provides very intensive, high-quality care almost for free. Medicare pays the hospice agency directly for a patient's care. The patient is responsible only for up to five dollars for each prescription medication provided by hospice and a copayment of 5 percent of what Medicare pays for the days she's a hospice inpatient while caregivers take advantage of respite care .

How does hospice care affect any other medical insurance coverage a patient has?

Even if someone enrolls in hospice , she should keep up her premium payments for Medicare Part B medical insurance and her medigap insurance policy , if she has one. If she's enrolled in a Part C Medicare Advantage plan instead, she should keep paying that premium. That's because she'll want to continue coverage for other medical needs she may have while she's in hospice. And she won't want any interruption in coverage if she decides to leave hospice for any reason.

Joseph L. Matthews

Joseph Matthews is an attorney and the author of numerous books, including Social Security, Medicare, and Government Pensions, Long-Term Care: How to Plan and Pay for It; How to Win Your Personal Injury Claim; and The Lawyer Who Blew up His Desk. See full bio

almost 2 years, said...

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over 3 years, said...

excellent article overall! Answered my questions clearly and in detail. I will use the information in this article to find a Hospice Service for my father in CT immediately.

about 4 years, said...

my fathers is in a skilled nursing facility we are currently waiting to be transferred to veterans state nursing home in land o' lakes , fl his dr at the ctr has asked me tol get him on hospice, his medicare coverage for skilled nursing maxes out the 19th of this month, he does however have tri care for life since dad is a Korean war veteran how do i get this started and how do I know which is the best and covered under medicare and tricare

almost 5 years, said...

Hi this is Linda again....what I meant to say is that Hospice will only be able to give 90 minutes on weekday mornings (total for the week)

almost 5 years, said...

My mom is 90 years old and is in the severe/end stage of alzheimer's. She is being cared for at home by my 84 year old dad (not in great health). She is in hospice care but they've told my dad he can only have 90 minutes of help during the week and none on the weekends. Mama is now basically bed-ridden. She cannot walk, talk (only gibberish), she is unable to do anything for herself. She cannot follow any directions - like lift your arm move your leg. She needs help with eating and drinking and needs complete help with bodily functions....toileting, vomiting, dressing, bathing. I help whenever I can, so that he can go and do his shopping and go to the pharmacy, BUT he is rapidly approaching BURNOUT. I'm very worried about him. He is not sleeping at night because of my mom moaning, waking, vomiting. We live in upstate new york. Is this true that Hospice can't provide anymore than 90 minutes a day, five days a week? He can barely lift her to change her diapers and has hired another aide to come in in the evenings (weekday only) To help get her toileted, changed and into bed. I pick up the evenings on the weekend and give him respite tues & thurs. so that he can have some respite and can go to the grocery store, the bank and all other necessary outside chores. He truly needs more help! Can you help us?

about 5 years, said...

I wish my mother would go into hospice, but the problem is, my mother will not accept the fact that she is dying. Therefor, my mother has be VERY DIFFICULT to take care of, and it has been in and out of hospitals, because she will not stay in there for more that 1 to 2 days.My mother never went to rehab to learn how to change and deal with her bag. My mother had breast cancer years back, and now it is in her bowels. My mother hates hospitals, her kidneys are failing, and she did nothing about it, because she don't want to stay in the hospital. Now she is kidney failure. Also, it was hard for her to even go for a scan. finally she had one done. My mother won't say much to me about it, only that there is one tumor in there growing that is causing her pain. My sister told me our dad told her that cancer is all in her bottom stomach area. I helped her at the beginning of all of this, but had to stop to take care of my husband who had his own operation. My mother wants me back, but excuses my sister from helping her. My mother wants me and her sister to be the ones to help her. My mother refuses any other help, and will not have a nurse in her home, and will not accept hospice care. My 85 year old father is taking care of her and changing her bag. My mother said to me once, the doctor takes of putting me in hospice, talked to me like I am dying. I am not going to die until I am ready to die. My mother is nothing but bone, and weighs (last I heard) only 72 pounds. My mother is blocking up again too! My mother throws up after she eats. My mother has sat on the couch not wanting to go to the hospital, and was in urgent need of water, and finally talking weird before she would agree to go to the hospital. my mother before she finally got her scan, was saying she has the stomach flu is why her stomach was hurting her. I guess it was her way of coping with all of this. My mother would run to her primary care to avoid going to her cancer doc to get meds, so she can stay out of the hospital. Last time she was in the hospital, they tried to help her, wanting her to see a kidney doctor while in there or to give her blood. My mother just lay in her hospital bed bucking all help, and finally they released her.

about 5 years, said...

If medicare and or the state is paying QSP's for in home health care, will this discontinue if hospice is involved?

over 5 years, said...

How does this work with people with dementia/Alzheimer's? Do they stop taking all dementia/Alzheimer's medications if they go on Hospice?

almost 6 years, said...

I need a live in hospice facility in Long Beach for my brother who has incurable cancer. Is there such a facility outside the home in Long Beach? If so can you spread some light on the facility for me?

almost 6 years, said...

was vey good, right now nothing would help.

about 6 years, said...

Thank you for a well written informative article. My experience with a terminally ill parent and home health care/hospice was not positive, perhaps because these conditions come on fast and leave little time to research and psychologically adjust. Our visiting nurse came in saw death was eminent and left. The doctor's office offered support/encouragement and said they would keep the phone line open. Through the years, I have cared for cardiac and cancer conditions. Now I will be tackling Alzheimer. At least this condition gives me a learning curve. I hear good and bad experiences but knowledge on what the system offer and does, prior to needing it is the best wisdom.

over 6 years, said...

It's so important to learn as much as we can, from this pages, it's so helpfull thank you so much maria aleman

over 6 years, said...

Thank you for pointing out that choosing hospice care is other than 'giving' up. You still receive 'palliative' care (comfort care). This is what I will choose when my time comes, and it is in all my paperwork as well.

over 6 years, said...

The comments are also very good.

over 6 years, said...

Very informative. Thanks!

over 6 years, said...

There is Hospice and there is Hospice! In between ther is Palliative care all of it depending on where you are in terms of your health and ability to care for your self. If you are doing better Palliative care where ever you want it can be available but it is intended to monitor and identify in advance any new problem. The "team" provides a tremendous amount of in sight and direction for thr family and the patient. If he gets worse for a while and with the hope they can keep him out of the hospital Hospice can be the next step but not the final step because that "team" is working to improve the patients well being. People need to become aware of the differences in Hospice and the benefits if you qualify. It too is paid for.

over 6 years, said...

Thanks for the article....I only knew that hospice was for the dying...no details. Thanks again. Your articles are certainly helpful. s

over 6 years, said...

Yes,I had no insight about hospice care other than it was for the dying. Thank you!

about 7 years, said...

Hi the kingbird­, Thank you for your comment. Sorry to hear that we weren't able to answer your question in this article. If you'd like, you can post your question in our Ask & Answer section, here: ( http://www.caring.com/ask ). I hope that helps. Take care -- Emily | Community Manager

about 7 years, said...

I still did not get an answer as to whether Hospice could turn down a patient due to the cost of the patient's mantenance medications. Without my Lovenox blood thinner, I would be comitting suicide to intentionally try to live without it. That would be the same as just quitting taking all medications at all. Luckily, I have found a primary physician that is on the board of the local Hospice to care for me. He uses the best available practices of normal care, gets me a pain medication that is sufficient for now, and trys to manage the other problems as they come up. I still think that surgery to take the massive fluid packs out of my abdomen would make me more comfortable, but the surgeons won't touch me for fear that I would not survive the surgery. It would be a lot more humane to try to take them out than my having to live with them from day to day. They currently have my urianry system in such a pressure that I have to have a drain line 24-7 from now on, and movement of my bowells is a terriable pain that is barely tolerable!These "packs" are like tumors taki9ng up space in my abdomen so much that they are clearly visable to the outside of my abdomen.

about 7 years, said...

I agree with the lackluster experience of home hospice. My mother passed away three years ago of pancreatic cancer. We were so unprepared for what was facing us, giving the medications, baths, etc. Now my dad has been told he has pancreatic cancer and we are facing the same situation. We are urgently looking for a hospice facility in our area but there's not very many and the hospital is pushing their vendor of choice which is an in home hospice. I guess we are wimps but we can't go through this again.

about 7 years, said...

I had read about how great hospice was and what a great experience everyone had. Our experience was lackluster to say the least. Mom was put into hospice while I was out of town..little did we know she would decline so rapidly. As a result the nurse would come to the apt and fill the "sticks" of morphine but it was my best friend who had to administer them. Something she never expected when i asked her to come and check up on Mom. And when Mom came up out of her morphine coma... the hospice nurse, on the phone, told us we were crazy, my Mother was in a coma...like H she was, she was looking me straight in the eyes, up on her elbows, choking on her own fluids and asking for help. Luckily the nurse from her independent living facility was in and ran to her side and administered the proper increase in morphine Mom needed. Hospice for my family was incompetent at best. They left a group of unskilled family and friends to tend to Mom, Mom's morphine was running out and we called at 5 AM, by 9 AM we had heard nothing back, by 10 we were out of Morphine and FINALLY at 11 the hospice nurse arrived.... it was one of the most traumatic events I had to face over the last 2 1/2 years of Mom's non-smokers lung cancer.