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Frequently Asked Questions (FAQs) About Hospice: Everything You Need to Know

Hospice Services

  1. What is hospice?
  2. Who is on the hospice team?
  3. Where do patients receive hospice services?
  4. What are hospice “levels of care?”
  5. Does choosing a hospice mean giving up on my loved one?
  6. When is it time for hospice?
  7. What is the difference between diagnosis and prognosis?
  8. Are there signs that a patient might be ready for hospice services?
  9. How often does the hospice nurse or doctor visit?
  10. Can my doctor still be my doctor if I go on hospice?
  11. Will our family still have a say about our mother’s care if she’s on hospice?
  12. What if the patient has special needs?
  13. Who will talk to me about my loved one once we have hospice? Who will keep us informed?
  14. If I have home health, why do I need hospice care?
  15. My mother is already in a nursing home. Why would she need hospice services there?
  16. Why would I put my child in hospice? Isn’t hospice for the very old?
  17. Will hospice care for my dad 24/7? Will I still need to take care of him?
  18. What does “comfort care” mean?
  19. I don’t want my wife to die in our home. Can we have inpatient care instead?
  20. Can you come to talk to my sister about hospice but not mention cancer, death or dying? She doesn’t know.
  21. What happens after my loved one dies?
  22. What about grief and other emotions? Does hospice address those?

Who Pays for Hospice

  1. Who pays for hospice? Is it covered by my insurance? Medicare? Medicaid?
  2. If I don’t have insurance, can I still receive hospice services?
  3. If Medicare covers my hospice services, will I lose my other Medicare coverage?
  4. Can I have hospice and also keep my HMO?
  5. Is there a fee for a consultation?

How Hospice Addresses Specific Medical Conditions

  1. What are the signs that hospice is right for heart patients?
  2. What are the signs that hospice is right for Alzheimer’s and dementia patients?
  3. Why would an Alzheimer’s patient get hospice care?
  4. What are the signs that hospice is right for ALS patients?
  5. What are the signs that hospice is right for cancer patients?
  6. Can a patient receive chemotherapy and hospice services at the same time?
  7. What are the signs that hospice is right for COPD patients?
  8. What are the signs that hospice is right for Parkinson’s patients?

VITAS Healthcare

  1. Who is VITAS Healthcare?
  2. Where is VITAS located?
  3. What services does VITAS provide?
  4. How do VITAS services begin?
  5. What is Palliative Care Associates?
  6. Why should I choose VITAS?

Hospice Services

What is hospice?

Hospice is a way to care for people who are terminally ill by focusing on pain relief and symptom management, as well as emotional and spiritual end-of-life issues, instead of trying to cure the disease.

It's a choice: Five Things to Know About Hospice

Frequently asked questions about hospice care

Who is on the hospice team?

Hospice patients receive services from an “interdisciplinary” team, meaning members come from different disciplines or fields. They may include a physician, registered nurse, hospice aide, social worker, chaplain, bereavement services manager, volunteer and other healthcare professionals.

A full range of services: The VITAS Care Team

Where do patients receive hospice services?

Hospice services are typically brought to wherever the patient calls home—a private residence, assisted living community or nursing home. Patients can also receive hospice services while in the hospital, or in an inpatient hospice unit.

Hospice is not a place: Hospice Care at Home

What are hospice “levels of care?”

Levels of care are specific types of hospice care to address different needs of patients and families. Medicare requires all hospice providers to offer four distinct levels of care. They are:

  • Routine hospice care in the home
  • Shifts of acute symptom management in the home when medically necessary. VITAS calls this Intensive Comfort Care®, it can also be called “continuous care.”
  • Round-the-clock inpatient care when symptoms cannot be managed at home
  • Respite inpatient care for the patient when the family caregiver is away 1−5 days

Does choosing hospice mean giving up on my loved one?

No. When treatment options for a disease have been exhausted or no longer work, hospice provides a way for people to live in comfort, peace and dignity without curative care. Hospice isn’t about giving up, but about improving the quality of the patient’s life by being free of pain, surrounded by family and in the comfort of home.

Focusing on the person, not the disease: Hospice is Not About Giving Up

When is it time for hospice?

Patients should consider hospice services when medical treatments can no longer cure their disease and/or symptom burden outweighs the benefits of treatment. Hospice services can begin when a doctor decides the patient’s life expectancy is six months or less.

When waiting won't help: Quality Hospice Care Takes Time

What is the difference between diagnosis and prognosis?

A diagnosis is when the cause of the illness is identified (e.g., the common cold, pneumonia, lung cancer, etc.). A prognosis is a prediction about how the illness will develop. In the case of people who are terminally ill, the prognosis is often the physician’s estimate of how long the illness will take to run its course before the patient dies.

Are there signs that a patient might be ready for hospice services?

When the burden of treatment outweighs the benefits and/or the patient has had multiple hospitalizations over the last several months, he or she might be ready for hospice. Other indications include:

  • Repeat trips to the emergency department
  • Unrelieved pain
  • Frequent infections
  • Sudden or progressive decline in physical functioning and eating
  • Weight loss/difficulty swallowing
  • Shortness of breath/oxygen dependence

How often does the hospice nurse or doctor visit?

The hospice nurse creates a plan of care with the patient’s and family’s input, designed to meet the patient’s needs. This determines the frequency of visits by the doctor, nurse and others on the hospice team.

Can my doctor still be my doctor if I go on hospice?

Yes. Hospice physicians and team members work with your doctor to ensure your clinical and emotional needs are being met and that your care is being carried out appropriately. Your doctor chooses his or her level of participation in your care.

Will our family still have a say about our mother’s care if she’s on hospice?

Yes. Family input is important and is the driving force behind developing the most effective plan of care for your mother.

Free Download: Hospice Family Discussion Guide

What if the patient has special needs?

The hospice plan of care is individualized to meet each patient’s needs. If special equipment (e.g., wheelchair, lift, trapeze bar, etc.) or therapies (e.g., respiratory therapy, physical therapy, etc.) are needed, the hospice provider offers these as part of its services. Perhaps the need is for a certain religious practice or person, a family or cultural tradition, a language other than English or another unique circumstance. Hospice providers address each patient’s needs.

Frequently asked questions about hospice care

Who will talk to me about my loved one once we have hospice? Who will keep us informed?

You will always be kept up-to-date on your loved one’s condition. The primary hospice nurse can answer any questions you have, tell you about your loved one’s care and progress, and prepare you for what to expect.

Considering all perspectives: What to Expect in the First Few Days of Hospice

If I have home health, why do I need hospice care?

Hospice offers many services home health care does not, such as prescriptions, medical equipment and visits from an interdisciplinary healthcare staff. Typically, the goal of home healthcare is to help the patient become more independent, and visits decrease in frequency as the patient’s condition improves. The goal of hospice is to keep the patient comfortable as symptoms increase. Hospice services change to fit the needs of the patient.

What's the Difference? Home Health Care or Hospice Care

My mother is already in a nursing home. Why would she need hospice services there?

Nursing homes focus on routine daily care and rehabilitation. Nursing home residents who receive hospice services get additional, customized support determined by their plan of care, which focuses on the physical, emotional and spiritual end-of-life needs of patients and their families.

Why would I put my child in hospice? Isn’t hospice for the very old?

Hospice is for anyone with a terminal disease. From infants to adult through old age, hospice offers quality of life near the end of life as well as support for those who are caring for the patient.

Read more: What is Pediatric Hospice Care?

Will hospice care for my dad 24/7? Will I still need to take care of him?

Yes, you will always be his primary caregiver. Hospice can supplement that care to help share the responsibility of caregiving with regular visits and education from the hospice care team.

Here to help: Hospice is a Full Range of Care

What does “comfort care” mean?

Comfort care focuses on comfort and relief from symptoms as opposed to curing or treating the disease. Comfort care addresses all the needs of the patient and family—physical, emotional and spiritual.

I don’t want my wife to die in our home. Can she have inpatient care instead?

Your preference for inpatient care should be discussed with the hospice representative who evaluates your wife or with the hospice team if she is already a hospice patient. Every patient and every situation is different.

Can you come to talk to my sister about hospice but not mention cancer, death or dying? She doesn’t know.

Hospice professionals are specially trained to discuss sensitive matters with patients and their loved ones. Usually, a hospice representative will begin the conversation by asking the patient what the doctor has said and what the patient understands about his or her condition. The answer to these questions will determine the words the representative will use.

What happens after my loved one dies?

Ideally, a member of your hospice team will be at the bedside at the time of death, able to explain the stages of death, make necessary phone calls, prepare the body and support the family in the first few hours. He or she will arrange for the body to be removed or, if the family would like to wait, perhaps until a family member arrives, that can be arranged as well. If a member of the team is not present at the death, he or she will arrive as soon as you call the hospice provider.

What to expect: What Happens When a Hospice Patient Dies at Home?

What about grief and other emotions? Does hospice address those?

Hospices employ bereavement specialists to address all aspects of grief, including anticipatory grief and the grief process after death. Hospices provide bereavement services for the family for up to 13 months after the death.

Grief is normal: Grief and Grieving - VITAS Provides Support After a Death

Who Pays for Hospice

Who pays for hospice? Is it covered by my insurance? Medicare? Medicaid?

Part A of Medicare covers 100% of hospice services. Generally, most hospices also work with Medicaid, the Veterans Administration and private insurance companies.

How payment works: Medicare and the Cost of Hospice

If I don’t have insurance, can I still receive hospice services?

Frequently asked questions about hospice care

Yes. If you don’t have insurance coverage, the hospice admissions staff will work with you to determine financial responsibility and self-payments and to find out if you are eligible for other benefits that could help pay for services.

Covered services: Hospice Patient Eligibility Requirements

If Medicare covers my hospice services, will I lose my other Medicare coverage?

No. If you need hospitalization for any reason unrelated to the terminal disease, traditional Medicare will be used. You can discontinue the Medicare hospice benefit at any time if you want treatment different from what hospice provides. You may also resume the Medicare hospice benefit at any time.

Can I have hospice and also keep my HMO?

Yes. Hospice will provide care related to the primary diagnosis, while the HMO can take care of unrelated healthcare issues.

Is there a fee for a hospice consultation?

Hospices do not charge fees for eligibility consultations.

Get a hospice consultation: Request information online or call 866.273.0802

How Hospice Addresses Specific Medical Conditions

Although each of the diseases listed below has unique symptoms, hospice is available to any patient with a prognosis of six months or less. While every patient’s case is unique, some symptoms to look for are listed below:

What are the signs that hospice is right for heart patients?

  • The patient has advanced congestive heart failure or advanced coronary disease with frequent episodes of angina
  • The patient has an abnormal heart due to disease and suffers from significant symptoms of fatigue, shortness of breath or functional decline
  • The patient has received optimal treatment for his/her disease and is not a candidate for further surgical or medical intervention
  • The patient has received optimal treatment for his/her disease and has chosen not to pursue advanced specialized treatment

Continue reading: Hospice Care for Heart Disease Patients

What are the signs that hospice is right for Alzheimer’s and dementia patients?

  • The patient can say only a few words
  • The patient can no longer walk and may be bed-bound
  • The patient is totally dependent on others for eating, dressing and grooming
  • The patient shows signs of severe anxiety
  • The patient has been through several years of decline

Continue reading: Hospice Care for Alzheimer's Disease and Dementia Patients

Why would an Alzheimer’s patient get hospice care?

At the end of their lives, Alzheimer’s patients present several challenges to their caregivers. When these patients are in the last stages of life, hospice can relieve some of the burden—physically, emotionally and spiritually—for caregivers as well as help the patient’s end-of-life experience be comfortable and dignified.

What are the signs that hospice is right for ALS patients?

  • Progression* from independent ambulation to wheelchair or bed-bound
  • Progression* from normal to barely intelligible or unintelligible speech
  • Progression* from normal to pureed diet
  • Progression* from independence in most or all activities of daily living (e.g., toileting, feeding, dressing, etc.) to needing major assistance with these tasks
  • Choice to forego feeding tubes for hydration and nutrition and supportive ventilation for breathing

* Progression is defined as the development of severe neurologic disability over a 12-month period.

Continue reading: Hospice Care for ALS (Lou Gehrig's Disease)

What are the signs that hospice is right for cancer patients?

  • The patient is rapidly weakening and the cancer is progressing
  • The treatment intervention is not fully effective
  • The burden of treatment on the patient and family outweighs the benefits

Continue reading: Hospice Care for Cancer Patients

Can a patient receive chemotherapy and hospice services at the same time?

If the chemotherapy were being used to attempt to cure the cancer, hospice would be inappropriate. However, a patient receiving hospice services may receive chemo for reasons of comfort and quality of life; for example, to shrink a tumor that is pressing on an organ.

What are the signs that hospice is right for COPD patients?

  • The patient has made one or more trips to the emergency department every three months due to infection or respiratory failure
  • The patient spends most of his/her days at home
  • The patient has endured repeated hospitalizations (i.e., one or more in three months) and wants to remain out of the hospital
  • The patient no longer wishes to be intubated

Continue reading: Hospice Care for Lung Disease Patients

What are the signs that hospice is right for Parkinson’s patients?

  • Continuous decline in function
  • Coma
  • Persistent vegetative state
  • Severely reduced level of consciousness
  • A significant compromise in breathing and/or swallowing
  • Any of the progressions under “ALS” above

Continue reading: Hospice Care for Neurological Diseases - Stroke, Coma, Parkinson's Disease and Multiple Sclerosis

VITAS Healthcare

Who is VITAS Healthcare?

VITAS® (pronounced VEE-tahss) Healthcare is the nation’s leading provider of end-of-life care.

7 more facts: VITAS Healthcare Fast Facts

Where is VITAS located?

VITAS cares for patients and families in 15 states and the District of Columbia. The company is headquartered in Miami, Florida.

Find us near you: VITAS Healthcare Locations

What services does VITAS provide?

Frequently asked questions about hospice care

  • An interdisciplinary team of hospice experts (physician, nurse, hospice aide, social worker, chaplain and volunteer)
  • An individualized plan of care
  • Four levels of care, including routine care in the home, shifts of acute symptom management in the home when medically necessary (Intensive Comfort Care®), round-the-clock inpatient care when symptoms can’t be managed at home, respite inpatient care
  • Telecare®—24/7 support for patients and family and team members ready to be dispatched to the patient’s home after hours if needed
  • Prescription drugs, over-the-counter medications, medical equipment and supplies
  • Holistic therapies, such as music therapy and pet visits for hospice patients
  • Bereavement specialist for 13 months of grief support after a loved one’s death

Coordinated care: VITAS Hospice Care Services

How do VITAS services begin?

Evaluating the patient is the first step in starting VITAS services. There is no need for a doctor’s referral in order to request an evaluation. A VITAS representative speaks directly with the patient and the family. If they choose to begin hospice services, the doctor’s referral is obtained. The patient, family, physician and VITAS team create a plan of care, which includes everything related to the terminal diagnosis.

Next step: What to Expect the First Few Days of Hospice

What is Palliative Medical Associates?

The word palliative means comfort. Palliative care is comfort care, intended to treat pain and other symptoms causing discomfort. Palliative Medical Associates is a division of VITAS Healthcare that offers consultation and expertise in aggressive symptom management and support to patients and families, whether or not the patient is hospice appropriate.

The difference: Palliative Care vs. Hospice Care

Why should I choose VITAS?

At VITAS Healthcare, everyone in the company works from the same belief: patients and families come first. We offer 24-hour support. Our nurses are available at all times, even weekends and holidays. Our patients receive individualized care plans to ensure their needs—physical, emotional, spiritual—and those of their families are always being met.

If you would like to learn more about hospice care or would like to schedule a hospice evaluation please contact our patient care experts.