Hospice Frequently Asked Questions (FAQs) for Healthcare Professionals
Find the answers to overarching questions about what hospice is, what factors determine hospice eligibility, and financial questions, including billing and reimbursement specific to hospice care.
You can find more answers in our full database of Frequently Asked Questions.
Frequently Asked Questions
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
- Worsening cognitive function or increased confusion
- Frequent infections
- Sudden or progressive decline in physical functioning and eating
- Weight loss/difficulty swallowing
- Shortness of breath/oxygen dependence
When exactly is the right time for hospice?
Physicians, patients and families should consider hospice services when medical treatments can no longer cure their disease and/or the 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. Hospice services are more efficacious if provided for months rather than days or hours. There is general dissatisfaction among families who believe their loved ones were referred to hospice too late. They reported more unmet needs, greater concerns, and lower satisfaction with the overall quality of care.
How can a physician know whether a patient will die in the next six months?
The physician applies his or her best medical judgment to the situation.
The prognosis is the physician’s best estimate of how long the illness will take to run its course before the patient dies.
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.
The need may be for a certain religious practice or person, acceptance of a family or cultural tradition, a language other than English or another unique circumstance. Hospice providers address each patient’s unique needs through a personalized plan of care.
Who pays for hospice? Is it covered by insurance? Medicare? Medicaid?
If the patient has Medicare Part A and meets hospice eligibility requirements, then the government will pay as much as 100% of the cost of hospice care. In such a case, there is no deductible and no copayment for the patient. Even if a hospice patient is enrolled in a Medicare Advantage plan, hospice benefits are covered by original Medicare.
About 90 percent of hospice patients rely on Medicare and Medicaid to cover their care, and the rest turn to other financing sources, which for most people means private insurance. Most private health plans align with Medicare in their requirements for hospice: A patient must be diagnosed with a terminal illness (indicating a life expectancy of six months or less) and must choose not to receive curative treatment.
Most people enroll in health insurance plans through an employer or retirement program, while others purchase plans through a private or public exchange. Individuals who do not have Medicare but have coverage from private insurance should contact their health plan directly for specific details on hospice care, including what the patient’s plan will cover and which out-of-pocket costs the patient and their family may be responsible for. Medicaid provides coverage, but it varies by state.
How is hospice covered for patients without insurance?
Hospice admissions staff work with patients who are not insured to determine financial responsibility, self-payments and eligibility for other benefits that could help pay for services.
Hospices employ financial specialists to help families who do not qualify for federal assistance and do not have insurance find available resources. The payment options for these families include self-pay and charitable organizations.
If Medicare covers hospice services, does that preclude other Medicare coverage?
No. If a hospice patient needs hospitalization for any reason unrelated to the terminal disease, traditional Medicare will cover that care. The patient’s medical insurance continues to pay for care unrelated to the terminal diagnosis.
For example, if a hospice patient with cancer in involved in an accident and breaks their leg, the ED and physician charges would be paid via regular medical insurance. Hospice would continue to cover the cancer patient’s comfort care. The patient need not and should not revoke their hospice benefit in order to receive emergent care for the broken leg.
The Medicare hospice benefit can be discontinued if the patient requests treatment for the terminal illness that is different from what hospice provides. The Medicare hospice benefit can also be resumed at any time.
How does hospice work with an HMO?
Hospice provides care related to the primary diagnosis; the HMO takes care of unrelated healthcare.
Contact VITAS to learn more about how we work with HMOs.
How is hospice different from home health services?
Hospice offers services home healthcare 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; 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.
Why would a nursing home resident require hospice services?
Nursing homes focus on routine daily care and rehabilitation. Nursing home residents who receive hospice services get customized support determined by their plan of care.
The focus of hospice is the physical, emotional and spiritual end-of-life needs of the resident, the family and even the nursing home staff.
What is hospice?
Hospice is palliative, not curative.
Hospice cares for the terminally ill by focusing on pain relief, symptom management and emotional and spiritual end-of-life issues. Hospice does not try to cure disease.
What are hospice “levels of care?”
Medicare outlines four levels of hospice care to address different needs.
Medicare requires all hospice providers to offer four levels of care to address different needs of patients and families:
- Routine hospice care in the home
- Shifts of acute symptom management in the home when medically necessary. VITAS calls this Intensive Comfort Care®; it is also called “continuous home 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.
Who is on the hospice team?
The team manages the patient's clinical and psychosocial needs.
Hospice patients receive services from an interdisciplinary team (IDT), including a physician, registered nurse, hospice aide, social worker, chaplain, bereavement services manager, volunteer and other healthcare professionals.
Where do patients go to receive hospice services?
Usually, hospice patients receive care in the place they call home.
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.
Who is VITAS Healthcare?
VITAS® (pronounced VEE-tahss) Healthcare is the nation’s leading provider of end-of-life care.
Headquartered in Miami, Florida, VITAS operates 47 hospice programs in 14 states and the District of Columbia. VITAS employs 12,145 professionals who care for terminally ill patients daily, primarily in the patients’ homes, but also in the company’s 27 inpatient hospice units as well as in hospitals, nursing homes and assisted living communities/residential care facilities for the elderly.
- Why should I choose VITAS? At VITAS Healthcare, everyone in the company works from the same belief: patients and families come first.