What is hospice care? Services, benefits and eligibility

1. What is hospice care?
2. When should you start hospice care?
3. How does hospice care work?
4. What services does hospice provide?
5. What is usually not included in hospice care?
6. What are the benefits of hospice care?
7. What is the difference between hospice and palliative care?
8. Who is eligible for hospice care?
9. Where can you receive hospice care?
10. How long does hospice care last?
11. How do you pay for hospice care?
12. Begin the hospice conversation early
13. Questions to ask your hospice provider
14. What VITAS will do for you in hospice care
15. Hospice care FAQs

What is hospice care?

Hospice care is specialized medical care for people with serious illness who are nearing the end of life. Rather than focusing on curing disease, hospice care focuses on comfort, dignity and quality of life for patients, while providing support for their families and caregivers.

Hospice care is not a place. It is an approach to care delivered wherever a patient lives or is receiving care, including a private home, a senior living community or a nursing home.

Hospice care supports people near the end of life with compassionate care by:

• Developing individualized care plans focused on each patient’s goals and wishes
• Managing symptoms and pain
• Improving quality of life in the patient’s preferred setting of care
• Encouraging patients and their families to make the most of their time together

At VITAS, care is designed to meet the needs of patients facing advanced illness, including cancer, heart failure, dementia, lung disease and other serious conditions. Once a patient is deemed hospice-eligible by a physician, care can begin as soon as the patient — or the person designated to make healthcare decisions on their behalf — chooses to shift from curative treatment to comfort-focused care.

Whether you are a patient, a family member or a clinician caring for someone with serious illness, understanding hospice care can help you make informed decisions about when and whether hospice may be appropriate.

When should you start hospice care?

Hospice care may be considered when a physician determines that a patient has a life expectancy of six months or less if the illness runs its normal course and when the patient chooses comfort-focused care rather than treatment intended to cure disease.

Signs that hospice care may be appropriate can include declining physical or cognitive function, frequent hospitalizations or emergency department visits, increased symptom burden or a desire to focus on comfort and quality of life.

Hospice care remains a patient choice. Patients and families decide when they are ready to begin hospice services.

How does hospice care work?

Hospice care begins with an evaluation by a physician to determine eligibility. Once a patient elects hospice care, an interdisciplinary hospice team completes an assessment and develops an individualized care plan based on the patient’s symptoms, needs, goals and wishes.

Care is provided through routine visits from hospice team members and 24/7 access to clinical support. The care plan is adjusted as the patient’s condition changes to ensure symptoms are managed and comfort is maintained.

Hospice teams also support families and caregivers with education, guidance and emotional support throughout the course of care.

What services does hospice provide?

Hospice care offers comprehensive services to support patients and families, including:

• Symptom and pain management, including medications related to the hospice diagnosis
• Care coordination and delivery of home medical equipment and supplies related to the hospice diagnosis
• Education and support for family members and other caregivers
• Regular visits from an interdisciplinary care team, coordinated with facility staff when care is provided in senior living communities or nursing homes
• Emotional and spiritual support, along with bereavement support for loved ones
• When medically necessary as per Medicare guidelines, VITAS offers Intensive Comfort Care^®, a higher level of care when patients experience symptom exacerbation. Care is delivered at the patient’s bedside in temporary shifts of 8-24 hours until symptoms stabilize.
• 24/7 access to a clinician who can provide guidance by phone and, when appropriate, through telehealth
• Short-term higher levels of care when medically necessary, including inpatient hospice care or respite care

Learn about the 4 levels of hospice care >

What is usually not included in hospice care?

The Medicare hospice benefit does not usually include:

• Medications unrelated to the hospice diagnosis
• Emergency room care not arranged by the hospice provider
• Curative treatments intended to heal the patient (If a new curative medication, therapy or treatment for the patient’s serious illness becomes available, they can withdraw from hospice care to receive it)
• Room and board, except during a short-term inpatient hospice stay when medically necessary

Patients and families remain responsible for routine living expenses, such as housing, food and personal care not related to the hospice diagnosis.

What are the benefits of hospice care?

Hospice care helps patients live as comfortably as possible by managing pain and symptoms and supporting physical, emotional and spiritual well-being.

For families and caregivers, hospice provides education, guidance and emotional support, as well as bereavement services after a loved one’s death. Hospice care may also reduce unnecessary hospital visits by managing symptoms where the patient lives.

What is the difference between hospice and palliative care?

Palliative care can be provided at any stage of serious illness and may be offered alongside curative treatment.

Hospice care is for patients who are expected to live six months or less and who choose comfort-focused care rather than treatment intended to cure disease. Hospice care is covered under the Medicare hospice benefit.

Both hospice and palliative care focus on pain and symptom relief and support for patients and families.

Who is eligible for hospice care?

A patient’s physician determines hospice eligibility based on clinical judgment and prognosis. In general, hospice care is an option when a patient is expected to live six months or less if the illness runs its normal course.

Diseases that may lead to functional decline and hospice eligibility include:

• Cancer
• Cardiac and circulatory diseases
• Dementia/Alzheimer’s
• End-stage liver or kidney disease
• Respiratory diseases
• Stroke, neurological diseases, ALS (Lou Gehrig’s disease)
• Sepsis and post-sepsis syndrome

Hospice care is always a patient choice. Patients may choose to stop hospice care and resume curative treatment, and they may return to hospice later if they meet eligibility guidelines.

Where can you receive hospice care?

Because hospice is a service, care can be provided in many settings, including:

• A private home
• A senior living community
• A nursing home
• A short-term inpatient hospice setting, when medically necessary

Hospice teams coordinate care with facility staff when patients receive hospice services in community settings.

How long does hospice care last?

There is no limit to the amount of time a patient can receive hospice care. Although hospice care is intended for patients who are expected to live six months or less, according to a physician, a patient’s stay may be extended when medically appropriate.

The six‑month timeframe is a Medicare guideline, not a deadline. Patients remain eligible for hospice care as long as a physician continues to certify that the patient meets hospice eligibility guidelines based on disease progression and clinical condition. When eligibility is recertified, hospice care can continue without interruption.

Hospice care may also change over time. Some patients are discharged from hospice if their condition stabilizes or improves and they no longer meet eligibility guidelines. Others may choose to revoke hospice care if they decide to pursue curative treatment again. Patients who are discharged or revoke hospice services may return to hospice later if they again meet eligibility guidelines.

Eligible patients benefit most from hospice services when they are referred earlier in their end‑of‑life journey. In surveys, family members often say, “We wish we had known about hospice sooner.”

How do you pay for hospice care?

Most hospice patients have little to no out-of-pocket cost for hospice services.

Medicare Part A covers up to 100% of hospice care related to the hospice diagnosis, including medications, equipment and support services. Medicaid and many private insurance plans also provide hospice coverage, though benefits and eligibility requirements vary.

Patients and families should check with their insurance provider for details about coverage and any potential costs.

Begin the hospice care conversation early

Hospice care provides the most meaningful improvement to the patient’s quality of life when it begins sooner in their disease process rather than later.

VITAS recommends end-of-life care conversations begin as soon as a serious diagnosis is made. Patients can ensure that they receive the care they want — and when they want it — by having early and ongoing discussions about their care goals and preferences with their family, physicians or facility staff.

Physicians can help patients understand their options and identify their preferences during advance care planning sessions and goals-of-care consultations. These Medicare-reimbursed discussions result in advance directives, medically binding documents that indicate how a patient should be treated, under what circumstances they should be resuscitated, who can make medical decisions on their behalf and more.

Everyone over the age of 18 should have an advance directive to maintain control over their care in case they become unable to speak for themselves. Advance directives include living wills, durable/medical powers of attorney, a Five Wishes document, physician/medical orders for life-sustaining treatment and other important documents.

Questions to ask your hospice provider

When considering hospice care for yourself or a loved one, understanding a potential provider’s capabilities, history and philosophy will enable you to make a more confident care decision. These questions can clarify whether a provider is a good fit for a patient:

• How are hospice costs covered? Does the provider accept Medicare, Medicaid, VA benefits and private insurance?
• What levels of care are provided? How often will care team members visit the patient at home?
• What is the admissions process? How quickly can care begin?
• What happens in the case of an emergency or an episode of aggressive symptoms? Does the provider offer 24/7 support?
• Can the provider manage complex symptoms at home? Do they offer specialized services for respiratory disease, dementia, cancer, heart disease, sepsis, HIV/AIDS, etc.?
• Is population-specific care available for veterans, LGBTQ+ patients, religious minorities, etc.? Can the provider accommodate and honor specific religious or cultural traditions?

What VITAS will do for you in hospice care

VITAS is guided by a core value: “Patients and families come first.” Every VITAS service is designed to surround patients, their families and caregivers with support that elevates quality of life, manages their symptoms and pain and ensures comfort and dignity during one of life’s most difficult — but meaningful — periods.

Once a patient is ready to consider hospice care, VITAS can typically conduct an eligibility assessment within 24 hours and, if appropriate, begin an immediate transition to our services. We can take on new patients day or night, even on holidays and weekends.

This always-available approach defines our entire care model. Clinical support for patients, families and caregivers is never more than a phone call away.

A VITAS interdisciplinary care team is assigned to each patient, working from an individualized care plan built around the patient’s unique needs, goals and preferences.

Members of the team — including a physician, nurse, aide, social worker, chaplain, bereavement counselor and other specialists — will visit routinely to manage the patient’s clinical, psychosocial and spiritual symptoms. Visit frequency depends on the needs of each patient and family.

Upon the patient’s death, spiritual staff and other members of the care team can be present to assist with end-of-life rituals, funeral home arrangements and the challenges of grieving.

For at least 13 months after the patient’s death, VITAS bereavement specialists continue to help the family navigate their loss with personal check-ins, grief support groups and other practical measures.