What are the different types of hospice care?

Types of Hospice Care

Hospice care is available in four primary settings: home-based hospice, inpatient facilities (either free-standing or within hospitals/nursing homes), integrated hospice care that can be delivered in any setting, and as a Medicare benefit subject to specific regulations and accreditation requirements. 1

Home-Based Hospice Care

Home-based hospice is the most common type of hospice care, allowing patients to remain in familiar surroundings while receiving end-of-life care. This model includes:

• Routine home care provided by an interdisciplinary team that visits the patient's residence
• A registered nurse with specialized end-of-life training who visits as needed and is available 24/7 1
• Medical social services provided by a social worker
• Consultation and oversight from a hospice medical director
• Home health aide and homemaker services
• Medications and medical supplies for symptom management 1

Home hospice services typically include:

• Pain and symptom management
• Psychosocial and spiritual support
• Short-term respite care
• Bereavement counseling for family members 1

Inpatient Hospice Facilities

Inpatient hospice care is provided in dedicated settings for patients who cannot be adequately cared for at home:

• Free-standing hospice facilities specifically designed for end-of-life care
• Dedicated hospice units within hospitals or nursing homes 1
• Staffed by specialized interdisciplinary teams trained in palliative care
• Appropriate for patients with complex symptom management needs or when family caregivers need respite 2

Integrated Hospice Care

This model provides hospice services in various settings based on patient needs:

• Can be delivered in any setting, including intensive care units 1
• Follows an individualized integrated model where palliative care is provided concurrently with curative/restorative care until the latter is no longer beneficial 1
• Allows for seamless transitions between care settings based on changing patient needs

Hospice as a Medicare Benefit

Hospice care in the United States is also defined by its status as a Medicare benefit:

• Subject to Center for Medicare and Medicaid Services rules and regulations
• Requires accreditation by The Joint Commission 1
• Eligibility requires certification that the patient has a terminal prognosis (life expectancy less than 6 months) by both treating physician and hospice medical director 2
• Patient must agree in writing to forego curative treatments for their terminal illness 2
• Medicare coverage continues if patients survive beyond 6 months and still meet eligibility criteria 2

Interdisciplinary Approach in All Hospice Settings

Regardless of setting, hospice care is delivered by an interdisciplinary team that typically includes:

• Physician
• Nurse
• Social worker
• Chaplain or spiritual advisor
• Volunteers
• Counselors
• Therapists (physical, occupational, respiratory, speech) as needed 1
• The patient and family as integral team members 1

Key Differences Between Hospice Settings

The primary differences between hospice settings relate to:

1. Level of medical intervention available: Inpatient settings can provide more intensive symptom management
2. Family involvement: Home hospice requires more family caregiver participation
3. Cost structure: Home hospice without inpatient facilities is generally less costly than conventional terminal care, while hospice with inpatient beds may have equivalent costs 3
4. Patient satisfaction: Home hospice care provides the highest quality of basic needs satisfaction and highest level of satisfaction with nursing care 4

Common Pitfalls in Hospice Care Selection

• Delayed referrals: Many patients are referred to hospice too late to receive maximum benefit 2
• Underutilization for non-cancer diagnoses: Patients with conditions like COPD often receive less palliative care than those with cancer 1
• Confusion about eligibility: Physician reluctance to discuss end-of-life care and limited awareness of hospice eligibility criteria for non-cancer conditions can impact appropriate hospice utilization 2
• Misunderstanding the difference between palliative care and hospice: Palliative care can be provided alongside curative treatments without requiring a terminal diagnosis, while hospice is specifically for terminal care 2

By understanding these different types of hospice care, healthcare providers can better match patients with the most appropriate end-of-life care setting based on their medical needs, personal preferences, and family support systems.