Hospice Care Definition
Hospice care is defined as the support and care for patients and their families in the last phase of an incurable disease so that they may live as fully and comfortably as possible. 1
Core Components of Hospice Care
Hospice care is characterized by several key elements:
- It is a comprehensive program of care appropriate when patients with chronic, progressive, and eventually fatal illness are determined to have a prognosis of 6 months or fewer 1, 2
- It provides patient and family-centered care that focuses on effective management of pain and other distressing symptoms 1
- It incorporates psychosocial and spiritual care according to patient/family needs, values, beliefs, and cultures 1
- It is delivered by an interdisciplinary team including physicians, nurses, social workers, chaplains, and other health professionals 3
- It affirms that death is an integral part of the life cycle and focuses on pain relief, comfort, and enhanced quality of life for the terminally ill 4
Settings for Hospice Care
Hospice care can be provided in multiple settings based on patient and family needs:
- Most commonly in the patient's home 1, 3
- In free-standing hospice facilities 1
- In dedicated units within hospitals or nursing homes 1
- In long-term care facilities 3
- In hospitals when needed for symptom control 3
Medicare Hospice Benefit Requirements
For patients to qualify for hospice under Medicare:
- A treating physician and hospice medical director must certify that the patient's prognosis is terminal—more likely than not having less than 6 months of life 1
- Patients must agree in writing that only hospice care (and not other Medicare services like curative care) will be used to treat their terminal illness 1
- If a patient survives beyond 6 months, Medicare will continue to reimburse if the patient still meets enrollment criteria 1
- Importantly, patients do not need a "do not attempt resuscitation" order to be enrolled in hospice programs 1
Services Provided by Hospice
Hospice offers a comprehensive range of services:
- Medical care from physicians with expertise in end-of-life care 3
- Nursing care from registered nurses with special training in end-of-life care, available 24 hours a day 1
- Medical social services provided by social workers 1
- Consultation and oversight by the hospice medical director 1
- Counseling services including dietary recommendations, bereavement counseling, and adjustment-to-death support 1
- Bereavement services for up to one year after the patient's death 1
- Spiritual support from clergy as needed 1
- Medications and medical supplies for palliation and symptom management 1
- Additional services like occupational therapy, physical therapy, speech therapy, home health aide, and homemaker services may be available 1
Benefits of Hospice Care
Research has demonstrated several important benefits of hospice care:
- Better symptom relief compared to standard care 3
- Better achievement of patient end-of-life wishes 3
- Higher overall rating of quality of end-of-life care 3
- Support for families during the patient's illness and the bereavement period 1
- Recognition of the potential for growth that exists within the dying experience for individuals and their families 4
Common Challenges in Hospice Referrals
Several barriers may prevent timely hospice referrals:
- Difficulty in determining accurate prognosis, especially for non-cancer conditions like COPD or interstitial lung disease 1
- Physician reluctance to discuss hospice due to lack of skill or training in communicating that death is near 1
- Lack of awareness among physicians about hospice availability for non-cancer patients 1
- Unfamiliarity with eligibility criteria for hospice enrollment 1
Hospice care represents an essential component of the healthcare system, providing specialized support for patients and families facing the end of life, with a focus on quality of life, symptom management, and holistic care.