How does Vitas Hospice operate and what services does it provide for eligible patients?

Understanding Hospice Care Operations

Hospice care operates through interdisciplinary teams that provide comprehensive end-of-life support across multiple settings—including home, dedicated facilities, or hospital units—focusing on comfort rather than cure for patients with terminal illnesses, typically with a prognosis of 6 months or less. 1

Core Structure and Settings

Hospice in the United States functions through four primary models 1:

• Free-standing facilities or dedicated units within hospitals or nursing homes
• Home care agencies that deliver services in patients' residences (the most common setting)
• Integrated palliative care that can be provided in any setting, including intensive care units
• Medicare benefit program regulated by the Centers for Medicare and Medicaid Services and accredited by The Joint Commission

Eligibility Requirements

To qualify for hospice services under Medicare, patients must meet specific criteria 1:

• Physician certification: Both the treating physician and hospice medical director must certify the patient's prognosis as terminal—defined as "more likely than not having less than 6 months of life" 1
• Written agreement: Patients must agree in writing that only hospice care (not curative Medicare services) will be used to treat their terminal illness 1
• Continuation beyond 6 months: If patients survive beyond 6 months, Medicare continues reimbursement as long as enrollment criteria are still met 1

Important Caveat About DNR Orders

Patients do NOT need a "do not attempt resuscitation" order to enroll in hospice programs—it is actually illegal under the Patient Self-Determination Act for Medicare-funded hospice programs to exclude patients who refuse to forgo CPR. 1 In such cases, hospice programs inform patients they don't provide CPR but will call 911 if resuscitation is requested.

Comprehensive Services Provided

Hospice delivers an extensive array of interdisciplinary services 1:

Medical and Nursing Care

• 24/7 registered nurse availability with special training in end-of-life care, visiting as needed and on-call around the clock 1
• Hospice medical director providing consultation and oversight 1
• Medications and medical supplies for palliation and management of both terminal and comorbid conditions 1

Psychosocial and Spiritual Support

• Medical social services provided by social workers 1
• Counseling services including dietary recommendations, bereavement counseling for the terminally ill patient, and adjustment-to-death support for family and friends 1
• Bereavement services continuing up to 1 year after the patient's death 1
• Clergy and spiritual support to foster communication between terminally ill patients and their congregation 1
• Trained hospice volunteers providing friendly visits, compassionate listening, and companionship 1

Rehabilitation and Support Services

• Occupational therapy, physical therapy, and speech-language pathology available by special arrangement 1
• Home health aide and homemaker services through inter-agency arrangements 1

Levels of Care

Hospice provides different intensity levels based on patient needs 2:

• Routine home care: Periodic visits by hospice team members
• Continuous care: A higher level of care used during short periods of crisis to keep patients at home, requiring hospice services in the home for at least 8 hours in a 24-hour period 2
• Inpatient hospice care: For symptom management that cannot be controlled at home 1

Palliative Care Philosophy

The overarching goal is achieving the best quality of life by preventing and relieving pain and other distressful physical, psychological, social, and spiritual symptoms. 1 Palliative care neither hastens nor postpones death but rather helps patients live as actively as possible until death while supporting families during illness and bereavement. 1

Common Pitfalls in Hospice Referral

Several barriers prevent appropriate hospice utilization, particularly for non-cancer patients 1:

• Prognostic uncertainty: Non-cancer patients (e.g., COPD, heart failure) have more difficult-to-predict trajectories than cancer patients 1
• Physician reluctance: Lack of skill or training in communicating that death is near 1
• Awareness gaps: Physicians may be unaware of hospice availability or eligibility criteria for non-cancer patients 1

Utilization Statistics

By 2007, approximately 39% of all deaths in the United States occurred under the care of a hospice program, demonstrating widespread acceptance of this care model. 1

Flexibility in Care Plans

Patients can be withdrawn from hospice programs if their condition unexpectedly improves, providing flexibility for those whose prognosis changes. 1