The four levels of hospice defined by Medicare are routine home care, continuous home care, general inpatient care, and respite care. A hospice patient may experience all four or only one, depending on their needs and wishes. Once a patient has accepted hospice care, they will receive routine care aimed at increasing their comfort and quality of life as much as possible. Routine care may include pain management, symptom management, emotional and spiritual counseling for the patient and family, assistance with daily tasks, nutritional services, and therapeutic services.
Routine hospice care can be provided wherever you call home; whether in a skilled nursing facility, assisted living facility, memory care, or your own home. Care will be intermittent based on the patient's needs.
Sometimes referred to as crisis care, continuous hospice care may be necessary when a patient experiences a medical crisis or when their symptoms require more intensive management. Round-the-clock nursing or extended periods of nursing support during this kind of medical crisis benefit the patient and the family, allowing caregivers the opportunity to step back from the hands-on care and focus on being with their loved one in a family role.
Inpatient care may be necessary if a patient's symptoms can no longer be managed at home. The goal here is to control severe pain and stabilize symptoms so that the patient can return home, if possible. Some patients may choose to spend their final days in an inpatient center as a neutral, safe space to be with family and loved ones. Inpatient hospice centers also offer respite care for home hospice patients.
The team is comprised of palliative care specialist doctors and nurses, and includes others such as social workers, nutritionists, and chaplains. A person's team may vary based on their needs and level of care.
To begin palliative care, a person's health care provider may refer him or her to a palliative care specialist. If he or she doesn't suggest it, the person can ask a health care provider for a referral. Palliative care can be provided in hospitals, nursing homes, outpatient palliative care clinics and certain other specialized clinics, or at home.
Medicare , Medicaid , and insurance policies may cover palliative care. Veterans may be eligible for palliative care through the Department of Veterans Affairs. Private health insurance might pay for some services.
Health insurance providers can answer questions about what they will cover. Visit the National Hospice and Palliative Care Organization website to find palliative care near you. In palliative care, a person does not have to give up treatment that might cure a serious illness. Palliative care can be provided along with curative treatment and may begin at the time of diagnosis.
Over time, if the doctor or the palliative care team believes ongoing treatment is no longer helping, there are two possibilities. Palliative care could transition to hospice care if the doctor believes the person is likely to die within six months see What does the hospice six-month requirement mean?
Or, the palliative care team could continue to help with increasing emphasis on comfort care. Increasingly, people are choosing hospice care at the end of life. Hospice care focuses on the care, comfort, and quality of life of a person with a serious illness who is approaching the end of life.
At some point, it may not be possible to cure a serious illness, or a patient may choose not to undergo certain treatments. Hospice is designed for this situation. The patient beginning hospice care understands that his or her illness is not responding to medical attempts to cure it or to slow the disease's progress. Like palliative care, hospice provides comprehensive comfort care as well as support for the family, but, in hospice, attempts to cure the person's illness are stopped.
Hospice is provided for a person with a terminal illness whose doctor believes he or she has six months or less to live if the illness runs its natural course. It's important for a patient to discuss hospice care options with their doctor. Sometimes, people don't begin hospice care soon enough to take full advantage of the help it offers.
Perhaps they wait too long to begin hospice and they are too close to death. Or, some people are not eligible for hospice care soon enough to receive its full benefit. Starting hospice early may be able to provide months of meaningful care and quality time with loved ones. Hospice is an approach to care, so it is not tied to a specific place. Find out how hospice care works and how it can provide comfort and support.
Hospice care is for people who are nearing the end of life. The services are provided by a team of health care professionals who maximize comfort for a person who is terminally ill by reducing pain and addressing physical, psychological, social and spiritual needs.
To help families, hospice care also provides counseling, respite care and practical support. Unlike other medical care, the focus of hospice care isn't to cure the underlying disease. The goal is to support the highest quality of life possible for whatever time remains. Hospice care is for a terminally ill person who's expected to have six months or less to live. But hospice care can be provided for as long as the person's doctor and hospice care team certify that the condition remains life-limiting.
Many people who receive hospice care have cancer, while others have heart disease, dementia, kidney failure or chronic obstructive pulmonary disease. Enrolling in hospice care early helps you live better and live longer. Hospice care decreases the burden on family, decreases the family's likelihood of having a complicated grief and prepares family members for their loved one's death. Hospice also allows a patient to be cared for at a facility for a period of time, not because the patient needs it, but because the family caregiver needs a break.
This is known as respite care. Most hospice care is provided at home — with a family member typically serving as the primary caregiver. However, hospice care is also available at hospitals, nursing homes, assisted living facilities and dedicated hospice facilities. No matter where hospice care is provided, sometimes it's necessary to be admitted to a hospital. For instance, if a symptom can't be managed by the hospice care team in a home setting, a hospital stay might be needed.
If you're not receiving hospice care at a dedicated facility, hospice staff will make regular visits to your home or other setting. Hospice staff is on call 24 hours a day, seven days a week. Medicare, Medicaid, the Department of Veterans Affairs and private insurance typically pay for hospice care. While each hospice program has its own policy regarding payment for care, services are often offered based on need rather than the ability to pay.
Ask about payment options before choosing a hospice program.
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