What is Hospice Care & Why is it Important?

Hospice 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, our care model is inclusive and is designed to meet the unique needs of diverse patients facing a broad array of advanced illnesses, medical conditions, and accompanying symptoms.

Once a patient is deemed eligible for hospice by their physician, the transition can start as soon as they—or the person who is designated to make healthcare decisions on their behalf—agrees to shift from a curative focus and begin hospice services.

Whether you’re a patient, family member, or clinician who treats patients with serious illnesses, having correct information about hospice services can help you make the best decisions about whether hospice care is appropriate.

Table of Contents:

• What Services Does Hospice Provide?
• What Is Usually Not Included in Hospice Care?
• What Is the Difference Between Hospice and Palliative Care?
• Who Is Eligible for Hospice Care?
• Where Can You Receive Hospice Care?
• How Long Does Hospice Last?
• How Do You Pay for Hospice?
• Begin the Hospice Conversation Early
• What to Ask Your Hospice Provider
• What VITAS Will Do for You in Hospice Care

What Services Does Hospice Provide?

Hospice offers compassionate care to improve the quality of life for seriously ill patients who have a prognosis of six months or less if the disease runs its course as expected.

Because hospice is not a place, patients can remain in their home, whether that is a private home or senior living community such as senior living, memory care, or a nursing home. Services include:

• Clinical symptom and pain management, including medications to help with symptoms.
• Care coordination, including the delivery of home medical equipment and supplies related to the cause of the illness. This includes shower chairs, oxygen tanks, hospital beds, toileting supplies, and more.
• Training for family members or friends who are the primary caregiver(s).
• An expert, multi-disciplinary team makes regular, scheduled visits to the patient’s household. For patients who live in senior living communities and nursing homes, the hospice team works with the facility staff.
• Therapies, including physical and occupational therapy. VITAS also offers respiratory therapy, music therapy, and spiritual and complimentary therapies in many programs.
• Spiritual support and bereavement care.
• Around-the-clock access to a clinical expert who can treat and triage over the phone or via a telehealth visit.
• When medically necessary as per Medicare guidelines, VITAS offers Intensive Comfort Care(R), 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.
• Short-term care in an inpatient hospice unit as needed (for patients) or respite care (for caregivers)
• A minimum of 13 months of grief and bereavement support for patients’ loved ones.

What Is Usually Not Included in Hospice Care?

Below are some items that are not included in the hospice benefit:

• Medications unrelated to the patient’s serious illness.
• Emergency room care not arranged by the patient’s hospice care 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.
• Housing or room and board, aside from an inpatient unit hospice stay when medically necessary. The patient and their loved ones remain responsible for their home, assisted living community, or nursing home and related costs such as rent, mortgage, and food.

What Is the Difference Between Hospice and Palliative Care?

Palliative care can occur at any point in life, for any duration, and it can occur in conjunction with curative care.

Hospice is for patients who are not responding to disease-directed treatments and are expected to live six months or less.

Both types of care offer pain and symptom relief with clinical and psychosocial services. Hospice is the only one of these options covered by the Medicare Hospice Benefit (Medicare Part A).

Who Is Eligible for Hospice Care?

A patient’s physician will determine hospice eligibility based on the patient’s prognosis. Hospice becomes an option when curative treatments are no longer effective and the patient has a life expectancy of six months or less as certified by their attending physician and a hospice doctor—either the hospice’s medical director or the director’s designee. Increased hospitalizations or emergency department visits, typically more than three per year, may be a sign of hospice eligibility.

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 remains a patient’s choice. Patients can choose to stop receiving hospice services or “revoke” hospice without a physician’s consent. They can then resume curative efforts. If they decide to return to hospice, they can do so as long as they meet eligibility guidelines.

Where Can You Receive Hospice Care?

Hospice is a service provided by a team of experts that comes to the patient in the place they prefer to receive end-of-life care. This means patients can remain surrounded by the faces and things they know and love:

• In a private home
• In a senior living community
• In a nursing home

When medically necessary, short–term treatment in an inpatient unit is available for some hospice patients.

How Long Does Hospice Last?

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

Eligible patients benefit most from hospice services if they are referred early 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?

Most hospice patients do not have any out-of-pocket expenses. Medicare Part A covers up to 100% of the cost of hospice care related to a hospice-eligible patient’s illness, with no deductible or copayment.

Private or employer-provided health coverage can vary. Check with your insurance provider for details about hospice eligibility, coverage, and out-of-pocket expenses. Medicaid provides hospice coverage, but specific services and eligibility criteria vary by state.

Begin the Hospice 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.