Considered to be the model for quality, compassionate care for people facing a life-limiting illness or injury, hospice care involve a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient’s needs and wishes. Support is provided to the patient’s loved ones as well.  At the center of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so.

Now is the best time to learn more about hospice and ask questions about what to expect from hospice services.  Although end-of-life care may be difficult to discuss, it is best for family members to share their wishes long before it becomes a concern.  This can greatly reduce stress when the time for hospice is needed.  By having these discussions in advance, patients are not forced into uncomfortable situations.  Instead, patients can make an educated decision that includes the advice and input of family members and loved ones.

Typically, hospice care starts as soon as a formal request or a ‘referral’ is made by the patient’s doctor.  Often a hospice program representative will make an effort to visit the patient within 48 hours of that referral, providing the visit meets the needs and schedule of the patient and family/primary caregiver.  Usually, hospice care is ready to begin within a day or two of the referral.  However, in urgent situations, hospice services may begin sooner.

• Progressive decline in status despite curative treatments
• Frequent hospitalizations
• Repeat or multiple infections
• Increased or uncontrolled pain
• Progressive/profound weakness and fatigue
• Shortness of breath with or without oxygen
• Dependency (decrease in ADLs)
• Alterations in mental status
• Weight loss

• Alzheimer’s/ dementia
• Cancer
• Heart disease
• HIV
• Liver disease
• Neurological disorders
• ALS
• Parkinson’s
• Nonspecific illness
• Stroke and/or coma
• Pulmonary disease
• Renal disease

• Nursing services
• Home health aides
• Medical social services
• Bereavement services
• Spiritual counseling
• Pharmacy services
• Nutritional counseling
• Infusion therapy
• Medical equipment and supplies
• Inpatient respite
• Physical, occupational, & speech therapy
• Volunteer support
• Pain & symptom control
• Physician directed medical services
• Wound care management

Many patients may have pain and other serious symptoms as illness progresses.  Hospice staff receives special training to care for all types of physical and emotional symptoms that cause pain, discomfort and distress.  Because keeping the patient comfortable and pain-free is an important part of hospice care, many hospice programs have developed ways to measure how comfortable the patient is during the course of their stay in hospice.  Hospice staff works with the patient’s physician to make sure that medication, therapies, and procedures are designed to achieve the goals outlined in the patient’s care plan.  The care plan is reviewed frequently to make sure any changes and new goals are in the plan.

Hospice services can be provided to a terminally ill person wherever they live.  This means a patient living in a nursing facility or long-term care facility can receive specialized visits from hospice nurses, home health aides, chaplains, social workers, and volunteers, in addition to other care and services provided by the nursing facility.  The hospice and the nursing home will have a written agreement in place in order for the hospice to serve residents of the facility.

The Medicare Hospice Benefit requires that a terminally-ill patient have a prognosis of six months or less: There is not a six-month limit to hospice care services.

Under the Medicare Hospice Benefit, two 90-day periods of care (a total of six months) are followed by an unlimited number of 60-day periods.

A patient in the final phase of life may receive hospice care for as long as necessary when a physician certifies that he or she continues to meet eligibility requirements.