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Frequently Asked Questions
The following are some basic answers to frequently asked questions about a hospice program of care
Additional information about hospice is available from the California Hospice and Palliative Care Association or from a hospice in your area. See more information about Advance Health Care Directives >
- What is hospice?
- Are there different types of hospice programs?
- When and how are hospice referrals made?
- Is hospice just for people with cancer?
- What services are covered?
- What isn't covered?
- What if someone changes their mind and wants to go back to curative treatment?
- Where is hospice care provided?
- When is it appropriate to ask about hospice? How does it begin?
- Does someone give up their physician if they choose hospice care?
- What kind of health care professionals provide hospice care?
- What is a hospice plan of care?
- Are family members involved in hospice care?
- What if someone doesn't have family who can serve as caregivers?
- Does the patient's primary physician work with the hospice team?
- Who pays for Hospice?
- Can I Change My Mind?
What is hospice?
Hospice is available to people living with an end-stage disease including cancer, pulmonary disease, ALS, heart disease, dementia, Alzheimer's, and any other life-threatening illness. Hospice care is available to patients who no longer wish treatment directed at curing their disease. The hospice benefit is flexible. Initially, a physician certifies that the patient has a life expectancy of six months or less, if the disease follows its normal course. The first two certifications are for 90 days each. Thereafter, the physician re-certifies eligibility every 60 days. As long as the patient is re-certified, he/she remains eligible for hospice, even when the timeline exceeds six months. Programs are available for adults, children and infants. When cure is no longer a real possibility, hospice focuses on and treats the person, not the disease. A primary goal is to control pain and other symptoms so the patient can remain as alert and comfortable as possible. Hospice includes all of the services needed to manage an individual's medical care and also provides emotional and spiritual support for the whole family. Hospice stresses quality of life and is an alternative to extended medical or curative treatments. Many people actually live longer under hospice because their symptoms are managed and treated based on their unique needs and preferences.
Are there different types of hospice programs?
Hospice programs differ in size, scope of care, and organization. Programs may range from volunteer hospices that rely heavily on professional and lay volunteers, to organizations that provide comprehensive palliative and support services through employees and lay volunteers.
When and how are hospice referrals made?
Hospice care is available to terminally-ill patients who no longer wish treatment to cure their disease and who have a limited life expectancy (6 months or less). Although the patient's primary physician usually refers to hospice, referrals can also be made by family members, friends, clergy, or health professionals.
Is hospice just for people with cancer?
No. Hospice care can be provided to people with end-stage heart disease, dementia, and lung disease, in addition to cancer and other diseases. The focus of hospice is to support the best quality of life that is possible, not only for the person who is ill, but for his or her loved ones.
What services are covered?
No. Hospice care can be provided to people with end-stage heart disease, dementia, and lung disease, in addition to cancer and other diseases. The focus of hospice is to support the best quality of life that is possible, not only for the person who is ill, but for his or her loved ones.
Hospice nurses evaluate what the person and family need in terms of physical, emotional and spiritual support and coordinate care with a physician and a team of health professionals. These services are usually covered by Medicare and other commercial insurance. Family members can also receive bereavement support for up to one year. Besides the support services, the patient's primary physician can continue to bill Medicare under its Part B benefit.
What isn't covered?
Hospice insurers, including Medicare, don't pay for a round-the-clock home nursing, although they may cover a limited amount. Family and friends are the primary caregivers, with 24-hour access to health professionals who are on call to help manage a patient's symptoms and support the family. Because hospice is aimed at palliative (comfort) care, it also does not pay for clinical trials or other medical services aimed at cure.
What if someone changes their mind and wants to go back to curative treatment?
They can leave the hospice program. Later, if the person wants to return to hospice, and still meets program criteria of a six month life expectancy, they can return.
Where is hospice care provided?
Hospice care is most often provided at home, but it can also be provided to someone who is in a skilled nursing or assisted living facility. Although less common in California than in some other regions, there also are some facilities that are dedicated to hospice care.
When is it appropriate to ask about hospice? How does it begin?
You don't have to wait until a physician brings up hospice to ask about it. The best time to learn about hospice and ask questions is before such services might be needed. Hospice care is available to people who are expected to live six months or less, no longer wish to pursue a cure and want to receive hospice care. Hospice care begins with a referral — usually from someone's primary physician — but referrals can also be suggested by family members, friends, faith leaders, or health professionals. Hospice usually begins within 48 hours after a referral, but services may start faster in an urgent situation. For example, if someone is in a hospital, hospice care may be arranged to start upon discharge from the hospital.
Does someone give up their physician if they choose hospice care?
Choosing hospice does not mean that someone has to give up their relationship with their physician. Some families become very involved with the hospice teams that support them, which include a medical director who has extensive experience in pain management. Personal physicians can remain involved and informed and can bill for their professional services.
What kind of health care professionals provide hospice care?
Hospice programs are known for their coordinated teams that draw upon many different kinds of professionals to ensure that services and resources are provided when needed, without the family having to locate and arrange for them. The interdisciplinary team includes a physician, nurses, and social workers — along with spiritual counselors, home health aides, therapists, and volunteers. The team develops a plan of care, teaches the family caregivers how to provide care, advocates for the patient and family, and provides bereavement support in addition to managing changing symptoms.
What is a hospice plan of care?
The plan of care is an outline of the care the hospice interdisciplinary team perceives as necessary to meet the needs of patients and families. It contains the plan the team develops to manage the patient's pain and symptoms, and also outlines plans for meeting the psychological, social and spiritual needs of the patient and family.
Are family members involved in hospice care?
Hospice views the patient and family as a unit of care. Family members and friends are encouraged to participate in the patient's care as much as possible. When family members cannot provide as much care as may be needed at certain times, hospice personnel will try to meet the patient's needs by exploring other options.
What if someone doesn't have family who can serve as caregivers?
Hospice programs may be able to help identify friends and people in the community who volunteer to help. All hospice programs have a group of volunteers who have been trained to support terminally-ill people and their families. They may provide companionship, emotional support, prepare light meals, run errands, or undertake other tasks to help.
Does the patient's primary physician work with the hospice team?
The patient's personal physician often refers the patient to the hospice program and usually either continues to plan most of the patient's care or works in coordination with the hospice team.
Who Pays For Hospice?
Hospice is covered by Medicare and most commercial insurance. It pays for a wide range of support services that are aimed at keeping someone as comfortable as possible - including medications, medical equipment, supplies, home assistance (such as for bathing), therapists, and respite care. While each hospice has its own policies concerning payment for care, it is a principle of hospice to offer services based upon need, rather than the ability to pay. While hospice care is a covered benefit under many insurance plans, hospices also rely heavily, if not entirely, upon community support for donations to provide care to those who cannot otherwise afford it.
Can I Change My Mind?
Yes, a person may elect to end their hospice care at any time and then may receive hospice care again, if desired, at a later date. For example, an individual can leave hospice to try a new curative treatment and return to hospice, if they still meet the program criteria of a six month life expectancy.
