When is hospice appropriate?


The decision to elect the Medicare Hospice benefit can be difficult. It’s a process and families need time to reach the decision.  I always used to say,” don’t wait too long and suffer more horrible nights alone, not knowing what to do.” Once they realized how helpful the hospice team is, families have often said that they wished they would have started hospice sooner.

  1. Medicare defines hospice to be a program of care that can be elected by a person with an incurable illness which, if it runs its normal course, will last for 6 months. Physicians admit that it is sometimes very difficult to determine. Medical practitioners often say that they do not have a crystal ball, and the disease course will vary from person to person.
  1. The primary care physician or nurse practitioner to assist the patient in deciding when the negative effects of treatment or medication outweigh the benefits. The goal at this point is to get the highest quality of life for the time remaining.
  1. Medicare Hospice Benefit covers most hospice expenses such as: Visits by Nurses, Home Health Aides, Social Workers, Spiritual and Bereavement Counselors and Volunteers to name a few. It also covers medications for the terminal illness, equipment and medical devices such as hospital beds, wheelchairs, commodes, special mattresses, dressings and oxygen. Short term inpatient acute care, continuous care at home by nursing staff and nursing assistants, and respite care are also included. 

There is an on-call nurse who will take calls from patients and families during evening, overnight and weekend hours. That nurse will determine if a home visit is needed, or if the doctor should be called. The Hospice Medical Director is available if the primary physician is unavailable. Most programs will send a nurse at the time of death if the family wants a visit then.

Medicare designed the Hospice Program to make it easy to opt out of the benefit if patients choose to pursue a new course of treatment. If they opt out, they can easily resume the benefit at a later date. Patients may also switch to another hospice program once during a benefit period, if they so desire. If a patient wants to travel, the hospice will find an appropriate hospice to cover care while traveling.

Written by: Kathryn Wornson, RN, AGNP, MS. Hospice Specialist with 41 years in Home Care and Hospice