5 Common Questions About Hospice Care, Answered

Here's what you really need to know about end-of-life care

aid helping person get out of bed Photo: Getty Images

One of the biggest challenges anyone can face is caring for a loved one in their final days: figuring out not only how to alleviate pain and maximize comfort but also how to address their emotional and spiritual needs.

Hospice, which was initially introduced as a Medicare benefit in 1982, offers medical and counseling services to those who are terminally ill. It focuses on comfort and quality of life—not cures. Services can be given at home or in a care facility.

More on End-of-Life Care

It can be difficult to understand the benefits of hospice, the costs, and importantly, when and how to bring it up to a loved one. “It’s a hard conversation,” says Arif H. Kamal, MD, an associate professor at Duke University School of Medicine in Durham, N.C. But talking about hospice before it’s needed can help. Here’s what you need to know about this type of end-of-life care.

Who Is Eligible for Hospice?

Those who have a life expectancy of six months or less (if a disease follows its usual course), as certified by a doctor. Adults must also be willing to give up curative treatments, such as chemotherapy for cancer.

“It could be very beneficial for people to consider hospice as an option as soon as they get news of a terminal illness,” advises nurse practitioner Ginger Marshall, CEO of the Hospice and Palliative Nurses Association. “Often people wait too long, and miss out on the benefits and support the patient and the family could have received.”

Where Do People Get Hospice Care?

“Hospice is provided to an individual wherever they call home,” says Edo Banach, president and CEO of the National Hospice and Palliative Care Organization (NHPCO). This could be a private residence, nursing facility, freestanding residential hospice, or nursing home. “When a patient requires intensified skilled care related to their symptoms, they can be cared for in a hospice inpatient unit, skilled nursing facility, or hospital,” he says.

What Kind of Care Can We Expect?

Typically, a family member provides daily care and gives medications. A hospice benefit generally provides access to a nurse on the phone 24/7, visits from a nurse once or twice a week, visits from a nurse’s assistant one to seven times a week (generally for 1 to a few hours a day), physical and occupational therapy, medication for symptom control or pain relief, and dietary counseling.

A chaplain or social worker will also generally visit the patient and family to offer grief counseling and spiritual guidance. Medical equipment for the home is also provided as needed at no charge.

The type and frequency of care depends on the needs of the patient and the family, Banach says.

How Much Will This Cost?

Medicare, Medicaid, and most private health plans cover home hospice care, but there may be copayments or out-of-pocket costs for prescriptions, hospital visits, and more. (Long-term-care insurance may cover what health insurance does not.)

Because hospice services don’t generally include in-home care 24/7, additional home care is sometimes required. The cost can be substantial: Genworth, a long-term-care insurance provider, says the national average bill for a home health aide is more than $4,500 per month.

How Should I Choose a Hospice?

Your doctor or hospital discharge planner may be able to help. State health, hospice, or social service agencies may have lists of licensed agencies. Or check the NHPCO directory. At Medicare’s directory, you can evaluate hospice providers based on care qualities, illnesses commonly managed, how likely families are to recommend a provider, and more.

Banach at the NHPCO suggests asking in advance about staffing as well as the services and support a hospice offers (including after hours).

Editor’s Note: A version of this article also appeared in the November 2021 issue of Consumer Reports On Health.

Lori Loannou

Lori Ioannou

Lori Ioannou is an award-winning journalist who writes on health, consumer affairs, careers, small business, investing, and technology. She was the senior editor for special reports at CNBC and an executive editor at Time Inc.