topic | preparing for end of life - final days

Step 3: hospice care

Once end of life is near and skilled care options have been exhausted, focus is on comfort for the loved one. Hospice caregivers are professionals who provide physical, emotional, social, and spiritual support for the 'whole person', including:

  • Physical care such as physical therapy, hygiene care, etc.
  • Medications and supplies as part of pain management;
  • Emotional and grief support by clergy, social workers, and volunteers
  • Respite relief for home caregiver
  • Coaching home caregiver
  • And others....

In most cases, hospice care is provided in the home, but it may also be provided in hospice centers, nursing homes, hospitals, and other long-term care facilities. As stated in the previous step, hospice nurses/doctors are on-call 24/7 regardless of where the care is administered.

Working together, the hospice team creates a family-centered plan using expertise from:

  • Physicians
  • Social workers
  • Clergy or other counselors
  • Nurses
  • Trained volunteers

Before selecting a hospice, be sure to understand how it will be paid for. The following activities will help.


Activity 1
Determine eligibility for Medicare and other funding

To qualify for Medicare, one must meet all of the following requirements:

  • Treatment by a Medicare-approved hospice
  • Medicare Part A (Hospital Insurance) eligibility
  • Physician certification of less than 6 months life expectancy
  • Patient signature confirming choice of hospice instead of other Medicare-covered benefits
For patients not eligible for Medicare, alternative funding may be available through hospice foundations, Medicaid, HMOs or other managed care plans. Check with the patient's medical insurance provider (see Insurance Policies) to determine if there is coverage.


Activity 2
Select a Hospice
Factors to consider in choosing a hospice include:
  • Recommendations by physicians, friends, etc.
  • Is the hospice Not for Profit?
  • Does the hospice have an 'in house' facility?
  • Is the hospice a member of the National Hospice Palliative Care Organization? (http://nhpco.org/templates/1/homepage.cfm)

Best Practices

If the patient is in a nursing home or assisted living facility, ensure the hospice that is being considered is under contract with that care facility. If not, ask the hospice if they can make those arrangements with the center.



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