Deciding when to consider hospice care can be a difficult and emotional process. This guide explains when hospice may be appropriate, what to expect during the referral process, what services are covered, and where care can be provided.
Author: Caitlin McLaughlin, RN and Care Expert
When to Consider Hospice
There may come a time when an individual with a chronic illness or disease decides to focus on their quality of life—choosing to spend their remaining time in the comfort of their home (or another preferred location) with loved ones. This decision may stem from exhaustion due to frequent emergency department visits and hospital admissions.
If you’re wondering about alternative care options, a hospice referral may be appropriate. A hospice agency can evaluate the individual’s situation to determine whether they meet the criteria for hospice care. To qualify, the individual must have a hospice-eligible diagnosis, and a physician must determine that they have six months or less to live.
In some cases, a care team may inform the patient that all treatment options have been exhausted or that further treatment would cause more harm than benefit. At this point, the care team may discuss the advantages of hospice care.
What Happens Next?
A referral will be made to a hospice agency that is in-network with the patient’s insurance provider. This referral can come from a physician, nurse, social worker, or directly from the patient or a loved one. The hospice agency will then work with the patient’s doctor to obtain medical records, verify insurance coverage, and contact the patient and their family to schedule an intake appointment.
During the intake, the patient and their loved ones will meet with a hospice nurse who will:
- Review the patient’s medical history
- Conduct an assessment
- Review current medications
- Discuss any symptoms the patient is experiencing
The nurse will also explain any necessary or recommended medical equipment and inform the patient about which medications will be covered under hospice care. Some medications may be discontinued if they are no longer necessary, but this will be discussed with both the hospice agency and the patient’s doctor.
If symptoms are not well managed, the nurse will collaborate with the physician to adjust medications for better symptom control. The primary nurse will develop a visit schedule based on the patient’s condition, with visits increasing as needs change.
While hospice care provides 24/7 phone support and in-person visits as needed, it does not offer continuous in-home care. Hospice visits typically last 30 to 60 minutes, similar to a standard visiting nurse appointment.
Hospice Coverage
Hospice care is covered by most insurance plans. Coverage typically includes:
- Medications related to the hospice diagnosis (such as those for nausea, pain, breathing difficulties, and anxiety)
- Necessary medical equipment (e.g., hospital beds, oxygen, bedside commodes)
Hospice Care Team
The hospice care team typically includes:
- A primary nurse
- A home health aide
- A social worker
- A medical director
- A chaplain (if requested)
- Grief counselors
Where You Can Receive Hospice Care
- At home: Family members may provide care, with or without private caregivers.
- At home with private caregivers: Private caregivers take on full responsibility for care.
- In an assisted living facility: Care is provided by facility staff in collaboration with the hospice nurse. Check whether the facility has 24/7 nursing support for medication administration; if not, private caregiving may be necessary.
- In a nursing home: Hospice teams collaborate with nursing home staff to provide care, monitor symptoms, and adjust medications. While hospice care is covered by insurance, room and board at a nursing home is typically paid out of pocket or through Medicaid.
- Hospice house: In some regions, hospice houses provide a home-like environment and are operated by hospice agencies. The cost is usually similar to a nursing home’s daily rate and is often paid out of pocket. Some hospice houses offer intensive symptom management, which may be covered by insurance.