What is hospice, and how is it used in cancer care?
Hospice is a special type of care in which medical, psychological, and spiritual support are provided to patients and their loved ones when cancer therapies are no longer controlling the disease. Hospice care focuses on controlling pain and other symptoms of illness so patients can remain as comfortable as possible near the end of life. Hospice focuses on caring, not curing. The goal is to neither hasten nor postpone death. If the patient’s condition improves or the cancer goes into remission, hospice care can be discontinued and active treatment may resume. Choosing hospice care doesn’t mean giving up. It just means that the goal of treatment has changed.
The hospice team usually includes doctors, nurses, home health aides, social workers, clergy or other counselors, and trained volunteers. The team may also include speech, physical, and occupational therapists, if needed. A hospice team member is on-call 24 hours a day, 7 days a week to provide support. The hospice team will work with the patient on the patient’s goals for end-of-life care, not a predetermined plan or scenario. Hospice care is very individualized.
Hospice services may include doctor or nursing care, medical supplies and equipment, home health aide services, short-term respite (relief) services for caregivers, drugs to help manage cancer-related symptoms, spiritual support and counseling, and social work services. Patients’ families are also an important focus of hospice care, and services are designed to give them assistance and support.
Hospice care most often takes place at home. However, hospice care can also be delivered in special in-patient facilities, hospitals, and nursing homes.
Who is eligible for hospice care?
Under most insurance plans in the United States, including Medicare, acceptance into hospice care requires a statement by a doctor and the hospice medical director that the patient has a life expectancy of 6 months or less if the disease runs its normal course. The patient also signs a statement saying that he or she is choosing hospice care. (Hospice care can be continued if the patient lives longer than 6 months, as long as the hospice medical director or other hospice doctor recertifies the patient’s condition.)
The hospice team or insurance provider can answer questions about whether specific care decisions, such as getting a second opinion or participating in a clinical trial while in hospice care, would affect eligibility for hospice services.
How can people get help paying for hospice services?
Medicare is a government health insurance program for the elderly and disabled that is administered by the Centers for Medicare & Medicaid Services (CMS). The Medicare hotline can answer general questions about Medicare benefits and refer people to their regional home health intermediary for information about Medicare-certified hospice programs. The hotline number is 1–800–MEDICARE (1–800–633–4227); callers with TTY equipment can call 1–877–486–2048. The booklet Medicare Hospice Benefits is available on the Medicare website. The Hospice and Respite Care page, also on the Medicare website, has answers to frequently asked questions about Medicare coverage for hospice and respite care.
Medicaid, a federal-state partnership program that is part of CMS and is administered by each state, is designed for people who need financial assistance for medical expenses. Information about coverage is available from local state welfare offices, state public health departments, state social services agencies, or the state Medicaid office. Information about specific state locations can also be found online.
Information about the types of costs covered by a particular private policy is available from a hospital business office or hospice social worker, or directly from the insurance company.
Local civic, charitable, or religious organizations may also be able to help patients and their families with hospice expenses.
What is the difference between hospice and palliative care?
Although hospice and palliative care share the same principles of providing comfort and support for patients, palliative care is available throughout a patient’s experience with cancer, whereas hospice is offered only toward the end of life. A person’s cancer treatment continues to be administered and assessed while he or she is receiving palliative care, but with hospice care the focus has shifted to just relieving symptoms and providing support. The NCI fact sheet Palliative Care in Cancer has more information about palliative care.
Where can people learn more about hospice?
The following organizations can provide more information about hospice.
The National Hospice and Palliative Care Organization’s Caring Connections website offers information and publications focused on improving end-of-life care for adults and children. The site includes a database of national hospice programs. Some Spanish-language publications are available.
Hospice Association of America
The Hospice Association of America distributes publications on such topics as the history of hospice, the benefits of hospice, hospice-related statistics, and locations of hospice organizations.
Hospice Net provides information and support to patients facing life-threatening illnesses and to their families and friends.
American Cancer Society
The American Cancer Society (ACS) provides free fact sheets and publications about hospice. The address of a local ACS chapter can be obtained by calling the organization’s toll-free telephone number.