Definition/Introduction

The underlying premise behind hospice care is to focus on the quality of care to patients who present with a life-limiting illness who are not expected to live more than six months instead of seeking treatment the prolong the condition or seek a medical cure. Hospice focuses on the entire person and supports the family by combining all elements of physical, psychological, and spiritual needs. The provision of hospice care can occur in an acute care setting; however, generally, the patients are cared for in a private residence or another residential living facility.[1]

Issues of Concern

Candidates of Hospice

The ideal candidates for hospice are patients nearing their final weeks to months of their life and want to focus on comfort measures rather than life-prolonging treatments. Physicians should give strong consideration in making a hospice referral when chronically ill patients present with a decreased functional status, spend more than half their time in bed or a chair and exhibit physical and psychological distress. A referral is paramount when there is a progressive decline in the patient's condition; their highest priority is to feel more in control and remain at home with support to keep comfortable.[2]

Qualifying for Hospice Benefits

Patients over 65 years of age or individuals younger than 65 with a long-term disability will receive coverage through Medicare Part A benefits. If a patient is ineligible for Medicare hospice, benefit coverage will vary depending on the individual's health insurance coverage.[3]

Currently, Medicare has four major qualification criteria to cover hospice services:

1. Eligible for Medicare Part A
1. United States citizen/legal resident eligible for Social Security benefits
2. Over 65 years of age or eligible for Medicare services due to long-term disability for greater than two years or having end-stage kidney disease
2. Certification by Medicare as a recognized hospice facility
3. Patient verification choosing hospice services instead of utilizing regular Medicare coverage
4. Certification from both a physician and hospice medical director verifying the patient has received a diagnosis of a terminal illness, and in typical circumstances, without treatment to prolong the patient's disease, they are expected not to live more than six months[4]

Hospice Coverage

When a patient has a terminal condition, Medicare will provide hospice care, including comprehensive services related to a terminal illness. The array of benefits may include:

1. Medical equipment
2. Medical supplies
3. Skilled nursing care
4. Medications to aid in the terminal illness to provide comfort
5. Social workers and chaplains
6. Home health care aids
7. Bereavement support
8. Short term inpatient and respite care[4]

Clinical Significance

Hospice provides patients with many benefits. Some of the benefits of hospice include a 24-hour on-call nurse, increased availability to health care professionals, and reduced to no cost durable medical equipment and medications to increase comfort. Additionally, patients who chose to die at home with hospice care exhibited an improved quality of life; this was also true for their family members. Once patients and their families have acknowledged the seriousness and life-limiting nature of the underlying disease, discussions regarding hospice as a care option should begin. Patients who have a prognosis of six months or less should be urged to enroll in hospice care so the family and patient can focus on improving their symptoms and increasing their comfort.

Unfortunately, acceding to hospice care is a difficult choice; once the patient and their family members accept the condition as a terminal illness, hospice care may be the best option. Hospice care provides the necessary support and cares to optimize the overall end-of-life patient and family experience when medications and treatments will no longer improve the patient’s condition.[5]

Nursing, Allied Health, and Interprofessional Team Interventions

Hospice care requires a highly coordinated interprofessional effort, including clinicians with specialized end-of-life training, specialty-trained hospice nurses, medical aids, and of course, the patient and their family.[6] A hospice agency coordinator (usually a nurse) can ensure that the patient derives maximum benefit from their insurance coverage and coordinate activities given the coverage available.[7] Only through this type of interprofessional teamwork can hospice care achieve its intended benefit for both the patient and their family members. [Level 5]