How Hospice Works


Providing comfort and pain management to terminally ill patients are the primary focuses of hospice. LWA/Getty Images
Providing comfort and pain management to terminally ill patients are the primary focuses of hospice. LWA/Getty Images

My mother recently spent 15 days in hospice care, at the end of which she drifted peacefully out of this world from the comfort of her own home, surrounded by those who loved her most. The path to the end wasn't pleasant, but there was a measure of comfort in knowing that her final days and hours were pain-free, thanks to hospice.

That period was full of contradictions for me, as her primary caregiver. I was simultaneously glad that her suffering would be managed by caring professionals, but devastated at the prospect of letting her go. Thrilled by the coverage Medicare provided, while also wishing it could do even more to ease the stress, sadness and burden. Because, even though I'd seen hospice in action over the years with ailing relatives, until it walked into my house and set up shop, I had precious little comprehension of the service, what its goals are, who's involved and how it's paid for. Although nothing can completely take away the tragedy of such an experience, knowledge (at least in my opinion) can better equip a person to power through an unthinkable time.

Most of us know enough to associate hospice with impending death. Indeed, to qualify for the Medicare hospice benefit (more on that later), a doctor must attest that the patient has approximately six months or less to live, provided that person's illness runs its course as expected. Hospice services are rarely needed for anywhere near that amount of time, however. In fact, 2014 numbers show that 35.5 percent of hospice patients died within seven days of acceptance. A scant 10.3 percent surpassed the 180-day mark [source: National Hospice and Palliative Care Organization].

Often, hospice candidates have spent months or years locked in battle with major diseases, so the shift away from trying to cure the problem can be jarring, especially for family members. That's the main gist of hospice — no more curative measures are taken. Instead, providing comfort and managing pain are the primary focuses for patients for the duration of the illness. "The goal really for both patients and families is making sure that through this very difficult transition, it's the best experience it can be for everybody involved," says John Mastrojohn, executive vice president of National Hospice and Palliative Care Organization (NHPCO).

One of the most rampant misconceptions about hospice care is that it's primarily a service for terminally ill cancer patients. This is understandable because the roots of the movement date back to 1948 when British doctor Dame Cicely Saunders presented ideas about specialized care for terminal cancer patients, then went on to open the world's first hospice center in 1967. Today, however, cancer patients actually make up 36.6 percent of people served, according to a 2015 report [source: NHPCO]. In fact, the majority of patients receiving hospice are actually noncancer diagnoses, like dementia, heart disease, lung disease, stroke/coma, kidney disease and liver disease, among others.