How Hospice Works

Where Do You Go for Hospice, and Who Pays for It?
Bud Anderson holds a therapy dog named Sally Sue, during a hospice visit at his house on Aug. 31, 2009. John Moore/Getty Images

A prevalent hospice myth is that people who enter hospice have to go somewhere to receive care. "About 94 percent of hospice care is routine home care," Mastrojohn explains. "That surprises most people. Most think the majority of hospice care is provided in a facility."

Almost all hospice patients receive care in their own home, or a place they call home, like an assisted living facility or family member's house. Dedicated hospice facilities do exist but are used far less often. "The difference is that those are the type of patients that are more acute. Their pain or symptoms can't be well controlled in the home," Mastrojohn says.

Respite care is another infrequent, but available hospice option. "It's basically care for the patients but it's really provided as a benefit for family members," Mastrojohn explains. The demands of constant caregiving can be exhausting, so respite care is available for a short break. "This is typically provided outside the home in a licensed facility such as a nursing home, up to several days. Then the patient can go back home." People using the Medicare hospice benefit can use respite care up to five days at a time, on an occasional basis.

Hospice situations come with enough stress, so probably the most pleasant surprise to both patient and family is that hospice care usually doesn't cost a penny extra. This is due to the 1982 passage of the Medicare hospice benefit, which is the predominant payer of hospice services by a long shot. In fact, in 2014, Medicare covered costs of 85.5 percent of hospice patients [source: NHCPO].

The benefit is uniform across all states, and applies to the great majority of hospice patients, who often qualify for Medicare simply by virtue of their age. A person has to be 65 to be eligible for Medicare (although certain people can qualify earlier), and in 2014, almost 84 percent of hospice patients were age 65 or older [source: NHCPO].

Every cost is covered fully by Medicare, from pain relief and symptom control medications (other types of meds are not covered) to equipment (hospital beds, shower chairs, bedside toilets, adult diapers, bath wash) to provider services. "It's really a comprehensive benefit. Everything is paid for related to that patient's terminal illness," Mastrojohn says. However, if a patient is too young to qualify for Medicare, he or she may get hospice benefit through a Medicaid state program. "And most insurances now have a benefit that's basically structured off the hospice benefit," he notes.