Frequently Asked Questions
HOSPICE CARE: FREQUENTLY ASKED QUESTIONS 
- When is the right time to ask about hospice services?
- Is hospice just for cancer patients?
- Why should we choose hospice services?
- What care and services can we expect from hospice?
- Who pays for hospice?
- Who is eligible to receive hospice services under the Medicare Hospice Benefit?
- What does Medicare cover?
- Will hospice come to me wherever I live?
- How do we decide which hospice to choose?
- How does hospice get started?
- Am I “giving up” if I choose hospice?
- May I keep my own doctor?
- May I continue with my treatments and therapies?
- Will I be in pain?
- I don’t want to become a burden on my family. How can hospice help?
- What if my family is unable to care for me?
- Will my personal beliefs be respected?
- When is the right time to ask about hospice services?
Although end-of-life care discussions may be difficult, it is best for family members and loved ones to share their wishes long before it becomes a concern. When the goal of treatment begins to shift from curing the illness to providing comfort, it is time to consider hospice. Families may feel this time has come long before a physician indicates that the patient's life expectancy is six months or less. By contacting hospice early, the patient and family have more time to understand their options and choose the path that will have the most positive impact on quality of life. The best time to learn about hospice is before you need it.
- Is hospice just for cancer patients?
In its earliest years, hospice was associated primarily with a cancer diagnosis. However, now hospice care has been made available to people with any life-limiting illness, including: cardiac and respiratory diseases, neurological diseases, AIDS, liver disease, Parkinson's disease, Alzheimer's disease, dementia, and others. If you are not certain whether your diagnosis is appropriate for hospice, speak with your doctor or a hospice in your community.
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Why should we choose hospice services?
When trying to decide about hospice care, take some time to think about the following:
- Hospice treats the person, not the disease; focuses on the family, not only the individual patient; and emphasizes the quality of life, not its duration.
- Hospice teams are experts in palliative, or "comfort" care, using of state-of-the-art pain and symptom management techniques.
- Hospice helps patients to focus on living their remaining days fully, at home, among family and friends.
- Hospice care relies on the combined knowledge and skill of a team of professionals, including physicians, nurses, certified nursing assistants, social workers, counselors, and volunteers.
- Hospice care allows terminally ill patients and their families to remain together in the comfort and dignity of their home and, if they wish, to die in familiar surroundings.
- Hospice care is a cost?effective alternative to the high costs associated with hospitals and traditional institutional care
If these characteristics of hospice feel right to you, your family and your physician then hospice may be the right choice.
- What care and services can I expect from hospice?
Hospice services are delivered by a team of healthcare professionals, including a physician, a nurse, clergy/counselor, a social worker, volunteer, and hospice aide. As appropriate, a pharmacist, dietician, physical, occupation, and speech therapist may also supplement the team. Most hospice patients, both nationally and in Virginia, choose to stay in their own home or in the home of a family member when receiving hospice care. Others receive care in nursing homes, assisted living residences, hospitals or hospice facilities.
Care is delivered to the home, including nursing home or assisted living setting, through pre- scheduled visits from hospice team members. Often it is the nurse who visits most frequently, up to several times a week depending on need. Other members of the team visit as often as needed to meet the support and comfort goals of the hospice patient and family. Hospice team care and the patient's progress are closely monitored by a physician are rare, through regular contact and team meetings.
In recognition that death is a natural part of life, hospice does not participate in any activity which hastens or prolongs the dying process is neither. The team focuses on pain and symptom management, understanding that psychological and spiritual pain are as significant as physical pain and will receive the same active attention as other forms of distress. As far as hospice is concerned, the family’s care needs and are just as important as the patient’s and so they also receive attention from the entire hospice team Bereavement support is extended to the family (how ever the patient may choose to define it) for up to a year after the patient has died.
Beneficiaries of Medicare Part A may elect their Medicare Hospice Benefit. Under this benefit, all the costs of the care, the services of the team, medications, equipment and supplies related to the person's terminal diagnosis are covered by Medicare. Virginia Medicaid and many private insurers have similar hospice benefits. Additional funding needed to support hospice operations comes from memorial gifts or community fundraising. Hospices are dedicated to providing quality care regardless of race, religion, sex, age, physical or mental disabilities, or ability to pay. To enroll in hospice under the Medicare benefit, a person must have an illness that, in a physician's professional opinion, is likely to cause their death within six months if the disease is allowed to run its normal course. At this time treatments directed toward curing the disease (which by now may be ineffective or too burdensome to continue) are stopped and all the focus is turned to comfort. Hospice care aggressively treats pain and other symptoms providing much needed relief and personal comfort.
Virginia is home to about one hundred licensed hospices serving almost every county in the Commonwealth and most of these are certified by Medicare and the Department of Medicaid Services. The majority of Virginia’s hospices are independent nonprofit community based programs; a few are branches of national chains and others are associated with hospitals or home-health agencies.
- Who pays for hospice?
Hospice is paid for through the Medicare Hospice Benefit, Virginia Medicaid Hospice Benefit and most private insurers. If a person does not have coverage hospice will work with the person and their family to ensure that needed services can be provided.
- Who is eligible to receive hospice services under the Medicare Hospice Benefit?
You are eligible for Medicare hospice benefits when you meet all of the following criteria:
- You are eligible for Medicare Part A (Hospital Insurance)
- Your doctor and the hospice medical director certify that you have a life-limiting illness and if the disease runs its normal course, death may be expected in six months or less
- You sign a statement choosing hospice care instead of routine Medicare benefits for your illness*
- You receive care from a Medicare-certified hospice program
*Medicare will still pay for covered benefits for any health needs that aren’t related to your life-limiting illness.
- What does Medicare cover?
Medicare has specified a set of core hospice services, which hospices are required to provide to each person they serve regardless of the persons insurance. Medicare covers the following:
Doctor services
Nursing care
Hospice Aides (for personal care)
Social work services
Trained volunteers
Counseling services, including dietary, spiritual and bereavement,
Medications, medical equipment and supplies that are related to the terminal illness
Physical, occupational and speech therapy
Short-term inpatient care for pain & symptom management or respite
Grief support to help you and your family
You may have to pay a small co-pay for medications and respite care.
*(Private insurance coverage may vary)
- Will hospice come to me wherever I live?
Hospice care is provided primarily in the home. For some, "home" may mean a house or an apartment. For others, it may be some form of extended care facility, such as a nursing home or assisted living community. Please note that even though you may receive hospice services wherever you live, hospice benefits do not cover room & board services. The majority of hospice patients live in their own home with the help of a family member or friend who serves as the "primary caregiver." This caregiver works closely with the hospice team to provide for the patient's daily needs. In extended care facilities, hospice teams create a partnership with the staff and family, just as they would with the family in the home.
Even if you move to another town or state, your hospice can make arrangements for you to receive hospice care from the provider in your new location.
In addition to home care, hospice provides short-term inpatient care, most frequently in a hospital setting, when necessary to manage distressing symptoms or to give the family a brief rest from the responsibilities of caregiving. During these times, the hospice team remains involved and helps the patient transition back to the home environment as quickly as possible.
- How do we decide which hospice to use?
Talk to people you know who have used hospice in the past including your doctor and other healthcare providers. By asking some of the following questions you will be able to decide which program is right for you
- Are you certified by Medicare and/or accredited? How long have you been operating as a state licensed and certified or accredited hospice?
- Are you a member of the Virginia Association for Hospices & Palliative Care or NHPCO Quality Partners?
- What services do you provide?
- How often will the hospice team members visit?
- What does the hospice volunteer do?
- How are services provided hours and on weekends or holidays?
- What are our options if I or my loved one can’t stay at home? Or what if my family needs a break?
- With which nursing homes or other long-term-care facilities does the hospice work?
- What kind of support is available to the family/caregiver?
- In what ways do you provide bereavement care and grief counseling?
- How long does it usually take to get enrolled in hospice?
- (If applicable) Do you have special services for the members of my cultural/religious group?
- How does hospice get started?
You, your family or a friend may contact hospice even if your doctor has not made a referral for hospice care. The hospice will contact him/her for approval and a liaison from the hospice will visit to your home to discuss the details of the program with you and your family. You or your decision maker will be asked to sign consent and insurance forms.
- Am I "giving up" if I choose hospice?
Hospice care focuses on enhancing the quality of life as it draws to a close. Hospice seeks neither to shorten nor prolong life. You may choose to leave hospice care at any time and return to aggressive curative treatment for the disease. The choice is always yours. A physician's referral to hospice care usually indicates that curative measures are no longer appropriate.
- May I keep my own doctor?|
Yes. Your doctor will play a crucial role on the hospice team working closely with hospice to develop a plan of care that best meets your individual needs and those of your family and caregivers. In addition, the hospice nurse will keep your doctor regularly informed about your condition and any changes that take place.
- May I continue with my treatments and therapies?
Palliative treatments and therapies used by hospice focus on controlling symptoms and managing pain, rather than attempting to cure. Some treatments can be either curative or palliative, so you should discuss with your physician which treatments will be provided in your hospice plan of care. If you wish to continue to aggressively seek a cure, hospice may not be right for you at this point in time.
- Will I be in pain?
Pain is not an inevitable side effect of terminal illness. For more than 25 years, hospice doctors and nurses have been dedicated to providing the very best pain control and symptom management. With appropriate medications and management of a person's changing condition, the vast majority of hospice patients can be alert and pain free throughout the course of an illness.
- I don’t want to become a burden on my family. How can hospice help?
This is a common concern with people who have a life-limiting illness. You should know that hospice provides considerable support to your family, helping them to manage your care in an environment of trust and respect. Many hospice families describe the experience of taking care of a loved one as one of the most meaningful in their lives a time when they strengthened relationships and captured valuable memories.
- What if my family is unable to care for me?
Some people do not have the option to stay with a family member who can serve as their primary caregiver and hospice can work with you where ever you choose to live, in an assisted living community or other extended care facility. Hospice will work with you to address your unique situation to ensure your safety and well being.
- Will my personal beliefs be respected?
From its beginning, hospice has demonstrated a profound respect for each person's unique values and beliefs. All hospice team members acknowledge diversity in cultural heritage, faith, spirituality, and lifestyle. If requested, hospice chaplains can provide an extra measure of support, offering spiritual comfort with an attitude of openness and acceptance.
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