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Hospice is a concept and a program of care that is specifically designed to minimize suffering for dying people and their family members. In the United States, hospice is the only widely available comprehensive program to support very sick people at home. Hospice programs forgo most diagnostic testing and life-prolonging treatments in favor of symptom relief. They also educate patients and family members about appropriate care and comfort care.
Hospice always involves different types of professionals, such as doctors, nurses, social workers, and attendants (for example, home health aides). Pharmacists, nutritionists, and therapists may also be involved. Hospice program personnel care for people at home, in nursing homes, or in other care facilities. Although hospice program personnel do not usually care for patients in hospitals and rehabilitation centers, many hospitals are establishing care programs that treat symptoms fully (palliative care services) to address the same care issues.
Hospice programs differ from each other in the services they readily provide and in treatments and devices they support and use. Whether hospice care serves a particular person and family best depends on their needs and wishes, on financial considerations, and on the skills and capacity of the local programs.
Hospice care can provide most necessary medical treatments, and physicians stay involved. Nurses ordinarily oversee the general plan of care, including drug use, oxygen therapy, and intravenous lines or other special equipment. Social workers, chaplains, and volunteers help address interpersonal, spiritual, and financial issues. Bereavement counselors provide support and insight during the grieving process. Hospice plans of care help family members prepare for the challenges of facing the death of a loved one and dealing with the situation at the time of death, including their roles and how to obtain needed help.
Most people ill enough to require hospice also require some assistance with daily activities (for example, dressing, bathing, and preparing food), and some may be completely dependent. Family members and friends often provide this care, and the hospice or the family can provide additional paid help from home health aides.
Medicare or insurance pays for most hospice services, but usually only after a physician certifies that the patient has a fatal disorder and is expected to live less than 6 months.
Doctors may be reluctant to use hospice because a treatable condition outside of the hospice program's capabilities could develop. However, many treatable conditions are within the scope of hospice care, and patients can leave hospice at any time in order to try a promising treatment and re-enroll later. Therefore, this reluctance is not justified.
Last full review/revision October 2007 by Joanne Lynn, MD
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