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Hospice is a concept and program of care that is specifically designed to minimize suffering for dying patients and their family members. In the US, hospice is the only widely available comprehensive program to support very sick people at home. Philosophically, hospice programs forgo most diagnostic testing and life-prolonging treatments in favor of symptom relief, education of patients and family members about appropriate care, and comfort care.
Hospice is always interdisciplinary, relying on a core team of physicians, nurses, social workers, and attendants (eg, home health aides). Pharmacists, nutritionists, and therapists may also be involved. Hospice program personnel care for patients 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 palliative care programs to address the same care issues.
Hospice programs differ substantially in the services they provide and in treatments and devices they use. Whether a particular patient and family should participate in a given program depends on their needs and wishes, on their financial considerations, and on the skills and capacity of the local programs.
Hospice care can provide most necessary medical treatments. Nurses ordinarily oversee and implement the general plan of care, including drug use, O2 therapy, and IV lines or other special equipment. Nurses are usually the first ones to assess and address patient needs. They can usually adjust drug doses and help obtain any new drugs or treatments. Hospice physicians see patients when needed and share in shaping the plan of care. Social workers, chaplains, and volunteers help with interpersonal, spiritual, and financial issues. Bereavement counselors support survivors through 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 role and how to obtain needed help.
Most patients ill enough to require hospice also require some assistance with daily activities (eg, dressing, bathing, preparing food), and some may be completely dependent. Family members and friends often provide this care, but additional help from home health aides and volunteers may be necessary.
Medicare or insurance mostly pays a per diem rate that is intended to cover all hospice services, including a negotiated amount of help from home health aides, but only after a physician certifies that the patient has a fatal disorder with life expectancy < 6 mo.
Physicians may be reluctant to use hospice because a treatable condition could develop. However, this reluctance is not justified because many treatable conditions are within the scope of hospice care, and patients can leave hospice at any time and re-enroll later.
Last full review/revision November 2007 by Joanne Lynn, MD, MA, MS
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