What is Hospice Care at Home? A Comprehensive Guide

Hospice care is a comprehensive program for end-of-life care and support for terminally ill patients and their families. The focus of hospice services is on providing comfort and pain and symptom management rather than medical treatment or a cure for the patient’s illness. 

Family members of a person with a serious life-limiting illness have access to a range of services. Hospice care is designed to help terminally ill patients by providing comfort, meeting emotional and spiritual needs, making final decisions, and offering grief counseling. 

End-of-life palliative care services are offered in a specialized medical facility, assisted living facility, nursing home, or in the patient’s own home. Please continue reading to learn more about hospice care at home.

What is the definition of hospice care at home?

Hospice care at home focuses on providing care and comfort to people with serious illnesses approaching the end of life in the comfort of their own homes. An in-home hospice care program is designed according to the patient’s wishes. Family members can plan hospice care to give their loved one the best possible quality of life. 

Home hospice care allows patients to live as comfortably in their homes, enjoy their remaining days as best as they can, and pass peacefully, surrounded by loved ones. 

Hospice care at home includes a range of palliative services, including medical care for symptom management, emotional support, spiritual counseling, and more.

Who is in the hospice care team?

A terminally ill patient’s hospice care team usually includes several care providers. The choice of care providers depends on the patient’s illness and the level of care required. Hospice agencies will usually send a hospice provider to evaluate a patient’s needs and plan the hospice program accordingly. 

The palliative care team can include healthcare professionals to manage symptoms, a hospice physician to provide specialized care to a dying person, care aides, wound care specialists, nurses, therapists, and spiritual counselors for emotional and spiritual support. These hospice providers provide their services in the patient’s home. The patient’s primary caregiver is usually a family member who is supported by hospice aides. Hospice care providers may help with meal preparation and other household chores or provide respite care.

What is Medicare hospice benefit?

Medicare palliative care and supportive care services are provided to patients with a life-limiting illness and their family members according to an individualized plan of care that meets the patient’s needs. 

Medicare hospice care services are provided in patients’ homes, nursing homes, and inpatient hospice facilities. Patients with Medicare Part A qualify for hospice care benefits if:

• Care is obtained from a Medicare-certified hospice provider.
• The patient is certified as terminally ill by a healthcare team consisting of an attending physician and hospice physician, and the patient’s prognosis is a life expectancy of 6 months or less if the illness runs its usual course.
• The patient signs a statement choosing the hospice benefit and waiving rights to Medicare payments for the terminal illness and related conditions.

Once the patient is certified for a hospice health plan, they can receive the hospice benefit for two 90-day periods and, following recertification, unlimited 60-day periods after. The recertification requires documentation by a healthcare professional or hospice nurse practitioner that they had a face-to-face encounter with the patient and that the clinical findings indicate a life expectancy of 6 months or less.

What is included in hospice services?

The following palliative care services are usually included for hospice patients with serious illness. They may be provided at home or in a hospice facility.

• Services of a care team consisting of a hospice physician, hospice aide, nurse practitioner, and other healthcare professionals 
• Medical supplies
• Medical equipment
• Drugs for symptom management and pain relief
• Short-term inpatient treatment for pain control and symptom management 
• Homemaker services 
• Respite care
• Speech-language pathology services
• Physical therapy and occupational therapy
• Dietary counseling
• Spiritual counseling
• Medical social services
• Grief counseling before and after the patient passes

What is usually not included in hospice care?

Hospice benefit includes services required for pain management and symptom relief from the terminal illness and related conditions. Things that are not usually included in hospice care include:

• Curative treatments and prescriptions
• Primary caregiver (this is usually a family member) for care coordination
• Room and board charges
• Inpatient or outpatient services provided in a hospital setting
• Emergency room services
• Transportation, including ambulance transportation

How do you take care of a hospice patient at home?

Every patient has different needs and preferences at the end of life. Family members should aim to provide emotional support and physical comfort and make daily living as comfortable as possible for the patient through hospice and other services. Whenever possible, families should follow the patient’s wishes. It’s important to treat the dying person with respect and take steps to ensure a peaceful death.

What is the average time in hospice at home?

The average time in hospice at home can be different for every patient, depending on their illness and health status. By definition, hospice care is provided to people who are expected to live 6 months or less. However, your loved one’s healthcare team can give you a better estimate of what to expect in terms of life expectancy and duration of hospice care. 
 

References:

1. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice
2. https://www.nia.nih.gov/health/providing-comfort-end-life