Hospice questions

There is no set day. Hospice is usually considered when a doctor believes a person has about six months or less to live if the illness runs its usual course, and when the person chooses comfort care instead of treatment meant to cure the illness.

Many families say they wish they had asked sooner. You can talk with your doctor about hospice at any time, even before you are ready to enroll. Medicare also lets you have a one-time consultation with a hospice doctor about your options and pain control, even if you decide not to sign up.

You do, whenever you are able. Your doctor can recommend hospice, but the choice belongs to you. Medicare requires the hospice doctor and your regular doctor (if you have one) to certify that you are terminally ill, and you sign a statement saying you choose comfort care over treatment to cure your illness.

If you cannot decide for yourself, the person you named as your health care agent or proxy, or your legal next of kin, makes the choice with your doctors, guided by what you would want. The rules on who can decide for you vary by state.

Most doctors do, but not every doctor brings it up. You are allowed to ask. Say plainly, "Could hospice be right for me?" and ask for a referral. You can also call a local hospice yourself. The hospice will then check whether you are eligible.

If you have a doctor you trust, you can keep them. See the question below on keeping your own doctor.

Palliative care is comfort care for anyone with a serious illness, at any stage, and it can be given while you are still having treatment to cure or control your illness. Hospice is for people who are expected to live about six months or less and who choose to focus on comfort rather than cure. Hospice is a type of palliative care, but not all palliative care is hospice. You can ask your doctor about palliative care at any point after a diagnosis.

Yes. Medicare says you always have the right to stop hospice care at any time. Some people feel better with good symptom care and decide to return to treatment, and some leave hospice for a time because their condition improves.

If you decide to stop, don't sign or date any form until the day you actually want hospice to end. If you are still eligible, you can go back to hospice later.

Nothing changes as long as the hospice doctor confirms that you are still terminally ill. Medicare allows hospice to continue past six months, with a recertification that includes a face-to-face visit with a hospice doctor or nurse practitioner. Living longer is not a failure. Some people do well with comfort care and the support around them. If your health improves enough that you no longer qualify, you can leave hospice and return later if you qualify again.

Often, yes, and they will not be alone. Most hospice care happens at home, with a team that teaches your family what to do, brings the supplies and equipment, and checks in regularly. Medicare says a hospice nurse and doctor are on call 24 hours a day, 7 days a week.

Caring for someone at home is hard work. If your family needs a rest, hospice can arrange a short stay in a facility (see the question on respite care). If caring for you at home is no longer possible, there are other places hospice care can be given.

Your hospice team builds a plan of care around you. Under the Medicare hospice benefit, that plan can include:

• doctor and nursing care
• medical equipment and supplies
• medicine for pain and other symptoms
• help from home health aides
• physical, occupational and speech therapy when needed
• social work and counseling for you and your family
• spiritual care, if you want it
• grief support for your family after a death
• short-term inpatient care and respite care when needed

You decide what matters most, and the team works with you.

Yes. Hospice care can be given wherever you live, including an assisted living facility or nursing home. It can also be given in an inpatient hospice unit or, for short stays, in a hospital when your symptoms need closer attention.

Medicare does not pay for room and board in a nursing home or assisted living facility, even when hospice is covering your care there. Short inpatient and respite stays arranged by your hospice team are the exception.

Yes. Medicare says you can keep seeing your regular doctor or nurse practitioner if you choose them as your attending provider, who helps oversee your hospice care. The hospice team works with them.

Possibly a few small ones. Your hospice team will visit and tell you what would help, such as a hospital bed, a commode or a wheelchair. Medicare covers medical equipment and supplies as part of your plan of care, so ask the hospice what they will bring. Moving some furniture to make room is usually the biggest change.

Respite care is a short stay in a Medicare-approved facility so your caregivers can rest. Medicare covers up to 5 days each time, and you may pay 5% of the Medicare-approved amount. It is meant for occasional use. Your hospice team arranges it, so speak with them first.

Yes. Pain and symptom control is the heart of hospice. The team can adjust medicines as your needs change, and Medicare covers medicines for pain and symptoms. Tell your nurse about every kind of pain, including the kind that is hard to describe. If symptoms get too hard to manage at home, short-term inpatient care is available.

Yes, and many people use them alongside medicine rather than in place of it. Holding hands, a light massage, soft music, turning or repositioning in bed, a cool cloth or an extra blanket, quiet company and prayer or meditation can all bring comfort. Your team can tell you what is safe for your illness.

Not usually. The goal is to ease pain while keeping you as awake and present as you want to be. Some pain medicines can cause drowsiness or confusion, so tell your nurse about any side effects and the team can adjust them. If you want to stay clear-headed for a visit or an important conversation, say so, and they can plan around it. Near the very end of life, many people sleep more.

No. Hospice neither speeds up nor postpones death. The goal is to keep you comfortable and let you live each day as fully as you can.

Medical aid in dying (sometimes called assisted suicide in law) is a separate matter. It is legal only in some states, and each hospice has its own policy about it. If this is on your mind, ask the hospice early and speak openly with your doctor. medical aid in dying page

Usually, yes. Medicare Part A covers hospice for people who qualify. If you have a Medicare Advantage Plan, Original Medicare covers your hospice care, and you can keep your plan for other needs as long as you pay its premiums. Medicaid hospice coverage is an optional state benefit, so it depends on your state. Most private insurance plans cover hospice too. Ask the hospice to confirm your coverage before you enroll.

For most people, hospice costs very little or nothing.

If you have Medicare Part A and qualify, you pay nothing for care from a Medicare-approved hospice. You may pay up to $5 for each outpatient prescription for pain and symptom control, and 5% of the Medicare-approved amount for inpatient respite care. Medicare does not pay for room and board at home or in a nursing home.

If you are a veteran enrolled in VA health care, hospice is part of your standard VA medical benefits, with no copays. Medicaid, private insurance, and local civic, charitable or religious groups may also help. If you have no coverage, ask the hospice and your doctor about financial help.

There are two 90-day periods, followed by an unlimited number of 60-day periods. After the first six months, care continues as long as the hospice doctor recertifies that you are still terminally ill. You can change hospice providers once during each benefit period.

Yes. Hospice care includes grief support for your family. Federal rules require hospices to offer bereavement support for up to a year after a death, and some offer it longer. Support may include visits, phone calls, support groups, counseling and mailings. Ask your hospice what they offer, and ask for the names of other grief resources too. grief support page

No. Hospice is a kind of medical care, not a religious program, and you don't need to belong to any faith. Hospices offer spiritual support, but you choose whether to use it. Many hospices have chaplains or counselors who can sit with you, pray with you if you wish, or simply listen. If you have your own clergy, they are welcome to be part of your care.

Medicare.gov has plain-language pages on the hospice benefit. CaringInfo.org, a program of the National Alliance for Care at Home, explains hospice and palliative care. Your doctor, hospital social worker or local hospice can also answer questions, and many hospices are glad to visit with you before you decide.

Some hospices can. A nonprofit called Pet Peace of Mind trains hospice teams to help patients keep their pets close. Trained volunteers may help with feeding, walking and pet sitting, arrange vet or grooming visits, buy pet food, and help find a loving home if the pet can't stay. Not every hospice offers this, so ask yours when you enroll.

Pet hospice, also called animal hospice or palliative care for pets, is comfort care for a dog, cat or other animal whose illness can't be cured. A veterinarian helps control pain and other symptoms, and you learn how to keep your pet comfortable at home. The aim is quality of life, and euthanasia is one choice when the time comes. The American Veterinary Medical Association says an animal's comfort and quality of life must always guide these decisions.

No one can make this choice for you, and your veterinarian is there to help. The AVMA suggests asking whether your pet can still enjoy the things they once did, and whether they now have more bad days than good. A hard decision made out of love is still a loving decision.

It is a visit from a veterinarian who helps your pet die peacefully in your own home. Euthanasia is usually done with an injection that makes the animal unconscious quickly and painlessly. Many veterinarians give a sedative first. Families often choose home visits because they feel calmer and more personal than a clinic. Some veterinarians also offer hospice care and aftercare, such as cremation and a paw print. Ask what is included before you book.

The International Association for Animal Hospice and Palliative Care (IAAHPC) has a "Find Support" page with a member directory and an in-home pet hospice and euthanasia provider directory. Lap of Love is a large network of in-home hospice and euthanasia veterinarians, with a "Find a vet" search on its site. Your own veterinarian may also know someone local. It is okay to call a few and ask about experience, timing and what the visit includes.

Visits are usually unhurried. The veterinarian takes time to meet your family, gives your pet a sedative, performs the euthanasia, and then gives you time together and may make a paw print. Afterward, they can help move your pet's body. After death, your pet's eyes usually stay open, and there may be a deep breath, a twitch or a release of the bladder or bowels. These are normal reflexes, and your pet isn't in pain. You may stay with your pet or step out. Both are fine, and there is no right answer.

Grieving is a family matter. Other pets can notice that a friend is gone. They may seek more attention, seem anxious or withdrawn, or change their eating and sleeping. Keep routines steady, offer extra comfort and be patient. Call your veterinarian if changes last, or if eating, drinking or bathroom habits change.

Children do better with simple, truthful words. Avoid saying a pet "ran away," since children may expect the pet to come back and feel betrayed later. Let them say goodbye, draw or write to their pet, and share happy memories. Seeing you grieve can show them that sadness is okay.