Hospice care

Palliative care - hospice; End-of-life care - hospice; Dying - hospice; Cancer - hospice

Definition

Hospice care helps people with illnesses that cannot be cured and who may be nearing death. The goal is to give comfort and peace instead of a cure. Hospice care provides:

  • Support for the patient and the family
  • Relief to the patient from pain and symptoms
  • Help for family members and loved ones who want to stay close to the dying patient
  • Bereavement support for family members after death

Most hospice patients are in their last 6 months of life.

Making the Decision to Start Hospice

When you choose hospice care, you have decided that you no longer want care to try to cure your terminal illness. This means no longer receiving treatment that is intended to cure any of your chronic health problems. Common illnesses for which this decision is made include cancer, and severe heart, lung, kidney, liver, or neurologic illnesses. Instead, any treatment provided is intended to keep you comfortable and support your family and loved ones.

Your health care providers cannot make the decision for you, but they can answer questions and help you make decisions such as:

  • What is the chance of curing your illness?
  • If you cannot be cured, how much time would any active treatment provide you?
  • What would your life be like during this time?
  • Can you change your mind after you have started hospice?
  • What will the dying process be like for you? Can you be kept comfortable?

Starting hospice care changes the way you will be receiving care, and it may change who will be providing the care.

What Hospice Care Offers

Hospice care is given by a team. This team usually includes health care providers, nurses, social workers, counselors, aides, clergy, and therapists. The team works together to offer the patient and family comfort and support.

Someone from your hospice care team is available 24 hours a day, 7 days a week to provide any support or help you, your loved ones, or your family needs.

Hospice care treats the mind, body, and spirit. Services may include:

  • Control of pain.
  • Treatment of other symptoms (such as shortness of breath, constipation, or anxiety). This includes medicines, oxygen, or other supplies that help you manage your symptoms.
  • Spiritual care that meets your needs and those of your loved ones.
  • Giving the family a break (called respite care).
  • Provider services.
  • Nursing care.
  • Home health aide and homemaker services.
  • Counseling.
  • Medical equipment and supplies.
  • Physical therapy, occupational therapy or speech therapy, if needed.
  • Grief counseling and support for the family.
  • Inpatient care for medical problems, such as pneumonia.

The hospice team is trained to help the patient and family with the following:

  • Know what to expect
  • How to deal with loneliness and fear
  • Share feelings
  • How to cope after death (bereavement care)

Where Does Hospice Care Take Place

Hospice care most often takes place in the patient's home or the home of a family member or friend.

It also may be given in other locations, including:

  • A nursing home
  • A hospital
  • In a hospice center

The person in charge of care is called the primary care giver. This may be a spouse, life partner, family member, or friend. In some settings the hospice team will teach the primary care giver how to care for the patient. Caring could include turning the patient in bed, and feeding, bathing, and giving the patient medicine. The primary care giver will also be taught about signs to look for, so they know when to call the hospice team for help or advice.

References

Arnold RM, Kutner JS. Palliative care. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 3.

Medicare.gov website. Medicare hospice benefits. www.medicare.gov/Pubs/pdf/02154-Medicare-Hospice-Benefits.PDF. Updated March 2023. Accessed February 13, 2024.

Nabati L, Abrahm JL. Caring for patients at the end of life. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 51.

Shreves A, Quest TE. End of life. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap e5.

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Review Date: 2/3/2024

Reviewed By: Frank D. Brodkey, MD, FCCM, Associate Professor, Section of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.


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