Hospice Care: What it is, What it Costs, and How to Pay for It

Hospice is a specialized type of care for terminally-ill patients. The primary objective of hospice care is to make a person comfortable and improve their quality of life in their final days. Hospice care can last six months or longer. According to the National Hospice and Palliative Care Organization, the median duration of care is about 24 days^[1].  Hospice care is not intended to cure the person of their terminal illness. In this sense, hospice care is focused on the patient rather than the disease^[2]. 

This type of care generally is appropriate where other medical options have been exhausted and the patient is deemed incurable and typically too frail to withstand additional aggressive medical treatment. Hospice is often the last line of treatment for those with terminal cancer, heart disease and other deadly diseases, including late stage Alzheimer’s. The only tradeoff of receiving hospice care is that you must be willing to forego additional medical treatment for your terminal illness. Once you elect to go into hospice, your health insurance typically will no longer cover medical efforts intended to cure your terminal illness. However, you can change your mind at any time, withdraw from hospice care and resume treatment of your terminal illness if you have a change of heart.

Hospice Services

Unlike many other types of care, hospice care is generally provided wherever the patient lives. Most hospice care is provided either in a terminally ill person’s home or a nursing home. However, hospice agencies will also provide care in assisted living communities, in-patient hospice facilities and other types of senior living. In some cases, a person who was previously in a hospital or nursing home may even be able to return home to receive hospice care since they will no longer be receiving the type of medical care that requires the resources offered by those types of medical facilities.

Hospice care is always overseen by a hospice physician. This physician will consult with your primary care doctor, but the hospice physician will always have the final say when it comes to your care. Hospice nurses will typically carry out the plan laid out by the hospice physician. Hospice staff and nurses are on call 24 hours a day, seven days a week. The primary objectives of the plan will be pain management and comfort and will include medication for pain and relief of symptoms. Medications may also be prescribed to aid the patient with sleep, digestion and other bodily functions^[3]. 

Hospice agencies provide a broad list of other services, including personal care with activities of daily living, housekeeping, transportation and most other services typically provided by home healthcare agencies. If you are already using a home healthcare agency, you will likely now receive many of those services from the hospice agency directly. If you are currently receiving personal care from family and friends, hospice agency staff will educate those individuals on providing better care. Hospice agencies also provide counseling, social workers and spiritual and bereavement counselors for patients and their families^[4].

In addition, patients in hospice will continue to receive medical care from their primary care physician and other healthcare providers for other ailments unrelated to their terminal illness. In other words, you don’t waive all medical care simply because you elect to go into hospice. Some patients even continue receiving physical therapy, occupational therapy, speech therapy and nutritional counseling while in hospice in order to maintain their ability to perform activities of daily living and enhance their quality of life. 

Finally, hospice agents will provide all necessary medical equipment to enable the patient to receive their care at home. This includes hospital beds, wheelchairs and other medical supplies.  All drugs and medical equipment or supplies provided are provided directly through the hospice agency rather than through a pharmacy or medical supplies store. For many patients in their final days, this adds an element of convenience for both the patients and their families who would otherwise have to coordinate this care. For most patients, this also means lower costs. 

Costs and Paying for Hospice Care

There is a wide range of costs for hospice care based on the level of services provided. Most patients receive routine hospice care in their home, which typically costs between $150 and $200 per day. This type of care is far less expensive than general in-patient hospice care in a medical facility or continuous home care, which is essentially 24 hour a day around the clock care. These types of care can cost close to $1,000 per day. 

Fortunately, hospice care is usually covered by Medicare and private insurance, or Medicaid for those with limited financial means. Generally, the only requirement for hospice care to be covered by insurance is that your physician deem you to be terminally ill with less than six months to live. Once this determination is made, your coverage will not necessarily be terminated merely because you outlive your physician’s original projection.

It is important to keep in mind that even if you qualify for hospice care, Medicare generally does not cover room and board. Consequently, if you reside in a nursing home or assisted living facility, you will still be required to pay for your room and board, with Medicare paying only for the hospice services you receive. If you are receiving hospice care at home and it is determined that you need to be transferred to a respite care facility on a short-term basis, Medicare may cover the cost of your stay (requiring you to pay only a 5% co-pay). 

Similarly, once you go into hospice care, Medicare will no longer cover any medical care or prescription drugs intended to cure your terminal illness. However, Medicare will still cover your medical care for other ailments, as well as prescription costs for pain medications and similar drugs. If you decide that you want to leave hospice care, you may elect to continue treatment for your terminal illness and at this point Medicare will resume regular coverage of your medical costs. 

Determining Whether Hospice Care Is Right for You

Deciding whether to pursue hospice care is both a personal and a medical decision. Choosing to cease standard medical care is a decision with serious consequences and you should not make this decision without consulting with qualified and trusted medical professionals. If your physicians are telling you that your illness is incurable and you feel like you no longer have the strength to endure aggressive medical care, hospice may be a preferable option. In some cases, people may even live longer in hospice than they would had they pursued aggressive life-threatening medical procedures. Again, this is not a decision to be taken lightly and certainly not one you can make simply by reading articles like this one on the internet. We recommend that you have a heart to heart conversation with your treating physician before acting on any recommendations you receive from others, including hospice care agencies and their staff.