When Is It Time For Hospice?

By Jenny Grant, LMSW


Hospice can be a scary word for many.  Perhaps you’ve had a relative or friend on hospice and understand its benefits, or have heard “horror” stories about patients who were “killed” with morphine or other medications commonly used in hospice care.  You may also think hospice is only for the last few days of life.  Hopefully, this blog will inform you of when it is the appropriate time to bring in hospice, how to get started, who pays for it, and ease your mind while making a difficult decision.  I spent almost 9 years as a hospice Social Worker, and now as a Care Manager, helping people navigate their emotions around hospice, as well as providing resources to help them be the most comfortable they can be at the end of life.

Does Hospice Mean Giving Up?

In my experience, patients and families who have chosen to seek hospice are just plain tired. They may have been fighting a disease for years, with trips back and forth to the doctor or hospital, feeling sick from treatments, often in a great deal of pain, and lacking a good quality of life. Some patients get to the point of feeling that they would prefer “quality over quantity,” wanting to spend the rest of their time at home with family and friends.  Some of my patients have even been able to travel while on hospice, once their symptoms are managed! Other patients may have just been diagnosed with a terminal disease and referred to hospice immediately, leaving their heads spinning.  When the doctor says, “there is nothing else we can do”,  hospice should be offered, or the patient or family should request it. No one should needlessly suffer physically, emotionally, or spiritually at the end of life. Hospice means living life on your own terms, with pain and symptom management.

Who Is Eligible For Hospice?

In order to be hospice eligible, the first step is getting a diagnosis of “terminal illness” from a physician. The physician would write an order, stating that the patient has a prognosis of 6 months or less to live. Now, this does not mean that your loved one will necessarily die within 6 months.  In fact, I have known patients on hospice for 4 years. Everyone’s journey is different, depending on the disease, the level of support, and the patient’s will to live. A patient will benefit most from the hospice team when they are admitted right after diagnosis. The doctor or family can make a referral to which ever hospice they choose. Did you know there are over 10 hospices in Nashville?  A Care Manager can help you determine which hospice can meet your needs.

Who Pays For Hospice And What Does it Cover?

The Hospice Medicare Benefit, and some private insurances pay for hospice care. Therefore, if you are under 65 years of age, and not yet on Medicare, your insurance may have a hospice benefit. There may be a pre-authorization needed in this case, which the hospice can acquire for you.  Some hospices will provide services to patients who are uninsured. Below is a list of what is covered under hospice care:

  • The services of a doctor, nurse, social worker, chaplain, and nurse’s aide (for bathing and changing sheets)
  • All medications related to the hospice diagnosis or for comfort care
  • All Durable Medical Equipment (DME) – oxygen, hospital bed, over bed table, walker, wheelchair, bedside commode, trapeze
  • Transportation to a hospice inpatient facility, a nursing facility for respite care, or to the hospital (in rare cases)
  • Supplies, such as; adult briefs, incontinence pads (chux), gloves, soap, shampoo, lotion, wound care supplies, and more.  At this time, cleansing wipes (baby wipes), are NOT covered by insurance or Medicare.
  • Respite care -either in a hospice facility, or in a nursing home

This knowledge will help you save money. Many people get a diagnosis and rush out to buy equipment or supplies, when hospice will cover it.

*Please note that Long Term Care Insurance does not pay for hospice care.  It may help pay for in-home care, or room and board at a nursing home.

Hospice Is For Everyone

From infants to the elderly, hospice care can be a bridge between dis-ease, and comfort. It is a “team of angels”, as I’ve heard from families over and over again, and the family is an integral part of that team.  They have their own special needs during the dying process of their loved one.  Grief counseling is available from some hospice agencies, and referrals can be made to other counselors in the community, if needed. Children and grandchildren can find support through counselors, as well as at “Kid’s Camp”, provided by a local hospice organization in Nashville.  A Care Manager can provide more detailed information about support services, as well as walk with you through this difficult, yet often sacred, journey.


Leave a Reply

Your email address will not be published. Required fields are marked *