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A patient usually meets hospice criteria long before they are actively dying. Hospice care is the “Gold Standard” for end-of-life care. When we say “end of life,” we’re referring to the final chapter, which can span a significant period, not just the final hours, days, or weeks. This period is characterized by a decline in health and the need for comprehensive care and support.

Hospice is not just for cancer patients. For decades, Medicare has recognized a wide range of diagnoses as hospice appropriate, such as End-Stage ALS, End-Stage Stroke or Coma, End Stage Dementia/Alzheimer’s, End-Stage Cardiac Disease, HIV Disease, End-Stage Liver Disease, End Stage Pulmonary Disease, End Stage Renal Disease, and Other Life-Limiting Illnesses. Hospice is a comprehensive form of care designed to support patients when their decline is not considered reversible, and there is no expected long-term improvement or cure if treatment is continued. This comprehensive care includes not only pain and symptom control but also emotional and spiritual support. It’s important to understand that hospice is not giving up; it’s the realization that there is hope to live as fully as possible until the end of life.

Every person who has Medicare Part A has the hospice benefit. The hospice benefit does not cost the person any more or less, as it is included in the overall Part A package. The Medicare Part A Hospice Benefit covers skilled nursing visits, ADL assistance, volunteers, dietary counseling, Patient/Family education, respite care, emotional support/counseling, Spiritual support, coverage of most medications related to the terminal hospice diagnosis, and supplies and equipment. This includes hospital beds, wheelchairs, walkers, bedside commodes, over-the-bed tables, wound care supplies, catheter & colostomy care and supplies, diapers, wipes, gloves, etc. Specifically, 24 hours/7 days a week nurse availability, a chaplain for emotional and spiritual support, a licensed medical social worker, certified hospice aides, planned nursing visits, a Medical Director who is an MD specifically trained in pain and symptom management. Since all of this is included in the hospice service that is covered by Medicare Part A, Medicaid, and other commercial insurance plans, it can provide a big cost savings to the patient and caregiver as well if that patient meets the criteria defined by CMS. Also, most hospice programs provide hospice care to individuals without health care benefits or those who are underinsured. Medicare has acknowledged that prognostication of life expectancy is, at best, a guess based on the “normal” course of the disease, and they realize that:

1. Hospice saves the patient and family money and provides much-needed support.
2. Hospice increases patient and family satisfaction.
3. Hospice improves quality of life.
4. Hospice provides holistic care to patients, families, and loved ones.
5. Hospice provides ongoing bereavement care for family and loved ones for up to 13 months after the death. The bereavement care under hospice has an additional list of benefits. Not all families need this, but for those who do, it is often invaluable.

“Hope is like the sun, which, as we journey toward it, casts the shadow of our burden behind us.” Samuel Smiles.

— Vickie C. Wacaster is a Patient and Hospice Advocate for Aveanna Hospice.