Hospice Myths and Realities

Myth: Hospice is a place.
Reality: Hospice care usually takes place in the comfort of an individual's home, but can be provided in any environment in which a person lives, including a nursing home, assisted living facility, or residential care facility.

Myth: Hospice means that the patient will soon die.
Reality: Receiving hospice care does not mean giving up hope or that death is imminent. The earlier an individual receives hospice care, the more opportunity there is to stabilize a patient's medical condition and address other needs.

Myth: Hospice is only for cancer patients.
Reality: A large number of hospice patients have congestive heart failure, Alzheimer's disease or dementia, chronic lung disease, or other conditions.

Myth: Patients can only receive hospice care for a limited amount of time.
Reality: The Medicare benefit, and most private insurance, pays for hospice care as long as the patient continues to meets the criteria necessary. Patients may come on and off hospice care, and re-enroll in hospice care, as needed.

Myth: Hospice provides 24-hour care.
Reality: The hospice team (which includes nurses, social workers, home health aides, volunteers, chaplains, and bereavement counselors) visits patients intermittently, and is available 24 hours a day/7 days a week for support and care.  Some hospices are able to provide "continuous care," but hospices must have a program in place for this to happen and hospice patients must meet certain criteria.

Myth: All hospice programs are the same.
Reality:
All licensed hospice programs must provide certain services, but the range of support services and programs may differ. In addition, hospice programs and operating styles may vary from state to state depending on state laws and regulations. Like other medical care providers, business models differ. Some programs are not-for-profit and some hospices are for-profit.

Myth: Hospice is just for the patient.
Reality: Hospice focuses on comfort, dignity, and emotional support. The quality of life for the patient, and also family members and others who are caregivers, is the highest priority.

Myth: A patient needs Medicare or Medicaid to afford hospice services.
Reality:
Although insurance coverage for hospice is available through Medicare and in 44 states and the District of Columbia under Medicaid, most private insurance plans, HMOs, and other managed care organizations include hospice care as a benefit. In addition, through community contributions, memorial donations, and foundation gifts, many hospices are able to provide patients who lack sufficient payment with free services. Other programs charge patients in accordance with their ability to pay.

Myth: A physician decides whether a patient should receive hospice care and which agency should provide that care.
Reality:
The role of the physician is to recommend care, whether hospice or traditional curative care. It is the patient's right (or in some cases the right of the person who holds power of attorney) and decision to determine when hospice is appropriate and which program suits his or her needs. Before entering a hospice, however, a physician must certify that a patient has been diagnosed with a terminal illness and has a life expectancy of six months or less.

Myth: To be eligible for hospice care, a patient must already be bedridden.
Reality:
Hospice care is appropriate at the time of the terminal prognosis, regardless of the patient's physical condition. Many of the patients served through hospice continue to lead productive and rewarding lives. Together, the patient, family, and physician determine when hospice services should begin.

Myth: After six months, patients are no longer eligible to receive hospice care through Medicare and other insurances.
Reality:
According to the Medicare hospice program, services may be provided to terminally ill Medicare beneficiaries with a life expectancy of six months or less. However, if the patient lives beyond the initial six months, he or she can continue receiving hospice care as long as the attending physician recertifies that the patient is terminally ill. Medicare, Medicaid, and many other private and commercial insurances will continue to cover hospice services as long as the patient meets hospice criteria of having a terminal prognosis and is recertified with a limited life expectancy of six months or less.

Myth: Once a patient elects hospice, he or she can no longer receive care from the primary care physician.
Reality:
Hospice reinforces the patient-primary physician relationship by advocating either office or home visits, according to the physician preference. Hospices work closely with the primary physician and consider the continuation of the patient-physician relationship to be of the highest priority.

Myth: Once a patient elects hospice care, he or she cannot return to traditional medical treatment.
Reality:
Patients always have the right to reinstate traditional care at any time, for any reason. If a patient's condition improves or the disease goes into remission, he or she can be discharged from a hospice and return to aggressive, curative measures, if so desired. If a discharged patient wants to return to hospice care, Medicare, Medicaid, and most private insurance companies and HMOs will allow readmission.

Myth: Hospice means giving up hope.
Reality:
When faced with a terminal illness, many patients and family members tend to dwell on the imminent loss of life rather than on making the most of the life that remains. Hospice helps patients reclaim the spirit of life. It helps them understand that even though death can lead to sadness, anger, and pain, it can also lead to opportunities for reminiscence, laughter, reunion, and hope.