Expert Health Articles


Dr. Christian JacobusDr. Christian Jacobus

Bridge Home Health & Hospice, Hospice and Palliative Care

Unlike palliative care (please see my most recent Weekend Doctor column – 6.18.16) most people have at least heard of hospice. Like palliative care, though, there are a lot of myths and misconceptions out there that are worth clearing up.

Hospice is a medical service that is designed for people whom we think are in their last six months or so of life. The philosophy of hospice is quality over quantity. It’s for people who are ready to switch from life-prolonging medical care to comfort-based care. In order to qualify, a patient must have two doctors say, “I wouldn’t be surprised if this person were not with us in six months.”

Hospice care can be given in any setting: the hospital, an inpatient hospice unit, assisted living or nursing home, but most people get hospice at home. For a home, nursing home or assisted living patient, their hospice nurse case manager will come to see them at the minimum of once a week, but as often as needed, sometimes every day. Every patient has a chaplain and a social worker assigned to them who are available as needed. Home health aides are available to help with bathing or dressing, and volunteers can be available to provide companionship or sit with a patient while their caregiver runs errands. One important thing to know, though, is that while hospice can provide a lot of care, we can’t provide 24/7 caregiving. That duty needs to fall to family, friends, paid caregivers or a nursing home.

Hospice pays for any medications related to comfort and to the terminal disease, and usually will have them delivered to the home. Hospice also pays for any medical equipment like a hospital bed, oxygen concentrator, bedside commode, etc. It is a completely covered benefit under Medicare and Medicaid, and the vast majority of commercial insurance policies. There should be no out-of-pocket expenses for hospice care.

Signing up for hospice doesn’t commit a person for life. If, after enrolling, they decide they want to, for example, get more chemotherapy, they can revoke their hospice benefit at any time and re-enroll later on. By the same token, if a person stabilizes and looks as if they may live longer than 6 months, hospice may discharge them back to their regular physician’s care.

Anything having to do with a topic as emotional as end-of-life care is going to have misconceptions and misunderstandings, and hospice is no exception. Here are some of the most common:

  • Hospice is not just for people with days left to live. On the contrary, the longer someone is on hospice the more benefit they get. Some patients live for years on hospice.
  • Patients do not need to be homebound to receive hospice care. In fact, if a patient wants to travel out of the area, even out of state, hospice can be arranged at their destination to help care for them while they’re there.
  • Patients can keep their family doctor while on hospice if they like and if their doctor agrees. The hospice medical director can serve as the family doctor, though, if they or their doctor prefers.
  • Hospice patients can go to the hospital under certain circumstances, when approved by the hospice.
  • Hospice does not stop all of a person’s medications when they enroll, but we do use that opportunity to look at what medications are still benefiting and stop those that are not.
  • Hospice is not about giving up on life; on the contrary, it’s about improving the quality of the time that a person has left.
  • Enrolling in hospice does not mean that a patient is going to die sooner; for some diseases like pancreatic cancer and heart failure, patients on hospice live longer than if they were getting traditional medical care.
  • Hospice does not try to overdose people on morphine or use drugs to shorten a patient’s life. Morphine, and other pain medications, are very useful for providing comfort from pain, shortness of breath, and anxiety, and do not shorten patients’ lives. There is some evidence that it even extends them.
  • Hospice is not euthanasia or assisted suicide. It’s not about helping people die; it’s about helping people who are dying die more comfortably.

If you or a family member feel hospice is a good fit for you, or if you want more information, call Bridge Home Health & Hospice or talk to your doctor. More information can also be found online at the webpage for the National Hospice and Palliative Care Organization at