While the hospice movement in America grows year by year, many people remain unfamiliar with hospice and its services. We hope that the following Questions and Answers will help familiarize you with these vital and needed services. Hospice care is one of the greatest gifts we can offer during the last part of one’s life.

Q.  How is a patient admitted to hospice care?

Usually, a physician, a family member, a health care worker, or the patient contacts Hospice & Palliative Care of Virginia (H&PC of VA). We then contact the patient’s physician to make sure he or she agrees that hospice care is appropriate. (H&PC of VA has medical staff available to help patients who have no physician.) If appropriate, the patient will be asked to sign consent and insurance forms agreeing to hospice care. These are similar to the forms patients sign when they enter a hospital. One of these is the “hospice election form” that states that the patient understands that the care is palliative (aimed at pain relief and symptom control) rather than curative and also outlines the services available. The form Medicare patients sign also tells how electing the Medicare hospice benefit affects other Medicare coverage for a terminal illness.

         Q. When should a hospice care decision be made - and who should make it?

It is appropriate at any time during a life-limiting illness to discuss all of a patient’s care options, especially hospice care. Of course, it’s the patient’s decision. While most of us are uncomfortable with admitting that an all-out effort to “beat” terminal disease is futile, that decision must be considered. H&PC of VA staff members are very sensitive to these concerns and are always ready and available to discuss them with the patient, the family, and patient’s physician.

         Q. Should I wait for my physician to raise the possibility of hospice, or should I raise it first?

The patient and family should feel free to discuss hospice care at any time with their physician, other health care professionals, clergy, or friends.

     Q. What if our physician is unfamiliar with hospice?

Most physicians know about hospice and are becoming more aware of the benefits it offers patients.  If your physician wants more information, please have her/him contact H&PC of VA at (800) 438-9484. Also, information is available from the Academy of Hospice and Palliative Medicine, medical societies, the Virginia Association of Hospices, or National Hospice & Palliative Care Organization.  In addition, physicians and all others can obtain information on hospice from the American Cancer Society, the American Association of Retired Persons, and the Social Security Administration.

Q. If a patient shows signs of recovery can he/she be returned to regular medical treatment?

Certainly, and we have found that some patients do improve after receiving hospice and palliative services because of the quality of the care.  If improvement in the condition occurs and the disease seems to be in remission, the patient can be discharged from hospice. If the patient chooses, he/she may be returned to aggressive therapies to treat the disease.

Q. Must someone be with the hospice patient at all times?

In the early weeks of care, it’s usually not necessary for someone to be with the patient at all times. Later, most hospice caregivers agree that someone should be there continuously since many patients fear dying alone. While family and friends must be relied upon to give most of the care, H&PC of VA’s volunteers will help with errands and provide a break and time away for caregivers.

One of the first things Hospice & Palliative Care’s team will do is prepare an individualized care plan that addresses the amount of care given a patient based on his or her needs. H&PC of VA staff visits regularly and are always accessible to answer questions and are on call 24/7.

Q. How difficult is caring for a dying loved one at home?

It’s never easy and sometimes can be quite difficult, both physically and emotionally. At the end of a long, progressive illness, nights can be especially weary. H&PC of VA has staff available around the clock to consult with the family and to make night visits as appropriate. 

Q. What specific assistance does hospice provide home-based patients?

Hospice patients are cared for by a team of doctors, nurses, social workers, counselors, home health aides, clergy, therapists, and volunteers - each provides special assistance in his/her area of expertise. In addition, H&PC of VA provides medications, supplies, equipment, hospital services when related to the terminal disease, and additional helpers in the home as appropriate.

         Q. Are there any changes I have to make in my home before hospice care begins?

As part of the patient’s plan of care, H&PC of VA will assess your needs, recommend any changes or necessary equipment, and help make arrangements.

        Q. Is the home the only place hospice care can be delivered?

No. Although most hospice services are delivered in a personal residence, H&PC of VA provides care within most area hospitals, nursing homes, and adult homes.

        Q. How does hospice “manage” pain?

Hospice & Palliative Care nurses and doctors are up-to-date on the latest in pain control and symptom relief medications and devices. In addition, physical therapists assist patients to be as mobile and self-sufficient as possible, and they are often joined by specialists schooled in other therapies.

H&PC of VA knows that emotional and spiritual pain is just as real as physical pain and must be addressed. Our staff of Social Workers, Spiritual Counselors and Clergy are available to assist patients as well as family members.

         Q. Is Hospice successful in controlling pain?

Very! Using combinations of medications, counseling and therapies, our patients attain an acceptable level of comfort in their homes or in home - like surroundings.

         Q. Do the pain medications prevent the patient from knowing what’s happening?

Patient pain and other medications are given according to the plan of care and are specifically formulated to keep the patient conscious and cognizant while providing comfort and pain control. It is our goal for patients to be as comfortable and alert as they desire. Our Medical Director and Consulting Pharmacist work constantly with the nursing staff to ensure that patient medication is sufficient and appropriate.

         Q. Is hospice affiliated with any religious organization?

H&PC of VA has a Chaplain and uses volunteer clergy.  We are not affiliated with any religious organization nor ascribe to any particular belief system.  We represent a broad community and have served patients of many spiritual beliefs.

          Q. Is hospice care covered by insurance?

Hospice coverage is provided by Medicare nationwide, by Medicaid in Virginia, and by most private health insurance plans.  H&PC of VA is a nonprofit organization. No one is turned away due to lack of insurance or financial resources. Our indigent patient program is very successful in finding resources for our patients and acquiring Medicare and/or Medicaid coverage.

         Q. If the patient is eligible for Medicare, will there be any additional    expenses to be paid?

Medicare covers all services and supplies related to the terminal illness for the hospice patient. H&PC of VA does not bill the patient for any medication or respite care related to the patient’s terminal illness.

        Q. Does hospice provide support to the family after the patient dies?

Hospice & Palliative Care provides continuing counseling and grief support for family and friends for at least 13 months following the death of a loved one. We also hold regular grief support meetings within our service area where anyone who has suffered a loss is welcome.

This document is based on information that the American Cancer Society originally created.