These Frequently Asked Questions about hospice end of life care are answered below to help clarify the care and services provided for individuals and families living with life-limiting illness. It is our hope that they will also dispel any lingering fears or myths that surround hospice care. Please don’t hesitate to contact us at if you have other questions: 800.662.8859.

Q. What is the history of hospice movement?
The word “hospice” (derived from the same root as “hospitality”) referred in medieval Europe to way stations where weary travelers could rest, and the ill could recover or find a peaceful death.

The present-day hospice movement was begun by Dr. Cicely Saunders who founded the first modern hospice in London in 1967. Hospital patients who were dying were taken out of isolation and provided with the best medication possible to control their pain so they and their families could address the emotional and spiritual challenges they faced.

In 1968 Florence Wald, then dean of the Yale School of Nursing, brought the idea of hospice to the United States. The hospice movement in the United States was engendered by groups of volunteers who worked tirelesesly in communities throughout the country on behalf of this holistic form of health care.

Q. How is hospice care provided today?
Hospice is a concept of health care that provides comprehensive and integrated services for the physical, emotional, and spiritual well-being of terminally ill individuals and their families. The goal of hospice is neither to cure illness nor hasten death, but to ease a patient's passage from life. The hospice philosophy of care has found broad and increased acceptance in the United States during the past four decades.

Hospice care is designed to alleviate pain and control the symptoms of disease so that individuals can live their lives to the fullest during whatever time remains. Medical professionals make "house calls" to deliver the care with expertise and compassion. In addition to physical care, hospice provides spiritual, social, and emotional support.

Individuals today are confronted with difficult choices about health care, particularly at the end of life. Questions of cost, availability, quality, and patient autonomy are debated by families, heath care providers, and politicians. For an increasing number of patients and families, hospice is an enlightened development in medicine, and hospice services are covered by Medicare, Medicaid and most private health insurance.

Q. What impact has hospice had in the United States?
Hospices across the United States today care for 45 percent of all dying patients. Rather than attempt to keep a patient alive at all costs, hospice offers a humane alternative to aggressive medical treatment for the terminally ill.

In 2013 in the United States, approximately 5,800 hospices cared for over 1.5 million patients.

Hospice care is a covered benefit under most public and private health plans, including Medicare.

"While hope for a miracle cure may not be evident in hospice philosophy,” states Jay Mahoney, former president of the National Hospice Foundation, “hospice care can be an extraordinary expression of hope and individual courage.” This philosophy of hope is at the heart of the hospice movement.

Q. What is End of Life Care?
The term “end of life care” is an umbrella term that includes four main approaches to addressing important needs in our life. Picture an umbrella. Its arching shelter is “end of life care”, and gathered under it are Advance Care Planning, Palliative Care, Hospice Care, and Bereavement Care.
Q. What is Advance Care Planning?
Advance Care Planning is a need all of us will have at some point in our adult lives — whether we are healthy or not, and with or without the responsibility of caring for someone else. In particular, members of the “sandwich generation" (those adults born between 1950 and 1975 and sandwiched between their living parents and adult children) will turn to advance care planning as they consider care for parents, children and themselves.

As you develop an advance care plan, you will explore your options for care, reflect on those options and your values, talk with your loved ones, and finally, record and share your wishes with loved ones, physician, and others. Your plan may change over time, as your situation or wishes change.

Options for care include Palliative Care and Hospice Care, which are philosophies of care focused on quality of life, rather than length of life. Neither is limited to a location or practice, and both address the many ways illness can affect a person's life. Both are available to people of all ages and illnesses.

Q. What is Palliative Care?
Palliative Care is a comprehensive patient- and family-centered approach to addressing the health status and treatment plan for a person living with a serious illness. Its goal is to assess the range of curative and comfort only options of care and to improve the everyday quality of life for the person and family. Palliative Care addresses goals of care for medical, emotional, social and spiritual well-being.
Q. What is Hospice Care?
Hospice Care can be an extension of Palliative Care and becomes a matter for consideration after the diagnosis of a life-limiting or terminal illness. Hospice care incorporates the needs of family members and caregivers, as well as the patient. Hospice care offers a team approach to medical, nursing, social, emotional and spiritual care. It is designed to give relief of pain and other symptoms and to help make the patient.s remaining time as meaningful as possible, as defined by the patient.
Q. What is Bereavement Care?
Bereavement Care is the final component of “end of life care.” Grief and loss counseling and other forms of assistance and resources are offered to surviving family members by the hospice for up to 13 months after the death of their loved one.
Q. Does hospice only take care of cancer patients?
No. Hospice serves those who are at the end-stage (having a life expectancy of six months or less) of any disease, including people with cancers of all kinds. Other people commonly served by hospice include those with diseases of the heart, lungs, and kidneys; AIDS, ALS (Lou Gehrig's disease) and Alzheimer's Disease.
Q. How does hospice work?
Once a patient chooses hospice care, a hospice team is assembled. The patient, family, and hospice team develop a comprehensive plan that supports the patient's decision to remain at home. Each hospice patient usually has a “primary caregiver.” This caregiver is often the patient's spouse, partner, or parent, although any family member or friend can fill this role. Members of the hospice team visit the patient and family regularly to provide medical and social services, and to support the caregiver.

Hospice care is available also in many skilled nursing homes, rest homes, and assisted living facilities. Facility staff welcome the expert knowledge and skills of hospice staff who can assist with the particular needs of residents with end-stage illness.

Some hospices also have inpatient facilities where patients with acute medical needs are cared for by hospice trained staff and volunteers.

Q. Who is the hospice “team”?
When a person chooses hospice care, they get a professional medical team that includes doctors, nurses, nursing assistants, social workers, counselors, spiritual caregivers, and volunteers. This team works together to coordinate pain and symptom management for the individual (and the medications, supplies, and equipment needed); and emotional and spiritual support for the person and their family.
Q. When is it time to refer a patient to hospice and who does it?
Any time during a life-limiting illness is an appropriate time to discuss all of a patient's health care options, including hospice. (People with life-limiting illnesses may have months versus years to live.) By law, the decision belongs to the patient. Many people are uncomfortable with the idea of stopping an all-out effort to “beat” a disease. The hospice team is sensitive to these concerns and is always available to discuss them with the patient, family, and physicians.

Some physicians may feel uncomfortable bringing up hospice care, so a patient or caregiver should feel free to bring up the topic. In addition to physicians, a patient, friend, family member, or pastor may make a hospice referral. An early referral enables the hospice team to develop the relationships that meet the needs of the patient and caregivers. If the patient continues to meet hospice criteria, services may continue longer than six months.

Q. What does the hospice admission process involve?
As soon as a hospice referral is confirmed by the person's physician, a hospice staff member will contact the person and set up a time for the admission to hospice services. Admissions can be done during evening or weekend hours if necessary to accommodate family schedules. During the admission visit, the patient and caregivers/family have the opportunity to discuss their values and goals of care and define their own “quality of life” so that the hospice staff can align their services with the patient and family goals. The admission process includes a comprehensive assessment by a nurse and other interdisciplinary team members, along with the signing of consent and insurance forms.
Q. Does hospice do anything to make death come sooner?
Hospice does nothing to hasten or unduly prolong the dying process. Hospice services are designed to bring comfort, to control pain and other symptoms, and to address the emotional, social, and spiritual needs of both the patient and his or her loved ones. Hospice staff are trained and experienced in providing the specialized knowledge and compassionate care called for during this particularly challenging time for families.
Q. How difficult is it to care for a loved one at home who is receiving hospice care?
While it is never easy, some caregivers have said it was an especially rewarding period of their lives, a time when they could express love and caring in a personal and meaningful way. One of the first things hospice will do is work with the patient and caregivers to prepare an individualized care plan. The hospice team works closely with the patient and caregivers to address their needs. The hospice team visits regularly and is always accessible to answer questions and provide support. While friends and family give most of the care, hospices do have volunteers to assist with errands and to provide an occasional break.
Q. Is a person's home the only place hospice care can be provided?
Hospice services are provided in a person's private residence, or wherever else a person calls "home". This can include a nursing home, assisted living facility, retirement community, group home, motel or other setting. Hospice services can be also be provided in a hospital until the person is discharged, or in a hospice inpatient facility. Most hospices can also provide care to homeless individuals.
Q. How does hospice manage pain?
Hospice staff has expert training and experience in pain management. They are up-to-date on the latest medications and approaches for pain and symptom relief; and they also recognize that emotional and spiritual pain is just as real as physical pain. The hospice team is uniquely skilled at addressing the needs of patients and their caregivers during this difficult period. With hospice care, most people living with a terminal illness can be both as alert and as comfortable as they desire.
Q. How is hospice care funded?
Hospice care is covered under the Hospice Medicare Benefit, and in North and South Carolina, through Medicaid and most private insurance plans.

If coverage is not available, hospice will help investigate other resources of which the family may not be aware. If needed, most hospices provide care regardless of insurance status, using money raised in their communities from memorials, special events, foundation gifts, and other contributions.

Q. Hospice provides bereavement care to the family. What does that mean?
Bereavement care refers to the organized program of grief support provided by a hospice to caregivers and families. Based on the needs of the families and caregivers, bereavement care might include individual counseling, support groups, or informational mailings. Family members can also call to request additional support any time during the year following the death of their loved one. In addition, many hospices sponsor bereavement functions and support groups for the community.