If you thought deciding to move your elderly mother or father into a nursing home or assisted living facility was hard, upgrading their care to a hospice program is an even tougher choice to make.
You might be on the precipice of that decision right now and may be wondering, what are the pros and cons of hospice?
Hospice is very advantageous for someone with a terminal illness, as they have around-the-clock care when they need it. Insurance such as Medicaid and Medicare should cover most hospice services, including medical supplies.
The downsides of hospice are that only some seniors are eligible and hospitalization is not usually offered.
In this extensive guide, we’ll elaborate much further on the pros and cons of hospice.
We’ll also discuss some hospice misconceptions, such as whether this type of care is only for terminal patients and whether patients can prolong their life when in hospice.
Let’s get started.
What Are The Advantages Of Hospice Care?
There are two sides to every coin, and that applies to hospice as well. Let’s start by outlining the advantages your senior parent or loved one can experience should you decide to enroll them in hospice care.
Seniors Can Receive Care 24/7
Hospice care provides around-the-clock attention to senior enrollees regardless of whether it’s needed in the middle of the night or the middle of the afternoon.
Your loved one will have immediate access to the hospice care providers that have been assigned to them, even on weekends and holidays.
Should they need pain management or the assistance of palliative doctors, the hospice staff can usually get a doctor on call to see the senior sooner than later.
An Interdisciplinary Team Of Caretakers Is Available
The professionals who work in hospice units specialize in various disciplines.
The staff might include hospice volunteers, doctors, medical social workers, home health aides, care manager nurses, physicians, and more.
The level of expertise each of these staff members brings ensures that no matter what kind of serious illness your senior parent or loved one faces, they can quickly receive the symptom management medication or treatment they need.
Adult Children Can Feel Confident In Their Parents’ Level Of Care
When your elderly parents are at the end of their lives – as so many who go into hospice are – as their adult child, you might be at a loss about what to do.
You likely don’t know how to provide the best care for your senior parent at this stage.
Perhaps you never did, which is why they were in assisted living or a nursing home for so long. If you feel stuck in taking the next steps, hospice can be a viable solution.
As we’ve touched on, between the varied staff and their differing levels of expertise, as well as the around-the-clock care, your senior can’t be anywhere better at this life phase.
Usually Covered By Insurance
As with any new treatment you consider for your senior parent or loved one, you have to ask, who’s going to pay for it? In the case of hospice, it’s usually not you who has to bleed your pockets dry.
Medicaid and Medicare’s hospice benefits will often pay for the service. If the entirety of the expenses isn’t covered, most of them will be.
What if your senior parent or loved one doesn’t have Medicare or Medicaid?
In that case, health maintenance organizations or HMOs, as well as private insurance companies, should step in to pay for most of the costs associated with hospice.
Read our article, Does Hospice Take Your Assets?
Prioritizes A Senior’s Comfort
The key difference between hospice care and traditional medical services is that hospice provides comfort care only.
It is a palliative care organization. That means no curative treatments are used. Instead, a palliative care team is strictly focused on the senior’s comfort so they have the best quality of life as they near their final days.
Thus, if certain medical treatments have been uncomfortable or even painful and they aren’t doing anything to improve the senior’s terminal condition, the hospice team might decide to discontinue them.
The staff will also prioritize a patient’s needs and comfort in other ways, such as providing end-of-life care in the person’s own home.
In some cities, hospice patients get inpatient care in a facility. These typically offer excellent care in a plush environment and allow regular visits from you, other family members, and close friends.
Is There A Downside To Hospice?
Before you decide with 100 percent certainty whether hospice care is the right choice for your senior parent or loved one, you should be sure to read this section, which covers the disadvantages of hospice care
Insurance Has Flat Daily Limits That Can Leave You Scrambling
We talked above about how most insurance plans will pay for the costs associated with hospice. That said, there’s a bit of a catch to this.
A senior’s health insurance will provide X amount of money per day that can be used on medications, medical equipment, and related medical expenses.
If that money covers the costs of everything your senior parent needs, then great! Your senior’s health insurance is more than sufficient.
Yet if there exists too big of a chasm between the amount of money you need and the amount that your senior’s health insurance is willing to pay, hospice can become unaffordable.
Extra expenses can also disqualify hospice as an option for some families. For example, additional caregiver services might be categorized as optional rather than mandatory for the senior’s health.
Your senior’s insurance won’t pay for it. You’d have to do so yourself, and this can be very costly.
Not Everyone Is Eligible For Hospice
Well, all this is assuming your senior parent or loved one is accepted into hospice at all.
Hospice has specific requirements for entry, and if your senior doesn’t qualify, then it doesn’t matter which hospice center you visit or home hospice care you request. You’ll be turned down for services.
What are those criteria?
Your senior’s doctor must be willing to certify that their condition has worsened to the point where death is imminent, typically within six months or fewer.
Then your senior needs to see a second doctor who agrees with this statement.
Although the diagnoses are just that, diagnoses and not death sentences, that two doctors share the same opinion usually means the senior doesn’t have much time left.
If a senior’s health improves while they’re in hospice, that’s one thing. If they’re healthy enough before entering hospice, though, they will be rejected.
A Hospice Patient Can Be Refused Some Testing
Since hospice is end-of-life care, diagnostic testing is not something a senior should expect to receive often.
The hospice center likely will not offer this testing themselves, nor will their doctors or physicians.
Your senior parent or loved one is free to get tested if they must, but this testing will not be covered by the senior’s insurance.
If you can’t afford the myriad of tests your senior might need, then they’ll have to go without.
Hospitalization Is Usually Not A Treatment
Another one of the possible cons of hospice care is that should your senior parent or loved one need hospitalization – especially long-term hospitalization – the hospice statutes are fairly vague.
The hospice staff may try to talk the senior out of pursuing this level of care and would still be within their rights to do so.
This is something that happens more in some parts of the country than others, but don’t be fooled.
Neglect, abuse, and other care mishaps can occur in hospice facilities just as they do in nursing homes and other long-term care facilities.
That’s not to say hospice isn’t a viable option for your senior parent or loved one, but in some cases their level of care can be negligible. You need to be aware of that.
What Is Usually Not Included In Hospice Care?
Hospice care typically does not include treatments or therapies aimed at curing a condition. Care is instead palliative, meaning it focuses on alleviating symptoms and providing comfort.
As such, many hospices don’t offer high-tech medical equipment or cover medical procedures, such as dialysis or chemotherapy.
For example, when my mom was under hospice care, her blood sugar spiked because of the steroids that were being used to aid with her brain tumor.
Hospice wouldn’t provide insulin to her, though – they wanted her to only use the oral diabetes medications she had been put on prior to entering hospice care.
Hospice care also does not provide custodial care, meaning assistance with activities of daily living like bathing or dressing.
Unless otherwise specified, these services are usually best left up to family members and other caregivers.
Again, in my mom’s example, we had to pay out of pocket for home care services to help her dress, shower, toilet, and so forth, once her brain tumor began affecting her ability to move.
Lastly, hospice care does not generally provide transportation for patients who need to visit doctors’ offices or pharmacies; this again is usually left to family members or caregivers.
Though hospice care can be very beneficial, it’s important to weigh the pros and cons before making a decision on whether or not to use this type of care for your loved one.
Be sure to ask questions of potential hospice providers (and check out several providers!) so you know what services are available and how they could benefit your family.
Is Hospice For The Dying Only?
Many people have a conception of hospice care as being only for those who are at death’s door.
Indeed, to be eligible for hospice, you must have been diagnosed by two doctors with a prognosis of six months or fewer, as we talked about before.
Read about When To Call Hospice For Elderly Care.
So yes, hospice is for the dying. However, that doesn’t mean the patients there are dying tomorrow. This goes back to what we said before. A diagnosis is just a doctor’s best estimate, not fact.
However, many people assume that because hospice is where people die, that it’s a death sentence. It is anything but.
Hospice is better than a sterile hospital room. Friends and family can visit. A senior can determine what they eat and how they spend their time.
They or the hospice staff may decide to suspend the use of certain treatments or medications for the senior’s comfort, as we discussed earlier.
Hospice is often the best option so a senior can enjoy their remaining time without as much fear and anxiety as they would have if they were in a hospital.
Does Hospice Care Prolong Life?
A hospice agency typically tries to prioritize the needs of their ill patients. Does it ever happen that an elderly person can get better when in hospice?
In some instances, a patient’s health improves because they’re taking their pain medications, eating a well-rounded diet, and receiving care whenever they need it.
For many more patients, hospice is where they pass away.
What if your senior parent or loved one undergoes major improvements while in hospice? What happens then?
Anyone who is enrolled in hospice is allowed to revoke hospice care if they so choose.
That does mean giving up their home hospice service, any treatment plan associated with hospice care, and the access to medical treatments and equipment.
The hospice center might decide to discharge the senior if their condition improves and they don’t revoke hospice.
Once the senior leaves hospice, they can resume at-home care with an adult child or possibly enter a nursing home or assisted living facility.
Final Thoughts
Hospice is a service that many seniors use during their last days. It’s a comfortable, comforting service that typically features excellent medical care and an array of medical supplies and equipment at a senior’s disposal.
That said, hospice care is sometimes not as encompassing as it could be, and certain aspects of care could get rather expensive. Before you decide whether hospice is right for your senior parent or loved one, you must weigh the pros and cons carefully.
Frequently Asked Questions
Do you lose Medicare when you go to hospice?
You do not lose Medicare when you go on hospice. However, the Medicare website says: “Original Medicare will still pay for covered benefits for any health problems that aren’t part of your terminal illness and related conditions, but this is unusual. Once you choose hospice care, your hospice benefit will usually cover everything you need.”
The website also notes, “Medicare won’t cover any of these once your hospice benefit starts:
1. Treatment intended to cure your terminal illness and/or related conditions.
2. Prescription drugs to cure your illness.
3. Care from any hospice provider that wasn’t set up by the hospice medical team.
4. Room and board.
5. Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation, unless it’s either arranged by your hospice team or is unrelated to your terminal illness and related conditions.”
Keep in mind that while Medicare pays for most of the hospice services covered by the plan, some out-of-pocket costs may still apply. Be sure to ask your hospice provider about any potential out-of-pocket expenses that might come up so you can prepare financially.
Also remember that if you choose a hospice provider outside of your network, additional fees or copays may apply.
Does Medicare pay for hospice after 6 months?
Medicare does cover hospice for more than 6 months, but the benefits and coverage may vary.
Generally speaking, when a patient qualifies for hospice services, the Medicare Hospice Benefit covers all of the medical equipment and supplies related to their terminal illness up to six months at a time.
After that initial period has ended, if you are still in need of hospice care and meet all of Medicare’s qualifications (including a doctor certifying that you have less than six months left to live), then Medicare will continue to pay for hospice services as long as you remain eligible.
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