The Hospice movement was started in Britain in 1967 by a physician, Cicely Saunders, who advocated pain management for the dying. Her philosophy was that dying people needed dignity, compassion and respect. and “abolished the prevailing ethic that patients should be cured, that those who could not be cured were a sign of failure and that it was acceptable and even desirable to lie to them about their prognosis” (British Medical Journal, 2005).
Hospice care came to the United States in 1974, in Connecticut, and started expanding in the 1980s, especially when Medicare recognized hospice’s value and cost savings and therefore started paying for hospice care. By 2000, more than 3,000 hospices and palliative care programs were serving the needs of the dying and sick. In 2023 there are more than 8262 hospice programs in the U.S., an increase of 2.1% from 2022.
Who Gets Hospice Care
According to the National Hospice and Palliative Care Organization, an estimated 1.55 million patients received services from hospice in 2018. The 2018 study by the National Hospice and Palliative Care Organization also found, 55.6% of people on hospice received care in their own home while 19.74% were treated at an assisted living facility and 17.27% in a nursing facility.
The days of care for the top four non-cancer primary diagnoses for patients admitted to hospice in 2018 were dementia (105.2), stroke (82.1), circulatory/heart (80), and respiratory (71) .
Hospice Services
Among its major responsibilities, the interdisciplinary hospice team:
- Manages the patient’s pain and symptoms
- Assists the patient with the emotional and psychosocial and spiritual aspects of dying
- Provides needed drugs, medical supplies, and equipment
- Coaches the family on how to care for the patient
- Delivers special services like speech and physical therapy when needed
- Makes short-term inpatient care available
- Provides bereavement care and counseling to surviving family and friends
The Hospice Team
The Hospice team usually consists of:
- The patient’s personal physician
- Hospice physician (or medical director)
- Nurses
- Home health aides
- Social workers
- Clergy or other counselors
- Trained volunteers; and
- Speech, physical, and occupational therapists, if needed.
Paying for Hospice
Hospice care is paid for in a variety of ways, including
- Medicare
- Medicaid
- Private insurance
- Tricare
- Private Pay
- Charity care
How to Choose a Hospice
- Does Medicare certify the program?
- Is the program licensed?
- How many years has the hospice been in business?
- Do they develop a care plan for each patient?
- How do they handle payment and billing
- Do they have a 24 hour on-call service?
Resources
- National Association of Home Care and Hospice – A nonprofit organization that represents 33,000 home care and hospice organizations in the United States.
- The Hospice Directory – A directory of hospice providers in North America and a subsidiary of Hospice Foundation of America.
- Medicare – The official U.S. government site for Medicare, providing comprehensive information about Medicare coverage, options, and costs.
