Hospice and palliative care: questions and answers

Hospice is care that focuses on comfort and quality of life when an illness can no longer be cured. A team of nurses, a doctor, aides, a social worker and a chaplain comes to wherever the person lives. Hospice also supports the family, including grief support after a death. See hospice care.

Medicare defines four levels of hospice care. Routine home care is the usual level, wherever the person lives. Continuous home care and general inpatient care are provided only when medically necessary during a symptom crisis. Inpatient respite care gives the family caregiver a rest, up to 5 days at a time. See levels of care.

No. The team visits on a schedule set by the plan of care, and family or hired caregivers provide daily care. A hospice nurse answers the phone 24 hours a day, 7 days a week, and can visit when needed. Continuous nursing at home is provided only when medically necessary during a symptom crisis. See what hospice provides.

Lorazepam is a calming medicine that a doctor may order for anxiety, agitation or restlessness, and for the distress that comes with breathlessness. The goal is comfort, not to speed up dying. Doses start low and are adjusted to the person. The hospice nurse explains each comfort medicine, what it is for and how to give it. See what hospice provides.

A good hospice tells you these things at the start. Hospice does not provide all-day caregivers, so family, facility staff or hired help give daily care. Room and board is not covered. Treatment meant to cure the terminal illness stops. And you can leave hospice at any time and return to regular coverage. See what hospice provides and paying for care.

First, a doctor certifies that the person has a terminal illness with a life expectancy of six months or less if the illness runs its usual course. Second, the person chooses comfort care instead of treatment to cure that illness, by signing a statement that elects the hospice benefit. See is it time for hospice.

Hospice is for people with a serious illness when a doctor certifies that life expectancy is six months or less if the illness runs its usual course. Our medical director and your doctor make that determination. A website cannot. The same standard applies under Medicare and Medi-Cal. Any diagnosis can be appropriate, not only cancer. See is it time for hospice.

Common signs are repeated hospital stays, weight loss, sleeping most of the day, needing more help with daily care, and treatments that help less than they used to. These are reasons to talk with a doctor or a hospice nurse, not a verdict. Only a doctor can determine eligibility. See is it time for hospice.

There is no fixed limit. Medicare provides hospice in benefit periods: two 90-day periods, then an unlimited number of 60-day periods. Before each period a doctor must certify that the person is still eligible, and from the third period on a hospice doctor or nurse practitioner visits in person first. See hospice care.

It is a Medicare rule about hospice owners, not patients. If a hospice is sold or has a change in majority ownership within 36 months of its Medicare enrollment or its last ownership change, the new owner generally must apply to Medicare as a new provider and be surveyed again. It does not limit how long a patient can receive hospice. See how to verify a hospice.

It is a cap on the hospice provider, not on any patient. In a year, a hospice's inpatient days for Medicare patients may not exceed 20% of its total patient days. The rule reflects that hospice is mainly care at home. It does not limit the inpatient care an individual may receive when it is medically necessary. See levels of care.

Medicare covers hospice care related to the terminal illness. Under Medicare, most people pay nothing for hospice care itself. There can be a copay of up to $5 per prescription for symptom medicines and 5% of the Medicare amount for inpatient respite care. Medicare does not pay room and board where you live. See paying for care.

Yes, through Medi-Cal. Medi-Cal covers hospice for eligible members, either directly or through a Medi-Cal managed care plan. For people with both Medicare and Medi-Cal, Medicare pays for hospice first, and Medi-Cal may cover nursing facility room and board for eligible residents. See paying for care and Medi-Cal and hospice.

For most families, little or nothing for hospice care itself. Medicare or Medi-Cal pays the hospice a set daily rate, and families are not billed that rate. What families do pay for is room and board and any hired caregivers, which vary widely. We check your benefits and tell you your costs before care starts. See paying for care.

Call before deciding it is out of reach. Most people who need hospice have Medicare or Medi-Cal, and families usually owe little or nothing for hospice care itself. If there is no coverage, our social worker can help with a Medi-Cal application and other options. See paying for care.

No. The hospice benefit does not pay room and board in a nursing facility, assisted living or board-and-care home. The resident, family or long-term care insurance pays it. Medi-Cal may cover nursing facility room and board for eligible residents. Hospice care itself is still covered there. See paying for care.

Once hospice is elected, it is paid by Original Medicare, not by the Medicare Advantage plan. You can stay in the plan for its extra benefits if you keep paying its premiums. You do not need the plan's permission to choose a Medicare-certified hospice. See paying for care.

Wherever the person calls home. We care for people wherever they call home, including nursing facilities, RCFEs and board-and-care homes, in coordination with facility staff. When symptoms cannot be managed there, short-term inpatient care can be arranged when medically necessary during a symptom crisis. See where care happens.

Yes. In California, a residential care facility for the elderly (RCFE) can keep a resident who is on hospice if the facility holds a hospice care waiver from Community Care Licensing and agrees to a care plan with the hospice. Ask the facility whether it has the waiver. See hospice in assisted living.

In California, yes for most purposes. Residential care facility for the elderly (RCFE) is the state license that covers assisted living communities and small board-and-care homes. RCFEs are licensed by the Department of Social Services. They are not medical facilities, which is why hospice brings the nursing care in. See where care happens.

Family, friends, facility staff or hired caregivers. The hospice team teaches you how to give medicines, move and clean someone safely, and what changes to call about. If no one is able to give daily care, tell the social worker early so options can be planned. See what hospice provides.

Call the hospice first, before 911, unless the team has told you otherwise. A hospice nurse answers the phone 24 hours a day, 7 days a week, and can visit when needed. If symptoms cannot be controlled with routine care, a higher level of care may be provided when medically necessary during a symptom crisis. See levels of care.

An admission visit with a nurse, consent forms, a review of medicines, and delivery of equipment and comfort medicines. Over the next days you meet the aide, social worker and chaplain if you want them, and the team writes the plan of care with you. See what to expect in the first week.

No. Hospice is comfort care near the end of life, usually paid by Medicare or Medi-Cal. California's Assisted Living Waiver is a separate Medi-Cal program that helps eligible people live in assisted living instead of a nursing facility. A person can have both, and neither one decides the other. Beta runs the two as separate programs. See hospice and the Assisted Living Waiver.

Yes. Choosing hospice is your decision. You can stop hospice at any time and return to regular Medicare coverage. You have the right to choose your hospice. A hospital, doctor or facility can suggest hospices, but the choice is yours. See how to choose a hospice.

No website can answer that for you, and we do not rank ourselves. Compare hospices on Medicare's Care Compare, check the license with the state, and ask each hospice how it handles after-hours calls, symptoms and family support. See our Medicare quality information on Care Compare through how to verify a hospice, and read how to choose a hospice.

Look up the license on the California Department of Public Health's Cal Health Find, and look up the hospice on Medicare's Care Compare. Be cautious of anyone who offers gifts or money, or asks for a Medicare number in an unsolicited call. Our step-by-step guide uses Beta as the example. See how to verify a hospice.

Yes. Under Medicare you can change your hospice once in each benefit period. You sign a statement naming the old and new hospice and the date, and the two hospices coordinate so care is not interrupted. Changing hospice is not the same as leaving hospice. See switching hospice providers.

Yes. A person can stop hospice at any time by signing a revocation statement, and regular Medicare coverage resumes. People do this to try a new treatment or because their goals change. They can return to hospice later if a doctor certifies they are eligible. See hospice care.

Both focus on comfort and quality of life. Palliative care can start at any stage of a serious illness, alongside treatment to cure or control it. Hospice is for the last months of life, when that treatment has stopped or is no longer wanted. See hospice vs palliative care.

Yes. Palliative care is offered in hospitals, clinics, nursing facilities and at home, depending on the program and your coverage. Home visits are especially useful when getting to appointments is hard. Call (909) 347-7000 with the patient's city and ZIP code to confirm current palliative program availability, the visit setting and coverage. See palliative care.

Medicare Part B covers medically necessary visits from a palliative doctor or nurse practitioner, including at home, with the usual deductible and 20% coinsurance. Medicare has no separate palliative benefit. In California, Medi-Cal managed care plans must offer a palliative care benefit to members who meet plan criteria, under SB 1004. See paying for care.

Palliative care has no time limit and is not tied to life expectancy. People receive it for months or years, for as long as it helps and their coverage allows. It does not shorten life. If the illness reaches its last months, the person can move to hospice. See palliative care.

Yes, and it is common. When treatment stops helping or is no longer wanted, and a doctor certifies eligibility, the person can choose hospice. The palliative team can help with that conversation and the handoff. It is always the person's choice. See hospice vs palliative care.