Hospice is a special type of care for people who are ill and are expected to have 6 months or less to live. Its goal is not to shorten life. Instead, the goal is to give comfort and support to a dying person and their loved ones. Hospice care helps to ease disease symptoms such as pain, upset stomach (nausea), and breathing problems. But treatments to cure a person's illness are stopped. Hospice also helps to meet the emotional and spiritual needs of a dying person and their family and friends.

A person with a life-limiting illness can go into hospice when a healthcare provider believes they have about 6 months or less to live. Hospice care can be used by people in the end stages of cancer, severe lung disease, heart failure, and other diseases. Hospice continues as long as it's needed. If a person’s health gets better, they can end the hospice care and start it again later. A person also has the right to leave hospice care at any time for any reason.

Hospice is most often provided in the home. It can also be offered in a nursing home, assisted living facility, or hospital. This depends on the person's care needs. Hospice care is provided by a healthcare team that includes doctors, nurses, and other healthcare providers. A registered nurse case manager (RN case manager) coordinates care given by the hospice team. The team includes the hospice doctor and the person's personal doctor. They also provide skilled nursing care as needed. The RN case manager makes visits no less than every 14 days and more often as needed to meet the needs of the client and their family. Hospice also offers access to other providers. These include:

• Social worker
• Home health aide
• Counselor
• Chaplain or other spiritual advisor
• Other providers, as needed

If hospice is done at home, family members give day-to-day care. Hospice support is given to the person and their family in many ways. This may include:

• Making sure medicines are given for the person's comfort

• Providing ongoing evaluations and care adjustments based on the person's comfort needs

• Helping the family set up the home

• Teaching the family about their loved one's medicines, how to give those medicines, and how to provide physical care

• Supplying medical equipment as needed

• Helping the family arrange 24-hour care

• Helping the person and family find emotional, spiritual, and financial resources

• Managing contact between the person, family, and healthcare providers

Help for loved ones in mourning (bereavement care) must be available for a year after the person’s death.

Here are answers to some common questions about hospice care:

• Where is hospice provided? Hospice is a method of care. It's not a physical location. It may be offered in the person’s home, a nursing home, a hospital, a designated hospice building, or in another facility.

• Does hospice only offer 1 type of treatment? People in hospice care receive treatments and interventions to give them the most comfort and quality of life. In some cases, they may have the same treatments they received before hospice. This can include palliative chemotherapy, radiation, and heart failure treatments. People can also come and go from hospice at any time. Once a person leaves hospice, they may come back to the program at any time if they qualify. For instance, if their healthcare provider finds that they only have 6 months or less to live.

• Can anyone who is ill receive hospice care? A person must have about 6 months or less to live to receive hospice. 

• Do people need a "Do not resuscitate" (DNR) order to receive hospice? In the U.S., people are not legally required to have made DNR arrangements to have hospice care. People must be informed that taking part in hospice is a choice to accept that death is coming. Aggressive life-sustaining treatments aren't part of hospice. These treatments include ventilator therapy, intensive care, and vasopressors.

• What happens if the person lives longer than 6 months? About 1 in 10 people in hospice care live beyond the 6-month limit. When this happens, the hospice staff may discharge the person. If the healthcare provider continues to certify that the person is still close to dying, Medicare can continue to pay for hospice services.

• Does hospice care shorten a person's life or bring about death? No. In fact, people in hospice care have been shown to live longer than people with similar illnesses who don't use hospice. 

• Can someone in hospice still keep their primary healthcare provider? Yes. The primary provider still plays an important role in the person's care.    

Medicare and Medicaid cover hospice care for people age 65 or older. Most health insurance companies also cover hospice care. Hospice may be available at no extra charge as a free benefit. Talk with your healthcare provider to learn more about hospice services in your area.

Many terminally ill people have trouble thinking about how they would like to die. There are many confusing, unexpected, and unwanted choices that need to be made. Here are a few things dying people might consider:

• Where do I want to die? At home, in a hospital, or at a hospice facility?

• How do I want to die? Alone or with family?

• What do I want or need to do before I die?

There are no right or wrong answers to these questions. When people begin to think about their own or their loved one's death, many spiritual and emotional issues arise. This can be a hard topic for the family and caregivers to talk about. But it's important to listen and help sort through these issues.

When a person knows death is near, they may search for the meaning of their life, illness, and coming death. This is a difficult journey that may lead the person down many different paths.

Once the person has come to some sort of terms with illness and death, they might then think about relationships with family and friends. Often when people are dying, they become closer with their loved ones and want to spend more time with them. Here are a few ideas that may help terminally ill people during these times:

• Spending time with people they care about

• Listening to family and friends

• Sharing wisdom

• Writing a poem or a family history

• Being involved as much as they can in things that are satisfying to them

When confronted with death, many people wonder how they'll be remembered. There are many ways for people to create a sense of meaning for themselves before they die. Here are 4 ways people can find meaning in their lives:

1. Leaving a legacy. People who are coming close to death find that leaving a legacy provides comfort and meaning to their lives. Ways of leaving a legacy can include writing or making a recording of the family history or creating a family heirloom.

2. Storytelling. Remembering and sharing life stories can help people to make meaning of their past, present, and future. Storytelling can also bring families closer together and help people build stronger connections with their loved ones.

3. Prayer, meditation, and journal writing. Prayer is very helpful in allowing people to review their lives and find out who they are. It can be done verbally, in a journal, or through meditation. When people are dying, they often use prayer to help them cope, ease pain, and relieve stress. Prayer also gives people a sense of hope when they feel that there is nothing to hope for. When some people are very close to death, they feel that praying for their loved ones brings them comfort.

4. Dedication to a mission or cause. This can create a sense of self-worth and purpose. Some people believe that it helps them to see life differently. A few types of missions or causes are anti-smoking campaigns, research funding, cancer support activities, and writing about the experience of cancer.

An important part of hospice care is making sure the person’s wishes at the end of life are addressed. When a person is terminally ill, legal and ethical issues may come up. These include making advance directives and deciding about the use of life support and resuscitation efforts. The Patient Self-Determination Act states that patients may state their last wishes (or advance directives) in writing. One form of advance directive is a living will. This document becomes important when people are not able to make or express their own wishes regarding their care. In a living will, a person describes what type of life-sustaining measures can or can’t be used for their care. Another choice is to name a person who is responsible to make these decisions when the person can’t. This is done through a durable power of attorney for healthcare (also called a healthcare proxy or a medical power of attorney). The hospice team or other healthcare providers can discuss advance directives with people and their families.

A healthcare provider must confirm that you or your loved one qualifies for hospice. A person with advanced cancer, heart failure, severe lung disease, or other illness can go into hospice when a provider believe they have about 6 months or less to live. You can then choose a hospice to make this time as comfortable as possible.

When you are looking at hospices, ask questions. What are their services? Where do they provide care : at home or in a facility? Ask for a copy of the hospice’s Patient’s Rights and Responsibilities. To learn more about your local hospices, contact:

• Healthcare providers or hospital case managers or home care staff

• Your place of worship

• The local agency on aging

• The Veterans Health Administration office

• State department of health or social services

• The state hospice organization

• National Hospice and Palliative Care Organization, www.nhpco.org

• Hospice Foundation of America, www.hospicefoundation.org

Hospice is provided by a team. The team often has a healthcare provider, a nurse case manager, and social worker trained in hospice care. It may also have a home health aide, spiritual counselor, and volunteers. The people receiving treatment are the center of the team. They can voice their wishes and goals. If hospice is done at home, family members give day-to-day care. A hospice aide can make several visits each week to help with bathing and bathroom needs. The number of visits made by the hospice aide is decided by the hospice team and depends on the needs of each client. A nurse, social worker, and other professionals will also visit. A hospice nurse or healthcare provider is on call 24 hours a day to answer questions and handle problems. Ask your healthcare provider if they participate in a hospice program if you wish to stay under their care while enrolled in a hospice program. If they don't participate, your hospice care can be managed by the hospice program's medical director. If you choose, the hospice team can keep your primary healthcare provider informed of your health.

Hospice is often done in the home. Family members are the main caregivers. They get support from the hospice team. The team may help you arrange care. They can provide medical equipment as needed. This may include a hospital bed, commode, oxygen, or other supplies. The hospice team can also help the family get breaks from caregiving. This is called respite care. For a short time, the person receiving hospice care can be put into a facility. This lets caregivers take care of other needs. If hospice is already being done in a facility, all of these things are taken care of on site.

Hospice care focuses on the person's quality of life and comfort. Symptoms are actively treated. These include pain, nausea, anxiety, breathing distress, and sleep problems. The hospice program will provide medicines to ease these symptoms. Treatments that are no longer helping may be stopped. The team will discuss what treatment changes may be needed. Caregiver education is provided on giving medicine , managing symptoms, and giving physical care. Questions from caregivers and family members are encouraged.

The hospice team provides compassionate emotional support for both the person and their family. When the family is ready, the hospice nurse can explain the dying process and what changes they may see as their loved one's condition changes. The team will also teach the family how to recognize symptoms and provide comfort measures. A team member is available to call 24/7 when crises or questions arise. No caregiver is left alone trying to figure out what to do. Both the person receiving treatment and family members can get counseling. This is to help with anxiety, grief, family conflict, and spiritual issues. Bereavement support can continue up to 1 year after the person dies.

The hospice team helps the person receiving treatment and family members understand the illness and how it progresses. They can help both the person and family members review choices so decisions can be made. The team can help with finding legal resources and answering insurance questions. And they give information about how to make funeral and memorial arrangements.

The person’s primary care provider will have contact with the hospice team on a regular basis. If the person’s health improves, they may no longer meet the terms for hospice or need hospice care. In this case, the person can end the hospice care. They can start it again later as needed. A person can go back to hospice at any time. They must be recertified by a healthcare provider. Also, a person has the right to leave a hospice at any time for any reason. A person can also change to a different hospice if they're not happy with the care.

Medicare, Medicaid (in some states), and most private health insurance plans cover hospice care. Families may be asked to meet some costs that aren't covered by insurance. Public and community support make it possible for hospices to cover the cost of care. This happens through donations, grants, memorial gifts, and fundraising events. People are generally not turned away for financial reasons.