Who provides and pays for hospice care?

Hospice care can be provided by independent hospices, or through programs based in hospitals, nursing homes, or other health care systems.

The hospice team

In most cases, an interdisciplinary health care team manages hospice care. Typically, the hospice doctor or medical director is in charge of your care, though your cancer doctor and/or primary care doctor can be involved, too. Doctors, nurses, social workers, counselors, home health aides, clergy, therapists, and trained volunteers care for you and your family. Together, they give complete palliative (supportive) care aimed at relieving symptoms and giving social, emotional, and spiritual support.

Hospice care staff members are typically kind and caring. They communicate well, are good listeners, and want to work with families who are coping with a life-threatening illness. They’re usually specially trained in the unique issues surrounding death and dying and given ongoing education and support to help with the emotional demands of the job.

Hospice volunteers play an important role in planning and giving hospice care in the United States. Volunteers may be health professionals or lay people who provide services that range from hands-on care to working in the hospice office or fundraising.

Where is hospice care given?

Hospice care is designed to be available 24 hours a day, 7 days a week. It can be given in the patient’s home, a hospital, nursing home, or private hospice facility. Your doctor, hospital social worker, or discharge planner can be very helpful in deciding which type of hospice program is best for you and your family.

Home hospice care

Most people get hospice care at home. People who live in places like residential facilities, assisted living, or nursing homes can get hospice care there, too.

Most hospice programs offer home hospice services. Although home hospice programs are staffed by nurses, doctors, and other professionals, the main caregiver is a family member or friend who’s responsible for around-the-clock supervision of the patient. This person is with the patient most of the time and is trained to provide much of the hands-on care.

It’s important to know that home hospice may require that someone be home with you 24 hours a day, 7 days a week. This may be a problem if you live alone, or if your partner or adult children have full-time jobs. But in most cases, creative scheduling and good team work among your friends and loved ones can overcome this problem. Members of the hospice staff will visit regularly to check on you, your family, and your caregivers. They will make sure that any symptoms you have are under control and give any needed care and services.

Care begins when you are admitted to the hospice program, which generally means that a hospice team member visits you at home to learn about you and your needs. Return visits are set up so that you can be re-evaluated regularly. To handle around-the-clock needs or crises, home hospice programs have an on-call nurse who answers phone calls day and night, makes home visits, or sends out the team member you may need between scheduled visits. Medicare-certified hospices must provide nursing, pharmacy, and doctor services around the clock.

Hospital-based hospices

Hospitals often have a hospice program. This gives patients and their families easy access to support services, and allows the patient to get around-the-clock care to help get control of symptoms. Some hospitals have a special hospice unit, while others use a hospice team that visits patients with advanced disease on any nursing unit. In other hospitals, the staff on the patient’s unit will act as the hospice team. The patient returns to home hospice care when they are again comfortable.

Nursing home or long-term care facility-based hospices

Many nursing homes and other long-term care facilities have small hospice units. They might have specially trained nursing staff to care for hospice patients, or they might make arrangements with home health agencies or independent community-based hospices to provide 24-hour care. This can be a good option for patients who want hospice care but don’t have someone to take care of them at home.

Independently owned hospices

Many communities have free-standing, independently owned hospices that feature inpatient care buildings as well as home care hospice services. As with long-term care facility hospice programs, the free-standing hospice can benefit patients who don’t have caregivers available at home or need around-the-clock care.

Who pays for hospice care?

Home hospice care usually costs less than care in hospitals, nursing homes, or other institutional settings. This is because less high-cost technology is used, and family and friends often provide most of the care.

Hospice care is paid for by Medicare, Medicaid in most states, the Department of Veterans Affairs, most private insurance plans, HMOs, and other managed care organizations. Also, community contributions, memorial donations, and foundation gifts allow many hospices to give free services to patients who can’t afford payment. Some programs charge patients according to their ability to pay.

Nearly all hospices have financial support staff who can help you with this, answer your questions, and help you get the care you need.



The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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