• Medical Author:
    Siamak N. Nabili, MD, MPH

    Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

How is referral to hospice made?

Referral to hospice is considered when a physician believes the patient's life expectancy is less than six months if the disease runs its natural course. Clinical guidelines are available to help clinicians with these determinations.

The option for hospice is then presented to the patient or their surrogate decision makers. If the patient's or their decision makers' goals and wishes are in line with hospice principles, then a formal referral can be made by the doctor.

Hospice staff meet with the patient and family to discuss hospice services. They evaluate the patient's medical condition, functional level, living situation, religious beliefs, and social support system. They determine long-term goals, wishes, and expectations of the patient and family members.

Once criteria for a terminal diagnosis are established and the patient and family consent to hospice care, a two-physician certification has to be signed certifying the terminal illness and appropriateness of hospice. The hospice certificate is typically signed by the referring physician and the hospice medical director.

How does hospice care work?

Hospice strives to optimize comfort and quality of the remaining life and to preserve patient's dignity. The patient agrees to forego further treatment aimed at curing their disease. A comprehensive care plan consistent with the patient's goals and wishes is established.

Routine home visits from nurses, social workers, clergy, volunteers, caregivers, and home aids are provided. The frequency of these visits may vary considerably for each patient's individual situation. Hospice nurses visit the patient at least once or twice a week, but these visits can increase to as often as daily in a crisis situation. Other staff may also attend to the patient as frequently as the patient's care mandates.

For patients living in assisted-living facilities or nursing homes, collaborative hospice services are coordinated with the facility's own staff.

Hospice medical directors or other hospice contracted doctors are available to the hospice team by phone 24/7 to address any issues that may arise at any time with patients.

The patient's personal physician or primary-care physician can stay on as the attending physician if he or she chooses to. In these situations, the primary doctor can work in collaboration with the hospice team and the hospice medical director. If the primary-care physician decides not to follow the patient on hospice, then the hospice medical director acts as the patient's primary-care physician.

Home visits by hospice doctors are sometimes necessary in cases of crisis or in situations where a physician's expertise is necessary in the care of the patient. Furthermore, since the beginning of 2011, Medicare has mandated more frequent doctor visits if a patient remains on hospice beyond six months. A face-to-face patient encounter is required every 60 days to justify continual hospice care.

Medications for treating pain and other symptoms, as well as medical supplies and equipment, are part of the care provided by hospice for their patients.

Generally, therapies that are thought to be a cure for the underlying hospice condition are not offered. For example, a patient who has a terminal cancer as their hospice diagnosis may not receive any further chemotherapy and radiation for a curative purpose while on hospice. However, if such a therapy is offered to relieve an intractable symptom (for a palliative reason), some hospices may agree to cover these costs.

Medically Reviewed by a Doctor on 10/6/2015

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