Modern hospice or palliative care is concerned with the effective relief of intractable pain giving the patient the opportunity to know about their illness to the extent they wish, and say good-bye how and when they wish.
Today, hospice is a philosophy, not a place, and involves interdisciplinary teamwork: physician, nurse, clergy, family, patient, pharmacist, etc. It is about a shift of focus from quantity of care to quality end-of-life care.
Compassion and gentleness are valued tools in the care of a hospice patient by staff who are nurturing and supportive and not afraid to draw close to offer death with dignity and respect for the unique choices of a dying patient and their family.
Most hospice care is delivered at home. This service is available to people in home-like hospice residences, nursing homes, assisted living facilities, veterans' facilities, hospitals and even prisons.
The four primary levels of care provided by hospice are routine home care, continuous care, general inpatient, and respite care. Patients undergoing hospice treatment may be discharged for a number of reasons, including improvement of their condition etc., but may return to hospice care as their circumstances change.
Generally, treatment is not diagnostic or curative, although the patient may choose some treatment options intended to prolong life, such as cardiopulmonary resuscitation (CPR).
Most hospice services are covered by Medicare or other providers. Hospice is covered 100% with no co-pay or deductible by Medicare Part A except that patient are responsible for a copay for outpatient drugs and respite care, if needed. Once a patient is enrolled in hospice, the hospice becomes the insurance payor for that patient for any hospice-related illnesses. In other words, if a patient is on hospice for end-stage congestive heart failure, the hospice is responsible for all care related to the heart failure. However, if the patient were to see a podiatrist, this would be billed through their regular insurance.
Hospice differs from other forms of care in that the core members of the hospice team function as an interdisciplinary, rather than a multidisciplinary, team. Multidisciplinary teams involve several professionals who independently treat various issues a patient may have. The problems that are being treated may or may not relate to other issues being addressed by individual team members. Interdisciplinary team approach involves all members of the team working together towards the same goal, which in this case is to afford patients a comfortable dying experience and families the support they need in coping with this. In an interdisciplinary team approach, there can often be role blending by members of the core team, who may take on tasks usually filled by other team members. Additionally, the team regularly reviews the patient's medical condition to ensure that the patient still meets criteria for hospice care.