Hospice & Home-Based Palliative Care

Hospice care provides comfort-focused, interdisciplinary care for individuals with a terminal illness and a life expectancy of 6 months or less if the disease follows its expected course. Medicare Hospice Benefit covers hospice services when the client elects hospice and agrees to forgo curative treatment for the terminal diagnosis (they can still receive treatment for unrelated conditions). Hospice is most commonly provided in the home, though it can also be delivered in residential hospice facilities, long-term care, or hospitals. The interdisciplinary hospice team includes the physician, nurse, social worker, chaplain, home health aide, bereavement counselor, and trained volunteers. The hospice nurse's role in the community includes symptom management (pain, dyspnea, nausea, anxiety, agitation), medication management focused on comfort (converting to subcutaneous or sublingual routes when the client can no longer swallow), family and caregiver education (what to expect during the dying process, medication administration, when to call hospice rather than 911), psychosocial and spiritual support, coordination with the interdisciplinary team, and pronouncement of death (in most states, the hospice nurse can pronounce death in the home). Palliative care differs from hospice — palliative care can begin at any point during a serious illness, does not require a terminal prognosis, and can be provided alongside curative treatment. The nurse educates families on the differences. Bereavement support extends to the family for at least 13 months after the client's death under the Medicare Hospice Benefit.