Eligibility
Medicare hospice benefit: 2 physicians certify prognosis <=6 months if disease takes usual course. Patient foregoes curative treatment for terminal diagnosis (can receive treatment for other conditions). Can revoke and return to curative. Re-certification: 90 days, then 60 days, then every 60 days. 6-month prognosis is an estimate, not a guarantee. Common diagnoses: cancer, heart failure, dementia, COPD, ALS, kidney failure, liver failure.
Levels of Care
Routine home care: most common, intermittent visits at home. Continuous home care: crisis management, 8-24 hours continuous nursing. General inpatient care: acute symptom management in facility. Respite care: up to 5 days, patient in facility to give family a break. Inpatient respite: SNF or hospice facility. Bereavement: 12 months post-death for family. Location: home, SNF, ALF, hospice facility, hospital (for general inpatient).
Nursing Management
Regular visits: assess symptoms, medications, psychosocial, spiritual. Manage: pain, dyspnea, nausea, anxiety, agitation, constipation, anorexia, skin. Coordinate care: MD, social work, chaplain, aide, volunteer. 24/7 on-call availability. Education: disease trajectory, what to expect, comfort measures, when to call. Family support: caregiving skills, anticipatory grief, self-care. Death: verify, pronounce (per state law), notify family/hospice/funeral home, post-mortem care, bereavement.
Important Notes
- Hospice eligibility: 2 physicians certify prognosis <=6 months if disease takes usual course — patient foregoes curative treatment for terminal diagnosis.
- Hospice can be revoked at any time — patient can return to curative treatment and re-elect hospice later if eligible again.
Clinical Tips
- Routine home care is the most common hospice level — intermittent visits at home, not 24/7 care.
- Continuous home care is for crisis management — 8-24 hours continuous nursing, then back to routine care.
Summary
Hospice care provides symptom management, family support, and bereavement services for patients with <=6 month prognosis under Medicare benefit.
