Hospice provides services for clients who have a terminal illness. It focuses on caring, not curing, addressing to the physical, spiritual, social, and psychological needs of the client and their families. In 2023, more than 1.7 million Medicare beneficiaries received hospice services, and Medicare hospice expenditures totaled about $25.7 billion (MedPAC.gov, 2025).
The hospice benefit can include visits by nurses, aides, social workers, physicians, and therapists. It also covers drugs, durable medical equipment, and supplies, short-term inpatient care and respite care, bereavement services for the family, and other services related to the terminal illness (MedPAC.gov, 2025).
Pre-Test: Try these True/False questions before continuing.
Answers are listed below the box.
- Hospice services are not for people who have dementia.
- Agitation includes irritability, confusion, making loud demands, and using obscene language.
- Wandering can be addressed by using a physical restraint to keep the person from wandering.
- A sign of moderate dementia can include needing more assistance with ADLs.
- Carefully designed activities can have a positive effect on depression, confusion, and challenging behaviors.
- To relieve stress, it is recommended that family members receive specialized training about dementia.
- In the early stage of dementia, family members are often unaware of dementia-care services.
- When a loved one dies, family members can experience grief that resembles clinical depression.
- Integrate staff into a homelike environment by hiring staff with the emotional skills to interact with people who are living with dementia.
- An ethical dilemma might arise when there are good reasons both for and against a particular course of action and a decision must be made.
Questions 1 and 3 are false; the remainder are true.
To receive hospice services, a client must agree to forgo curative treatment related to the terminal diagnosis, not all medical treatment. Most commonly, hospice care is provided in a client’s home, but may also be provided in nursing, assisted living, and hospice facilities, and other inpatient settings (MedPAC.gov, 2025).
Hospice is defined under Medicare Part A as a benefit that requires physician certification of a six-month terminal prognosis (if the illness runs its normal course) and election of comfort-focused care in place of curative treatment for the terminal diagnosis.
A family member usually serves as the primary caregiver. Hospice staff make regular visits to assess the client and provide additional care and support. Hospice staff are on-call 24 hours a day, seven days a week. In Florida, more than 150,000 clients are enrolled in hospice (National Alliance for Care at Home, 2024).
Originally, hospice services were designed for people with cancer. However, the number of people living with a primary diagnosis of dementia using hospice services has dramatically increased. Nationwide, about 20% of hospice clients are living with dementia (Lassell et al., 2022).
A hospice client can have an unlimited number of days in hospice, as long as they are recertified as having a six-month prognosis (after the first six months of hospice care) and each ninety-day period thereafter. People living with dementia tend to be enrolled in hospice for a longer amount of time and to have higher rates of disenrollment* from hospice before death compared with hospice clients who have other terminal illnesses (Aldridge et al., 2023).
Disenrollment: ending hospice services. The 2 most common reasons for disenrollment from hospice are 1) a person lives longer than 6 months (extended prognosis) or 2) the client or family stops hospice services.
Palliative* care is an important part of hospice, providing relief and support and managing pain and other complex symptoms as a person nears the end of their life. It focuses on symptom management and is available to anyone of any age following complex surgeries or while undergoing treatment for life-threatening conditions such as cancer. Palliative care has no prognosis requirement and may be provided alongside curative treatment at any stage of serious illness.
*Palliative: a medicine or type of medical care that relieves symptoms without dealing with the cause of the condition.