Hospice Care

Hospice uses an expert multidisciplinary team to ease physical, emotional and spiritual pain and to support family members. Critical illness impacts everyone close to the patient, and hospice can offer individualized teaching and support to prepare for the patient’s death.

Hospice care happens where the patient lives, be it his/her home or in an assisted living facility, nursing home, or group home. Care may also be provided in a hospice inpatient unit on a short-term basis for acute symptom management. After the patient’s death, hospice will offer bereavement care to family members for approximately one year. For more on hospice care, visit the National Hospice and Palliative Care website.

The Medicare and Medicaid hospice benefits and most private insurers cover hospice. If a person does not have insurance coverage, many hospices receive community financial support and will work with the family to ensure that needed services are received.

Despite broad availability, hospice care is underutilized in general. The United States Renal Data System (USRDS) 2005 Annual Data Report states that less than 22 percent of all dying Americans used hospice, and even fewer dialysis patients—13.5 percent—used hospice. This underutilization in ESRD or CKD populations may be due to a misunderstanding about eligibility, as well as hospice providers’ variability in accepting these patients.

“If the patient’s terminal condition is not related to ESRD, the patient may receive covered services under both the ESRD benefit and the hospice benefit.  Hospice agencies can provide hospice services to patients who wish to continue dialysis treatment.” (Reference: Medicare Benefit Policy Manual, Chapter 11 End Stage Renal Disease 40.B (pg. 37) – Coverage under the Hospice Benefit (Rev. 219, 01-13-16)) 

A common misconception is that a dialysis patient must stop dialysis in order to be accepted into a hospice program. Hospice provides care and services for patients based on their terminal diagnosis. Most patients have several co-morbidities. If an ESRD patient utilizes the Medicare hospice benefit for a terminal diagnosis other than ESRD, then the patient could continue to use the ESRD Medicare benefit for continuing dialysis.

If hospice benefits are based on ESRD as the terminal diagnosis, the Medicare hospice benefit must provide the coverage for all ESRD care and the Medicare ESRD benefit ceases. This would mean that hospice pays for dialysis; for many reasons, a hospice may not be willing to accept a patient in this situation.

Please see the Medicare Hospice Benefit & ESRD Patients Flowchart for more information.

Medicare Hospice Benefit & ESRD Patients
Note that hospice and palliative medicine is officially recognized as an ABMS subspecialty.  To find a board-certified specialist, go to www.palliativedoctors.org.