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A type of care for people with a life expectancy of about 6 months or less, focused entirely on comfort rather than cure. Hospice can be at home, in a hospice facility, in a nursing home, or in a hospital. Medicare covers hospice for eligible patients with no out-of-pocket cost for the hospice services themselves.
Hospice is one of the most misunderstood services in American healthcare. It is not a place; it is a Medicare benefit and a philosophy of care. Patients can receive hospice at home (about 60% of US hospice patients), in a stand-alone hospice facility, in a nursing home, or in a hospital. The unifying feature: when the goal of care shifts from cure to comfort, hospice is the formal program that supports that shift.
The Medicare hospice benefit covers ALL hospice-related services at zero out-of-pocket cost — nursing visits, social work, chaplaincy, hospice aide for personal care, durable medical equipment (hospital bed, oxygen), medications related to the hospice diagnosis, respite care for the caregiver, bereavement counseling for the family for up to 13 months after death. Most families are surprised by how comprehensive the benefit is. The trade-off is that patients sign off on curative treatment for the hospice diagnosis (though they can still treat unrelated conditions).
Eligibility requires two physician certifications that the patient is likely to die within 6 months if the disease runs its usual course. The vast majority of US patients enter hospice in the last 2 weeks of life, often after months of avoidable suffering and ICU admissions. The single most-common family regret in end-of-life care is "I wish we'd started hospice sooner." Most hospice programs will accept families for an evaluation conversation at any point during a serious illness, without commitment.
Hospice is NOT giving up. It is choosing a different, more aggressive form of care for the goals that matter at the end of life — symptom control, dignity, presence, family time. The medications and interventions are often more aggressive than what curative-focused care provides at the same stage.
When two physicians certify the patient is unlikely to live more than 6 months if the disease runs its usual course. Many families recognize after the fact that they wish hospice had started weeks or months earlier than it did.
Terms families frequently confuse with hospice.
Palliative care can begin at any stage of serious illness and can be provided alongside curative treatment (chemotherapy, dialysis, hospitalization). Hospice is a specific Medicare benefit for patients with ≤6 months prognosis who have chosen to forgo curative treatment for the hospice diagnosis. Many patients receive palliative care for years before transitioning to hospice in the last weeks of life.
Comfort care is the philosophy (focus on symptom relief and dignity). Hospice is one specific program that operationalizes comfort care under Medicare. Comfort care can be provided in any setting at any stage; hospice has specific eligibility rules + a Medicare benefit structure.
Assisted living is a residential setting for people who need help with some daily activities. Hospice is end-of-life care that can be provided anywhere — including in an assisted living facility, alongside the resident's existing care.
See also: all glossary terms · conditions by name · step-by-step playbooks