Hospice and Respite Care

Hospice is a compassionate method of caring for people who are terminally ill. Hospice is a medically directed, interdisciplinary team-managed program of services that focuses on the patient/family as the unit of care.  

Hospice is the gold standard method of caring for people at the stage of a terminal illness when no further curative or life-prolonging therapy is available, or wished to be pursued by a patient or family member.  

Hospice services can assist the family (as well as family caregivers) in making the patient as comfortable as possible by optimizing pain and symptom management at home or in a home-like setting.  

Hospice providers must be licensed as a Home and Community Support Services Agency and have a contract with the Texas Health and Human Services Commission to provide Medicaid hospice services. 

The law leaves the final decision up to the patient. However, the decision is usually made after discussion with the members of the family, the physician, clergy and others. 

Hospice is for those persons who have a life expectancy of six months or less and can no longer benefit from curative treatment. Most hospice patients receive care at home and an interdisciplinary team of physicians, nurses, counselors, therapists, social workers, aides and volunteers provides treatment. The hospice team provides medical care to the patient and support services to the patient and to the patient’s family and friends. Hospice does not attempt to cure, but rather to control pain and other symptoms in order to enable the patient to live as fully and comfortably as possible.  

Hospice addresses the medical, emotional, psychological and spiritual needs of the patients and their loved ones. Hospice is provided seven days a week. Patients routinely receive periodic in-home services of a nurse, home health aide, social worker, volunteer and other members of the hospice team. 

Hospice care has been shown to usually be less expensive than conventional medical care during the last six months of life. Hospice care is covered by most private health insurance carriers, nationwide by Medicare and in Texas by Medicaid. 

You qualify for hospice care if you have Medicare Part A (Hospital Insurance) and meet all of these conditions: 

• Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of 6 months or less). 

• You accept comfort care (palliative care) instead of care to cure your illness. 

• You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions. 

Medicare-certified hospice care is usually given in your home or other facility where you live, like a nursing home. You can also get hospice care in an inpatient hospice facility.

Original Medicare will still pay for covered benefits for any health problems that aren't part of your terminal illness and related conditions, but this is unusual. Once you choose hospice care, your hospice benefit will usually cover everything you need. 

You pay nothing for hospice care. 

You pay a copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management. In the rare case the hospice benefit doesn't cover your drug, your hospice provider should contact your plan to see if Part D covers it. The hospice provider will inform you if any drugs or services aren’t covered, and if you’ll be required to pay for them. 

You may pay 5% of the Medicare-Approved Amount for inpatient respite care. 

You may have to pay for room and board if you live in a facility (like a nursing home) and choose to get hospice care. 

Depending on your terminal illness and related conditions, your hospice team will create a plan of care that can include any or all of these services: 

• Doctors' services. 

• Nursing and medical services. 

• Durable medical equipment for pain relief and symptom management. 

• Medical supplies, like bandages or catheters. 

• Drugs for pain management. 

• Aide and homemaker services. 

• Physical therapy services. 

• Occupational therapy services. 

• Speech-language pathology services. 

• Social services. 

• Dietary counseling. 

• Spiritual and grief counseling for you and your family. 

• Short-term inpatient care for pain and symptom management. This care must be in a Medicare‑approved facility, like a hospice facility, hospital, or skilled nursing facility that contracts with the hospice. 

• Inpatient respite care, which is care you get in a Medicare-approved facility (like an inpatient facility, hospital, or nursing home), so that your usual caregiver (like a family member or friend) can rest. Your hospice provider will arrange this for you. You can stay up to 5 days each time you get respite care. You can get respite care more than once, but only on an occasional basis. 

• Any other services Medicare covers to manage your pain and other symptoms related to your terminal illness and related conditions, as your hospice team recommends. 

Medicare doesn’t cover room and board when you get hospice care in your home or another facility where you live (like a nursing home). 

Medicare won't cover any of these once your hospice benefit starts: 

• Treatment intended to cure your terminal illness and/or related conditions. Talk with your doctor if you're thinking about getting treatment to cure your illness. As a hospice patient, you always have the right to stop hospice care at any time. 

• Prescription drugs to cure your illness (rather than for symptom control or pain relief). 

• Care from any hospice provider that wasn't set up by the hospice medical team. You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can't get the same type of hospice care from a different hospice, unless you change your hospice provider. However, you can still see your regular doctor or nurse practitioner if you've chosen him or her to be the attending medical professional who helps supervise your hospice care. 

• Room and board. Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay. 

• Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation, unless it's either arranged by your hospice team or is unrelated to your terminal illness and related conditions. 

No. Medicare pays for the cost of hospice and Social Security payments are not affected. 

HMOs are not required to provide hospice care, though many of them do. Any HMO receiving monthly payments from Medicare must inform Medicare recipients of Medicare certified hospice programs in the area. A hospice patient does not have to leave the HMO, and may continue to receive other HMO benefits not covered by Medicare. 

Hospice offers palliative rather than curative care, with an emphasis on pain and symptom management through an interdisciplinary team of physicians, nurses, social workers, bereavement counselors, clergy, physical and speech therapists, and volunteers who address the medical, emotional, spiritual, and psychological needs of the patient and their loved ones. 

Hospice is usually provided in the home, but it can be provided in a nursing home or inpatient facility if available. Upon entrance to a hospice, the hospice team will assess the patient’s needs and prepare an individualized care plan. The care plan will address medication and equipment needs and outline the care to be provided by the family and the hospice. This plan is updated periodically to allow for increased care as the patient’s condition changes.  

Care giving at home is not always easy and hospice provides telephone consultation on a 24-hour basis and night visits, when appropriate. In addition, hospice volunteers can be provided to run errands or a staff member for needed “respite” care to give family members a break and/or provide companionship to the patient. 

A patient that elects to be discharged from hospice has the right to re-enter the program so long as they still meet the criteria for hospice eligibility. If a patient is discharged for no longer meeting hospice eligibility may re-enter hospice is their condition changes to the point that they now meet hospice eligibility criteria. 

Respite care provides short-term relief for primary caregivers. It means having someone else look after your loved one while you take a break.  It can be arranged for just an afternoon or for several days or weeks. Care can be provided at home, in a healthcare facility, or at an adult day center.

Respite takes place either in your home (or that of a family or friend) or at a location in your community. 

You can have someone come to your home to take care of your loved one. They can visit, read or take a walk together. Basically, they make sure your loved one is safe and cared for while you are away. 

Some respite organizations offer additional services, such as: 

• Light housework or chores 

• Personal care, which is help with things such as brushing teeth, getting dressed, bathing or shaving 

• Medical care, which can include help with medication or using medical devices. 

If your family member needs services that you can't have provided in your home, you may need to access one of the options listed below. Some may provide overnight or weekend services and some may provide more medical or nursing care. Options include: 

• Adult day care centers are where you bring your loved one to a facility where they participate in supervised activities and often are provided meals and snacks. Some facilities are allowed to provide medical services. 

• Specialized camps that serve either adults or children with special needs have trained staff to provide medical care. 

• Assisted living facilities may offer overnight stays where trained staff supervise your loved one. Some provide medical care. 

• Nursing homes also may provide extended respite care. And, because they have medical staff, they can provide medical care. 

In the case of a family emergency, some respite providers will offer crisis or emergency care either at a facility or in your home. 

Respite can be provided by a variety of people. Sometimes, a family member or friend can step in when you need a break. Other times, you may need to hire someone. 

If having family or friends help out does not work in your situation, you may need to find paid caregivers. However, this does not necessarily mean you have to foot the bill. 

Some government programs, such as those funded by Medicaid, Medicare, Veterans Affairs or the state of Texas may provide free or low-cost respite care.  

To find out if your loved one may qualify for federal or state services that provide respite care, call 1-855-937-2372 to talk to a trained professional about your options. 

Visit this searchable list of respite providers and programs in Texas, provided by the Texas Health and Human Services Commission (HHSC). It includes all types of providers and you can search it based on the type of service you need and where you live. 

To learn more about hospice, visit the Hospice Care page on the Texas Health and Human Services website, the Hospice Care Coverage page on the Medicare website.  

To learn more about respite care, visit the Take Time Texas: What is Respite? page on the Texas Health and Human Services website.