Guides to Help You
Understand Your Options

The Simple Definition

Hospice is specialized medical care for people with a life-limiting illness who have decided to focus on comfort rather than continuing curative treatment. It is not a place — it's a philosophy of care, and it comes to your loved one wherever they call home.

The goal of hospice is not to hasten death or prolong it. It is to ensure that however much time remains is spent with as little pain, as much dignity, and as much meaningful connection as possible.

What Hospice Is Not

The biggest barrier families face in accessing hospice is a set of persistent misconceptions:

• It's not giving up. Choosing hospice is one of the most loving, courageous decisions a family can make. It is choosing quality over quantity — presence over procedures.
• It's not only for the last days of life. The Medicare hospice benefit begins when a physician certifies a life expectancy of six months or less — but patients can be on hospice for months, and some for over a year.
• It doesn't mean leaving home. Most hospice care is delivered at home, or in whatever residential setting the patient already lives in — an assisted living facility, memory care unit, or even a skilled nursing facility.
• It doesn't mean losing your doctor. Your loved one's existing physician can remain involved and is part of the care team throughout.

What Hospice Actually Includes

A hospice team is interdisciplinary — meaning it's not just nursing. At Refined Hospice & Home Health, the hospice team includes:

• A physician medical director overseeing all care plans (Dr. Brock Aldrich, DO)
• A nurse practitioner specializing in adult-gerontology (Carley Florence, MSN, APRN, AGPCNP-C)
• Registered nurses making regular home visits for symptom management
• Certified nursing assistants for personal care and daily comfort
• Chaplains for spiritual support — tailored to any faith tradition, or none at all
• Music therapists to reduce pain, anxiety, and create meaningful moments
• Medical social workers for practical and emotional guidance
• Trained volunteers, including veteran volunteers for veteran patients
• A bereavement coordinator who supports the family for 13 months after a patient passes

You don't need to check every box on this list. If several of these resonate, it's worth having a conversation with your loved one's physician — or calling us directly. We can help you think through whether hospice is the right fit.

• Repeated hospitalizations with diminishing returns. Multiple ER visits or hospital stays in a short period, where each stay helps less than the last — this is often a signal that the underlying illness is progressing despite treatment.
• Significant, unintended weight loss. Losing more than 10% of body weight without trying, particularly over a few months, is a recognized indicator of advanced illness progression.
• Increasing difficulty with daily activities. Needing help with things they used to do independently — bathing, dressing, moving from room to room — and a general decline in functional ability over time.
• Spending more time in bed or sleeping. Fatigue and weakness that isn't improving, and a gradual shift toward spending most of the day resting.
• Pain or symptoms that aren't well-controlled. Persistent pain, shortness of breath, nausea, or other distressing symptoms that aren't being adequately managed by current treatment.
• A physician has mentioned a prognosis of six months or less. This is the formal Medicare eligibility criterion for hospice — but it's also a signal worth discussing openly with the care team.
• The patient has expressed a desire to stop treatment. When a loved one says they're tired of fighting, that they want to be comfortable, or that they don't want any more procedures — this is a profound and important communication that deserves to be honored.
• Caregiver exhaustion. Family members who are burned out, overwhelmed, or unable to safely manage care at home. Hospice provides professional support that lifts some of that burden.
• Increased confusion or changes in mental status. Particularly in the context of a known terminal illness, increasing confusion or cognitive changes can indicate progression.
• A general feeling that something has shifted. Sometimes families just know. A sense that the illness has entered a new phase — that the goal has shifted from fighting to being present. Trust that instinct.

Palliative Care: Comfort Alongside Treatment

Palliative care is specialized medical care focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family. Critically, palliative care can be provided at any stage of illness — including alongside curative treatment. A patient undergoing chemotherapy, for example, can also receive palliative care to manage nausea, pain, and fatigue.

Palliative care is delivered by a team of specialists — doctors, nurses, social workers — who work in coordination with the patient's existing treatment team. It does not require a terminal prognosis and does not require giving up other treatments.

Hospice: Comfort as the Primary Focus

Hospice is a specific type of palliative care for patients who have decided to stop pursuing curative treatment and focus entirely on comfort. To qualify for the Medicare hospice benefit, a physician must certify a life expectancy of six months or less if the illness runs its natural course.

When a patient chooses hospice, the Medicare hospice benefit covers a comprehensive set of services — nursing, medications, chaplain care, social work, and more — all focused on comfort rather than cure.

Which One Does My Loved One Need?

If your loved one is still receiving active treatment for their illness — chemotherapy, dialysis, surgery — and wants support managing symptoms and side effects, palliative care is likely the right fit.

If your loved one has decided to stop curative treatment, or if their physician has indicated that treatment is no longer helping and the focus should shift to comfort, hospice is likely the right next step.

Many patients transition from palliative care to hospice as their illness progresses. Our team can help you understand where your loved one is in that journey and what the right fit looks like for your family.

The Short Answer: Almost Everything

Medicare Part A covers hospice care at 100% — with no copays and no deductibles for core services. When eligibility criteria are met, this includes:

• Physician medical director services and oversight
• Skilled nursing visits — as often as medically necessary
• All medications related to the terminal diagnosis
• Medical equipment and supplies (hospital bed, wheelchair, oxygen, etc.)
• Chaplain and spiritual care
• Medical social worker services
• Certified nursing assistant and home health aide visits
• Music therapy and other complementary therapies
• Volunteer support
• Short-term inpatient care if a patient needs a higher level of care during a crisis
• Respite care — short-term inpatient stays to give family caregivers a break
• Bereavement counseling and support for the family for 13 months after the patient passes

Are There Any Out-of-Pocket Costs?

The only potential costs under the Medicare hospice benefit are:

• A copay of up to $5 for outpatient prescription drugs related to the terminal illness (most patients do not incur this)
• 5% cost-sharing for inpatient respite care (this applies only if the patient uses respite care, and only to the Medicare-approved amount)

For most families, hospice care under Medicare results in zero out-of-pocket costs.

What About Medicare Advantage Plans?

Medicare Advantage plans are required by law to cover the hospice benefit at the same level as traditional Medicare. We accept all Medicare Advantage plans for hospice. We verify your specific plan coverage before the first visit.

What About Medicaid?

State Medicaid programs also cover hospice care. If your loved one has both Medicare and Medicaid, Medicare pays first and Medicaid may cover any remaining costs. We accept State Medicaid and can help you understand how your specific coverage works.

Why These Conversations Are So Hard

Talking about hospice means talking about dying — and most of us have very little practice with that. It can feel like raising the topic is giving up hope, or like it will upset the person who is ill. Sometimes family members disagree about what's right. Sometimes the patient is more ready to have the conversation than the family is.

These feelings are normal. And the conversation, while hard, is almost always worth having sooner rather than later.

Start With What You're Seeing

Rather than leading with "I think it might be time for hospice," start by sharing what you've been observing. "I've noticed you seem more tired lately." "I can see that you're in more pain." "I'm worried about how hard things have been getting." This opens a conversation rather than delivering a conclusion.

Ask What They Want — Not What You Think They Should Want

The most important question you can ask a seriously ill person is: What matters most to you right now? Not "do you want hospice?" but "how do you want to spend your time?" and "what does a good day look like for you?" The answers will guide the conversation naturally toward the right kind of care.

Address the "Giving Up" Fear Directly

Many people — patients and family members alike — worry that choosing hospice means abandoning hope. It can help to reframe it: "This isn't giving up — it's choosing to focus on what matters most." Or: "The doctors are saying treatment isn't helping the way we hoped. Hospice means we'd have a whole team focused entirely on making sure you're comfortable and at home."

What to Do If Family Members Disagree

It's very common for family members to have different feelings about hospice. One sibling may be ready; another may feel it's too soon. A spouse may have strong religious or cultural beliefs about continuing treatment. These disagreements are painful but normal.

In these situations, a neutral third party — a social worker, a hospice nurse, or your loved one's physician — can be enormously helpful. We've facilitated many of these conversations. Sometimes hearing information from a clinical professional helps families come to a shared understanding.

You Don't Have to Have All the Answers

You don't need to walk into this conversation knowing exactly what hospice involves or what the next steps are. It's okay to say "I don't know everything about hospice, but I'd like us to find out together." We're here to be part of that conversation whenever you're ready.

The Big Thing Most Families Don't Know

If a veteran has both VA benefits and Medicare, they do not have to choose between them. Through the VA Concurrent Enrollment Program, a veteran can receive VA benefits and the Medicare hospice benefit simultaneously. This is a legal, established program — and it results in significantly more services at no additional cost.

How the Benefits Work Together

Medicare Part A covers the full hospice benefit:

• Skilled nursing visits
• All medications related to the terminal diagnosis
• Medical equipment and supplies
• Chaplain, social work, music therapy, and counseling
• Home health aide visits
• Bereavement support for the family

VA benefits can cover additional services:

• Personal care and home health aide support beyond what Medicare covers
• Transportation to VA medical appointments
• Expanded volunteer visits
• Social services and community support through the VA
• Continued access to VA medical treatment for conditions unrelated to the terminal diagnosis

The We Honor Veterans Program

Beyond benefits, veterans deserve end-of-life care that acknowledges and honors their service. Refined Hospice & Home Health is a Level 4 We Honor Veterans partner — the highest designation in this national program, held by fewer than 5% of hospice organizations nationally.

Through our Duane V. Blackwell Hospice Program for Veterans — named for a Sergeant Major who served 35 years across five branches of the United States Armed Forces — we provide:

• No Veteran Dies Alone — ensuring every veteran has companionship and presence at end of life
• Vet-to-Vet Volunteer Program — veteran volunteers who connect through shared military experience
• Veteran Recognition Ceremony — a service-specific flag and certificate of appreciation for every veteran we serve
• Staff trained in military culture, PTSD, moral injury, and trauma-informed end-of-life care

What If the Veteran Only Has VA Benefits?

The VA also provides a hospice benefit directly for veterans enrolled in VA healthcare who do not have Medicare. VA hospice coverage is comprehensive and is provided at no cost to the veteran. We work closely with VA social workers and case managers to ensure seamless coordination.