Hospice Is Not Appropriate for Every End-of-Life Situation

COVID-19 has hit close to home lately. Yesterday I received word that another friend had died due to the virus. That makes three people in my circle. I really do not like those statistics.

However, this friend’s situation caught my attention, not because of COVID-19 but because his wife had shared that the hospice doctor was keeping him comfortable, yet she also stated that he was agitated. I need not reflect on my 30-year hospice career when I say that statement is a definite oxymoron. If he was being kept comfortable, then he would not be agitated. But even beyond that contradiction, was the fact that he was being followed by a hospice doctor. Immediately I wondered, why?


The fact is that as sure as each of us is born, we also will die one day – but just because we are dying, it does not make us eligible for hospice care. Hospice is for people who have been diagnosed with a life-limiting illness. COVID-19 is a virus…not a terminal disease.

For reasons such as this, Medicare has set guidelines and criteria for what makes a patient appropriate for the hospice level of care. A hospice nurse’s job is to assess their patient against the criteria to be sure that it is an appropriate admission. We often are introduced to people who have failing health, however, if their condition does not meet hospice criteria then it is not appropriate to admit them onto service. Simply put, that is following federal law.

Each year, Medicare hospice fraud costs the federal government billions of dollars. A quick Google search will uncover programs that have been cited for fraud, assessed penalties, and made to pay back a portion of what they have essentially stolen, yet they continue to operate.




Much of the fraud is due to patients being admitted to programs that do not qualify for services. Elevate that issue to find patients admitted to a level of hospice care that is not appropriate for their condition which then yields reimbursement at up to seven times the normal daily reimbursement rate. These practices are not only inappropriate; they are also illegal.


The word hospice is derived from the word hospitium, meaning hospitality. Hospice was founded on Christian principles beginning in the early 1900s when lodging and care would be provided for weary travelers and the dying at way stations run by monks. Today that philosophy plays out in many countries as compassionate, holistic care for people with life-limiting illnesses. Despite hospice maintaining some of that foundation today, it has also changed in a variety of ways. What began as volunteers with a “neighbor helping neighbor” philosophy, grew into a more sophisticated level of health care in the 1980s when Medicare authorized formal hospice care by introducing the Medicare Hospice Benefit. With this development, hospices were able to acquire state licensure and Medicare certification which presented the ability to bill a patient’s insurance for services provided by the hospice team. The ability to receive compensation quickly led to the influx of new hospices.

So why is it important to know the history of hospice? Because although many hospices have altered the founding principles to meet their own models, it is essential that we do not lose the hospice philosophy foundation. We owe that to the patients who are entrusted to our care.



At Advanced Hospice, we strive to provide superior patient care. Being diligent in our patient assessments ensures that patients receive not only the level of care appropriate to their condition but the level of care that is in alignment with their physician’s recommendation and the patient’s wishes.


We are honored to care for our community neighbors throughout the Greater Pittsburgh area. Thank you for welcoming us into your homes.


About Advanced Hospice Advanced Hospice is a local, family-owned, hospice and palliative care provider located in Western PA, servicing Allegheny, Beaver, Butler, Lawrence, and Washington Counties.




Have questions on hospice? Call our education line at 412.710.7300.