What is hospice?
Comfort-first care at the end of life, and what it does and does not include.
Hospice is a type of care for people with a terminal illness, including late-stage dementia, that focuses on comfort and quality of life rather than cure. Under Medicare, a doctor must certify a life expectancy of six months or less, and the person chooses comfort care over curative treatment. Most hospice care happens at home.
What hospice looks like day to day
A hospice team (nurse, aide, social worker, chaplain and doctor) visits your loved one at home or in a facility on a schedule, manages pain, breathing and agitation, delivers equipment like a hospital bed, and gives the family a number to call with questions.
The nurse might come weekly and the aide a few times a week for bathing. Between those visits, the family is still the main caregiver, which surprises many people.
Why it is used in dementia
In late-stage dementia, the Alzheimer’s Association describes around-the-clock care needs, trouble communicating pain, loss of walking and eventually swallowing, and higher vulnerability to infections such as pneumonia. Hospice shifts the goal to comfort: treating symptoms, avoiding hospital trips that confuse and exhaust, and supporting the family.
What Medicare covers, and what it does not
Covered
Team visits, medicines and equipment for comfort, short-term inpatient care and short-term respite that the team arranges. You pay $0 for this care; up to $5 per prescription; 5% of the approved amount for inpatient respite.
Not covered
Treatment intended to cure the terminal illness, room and board at home or in a nursing home, and care the team did not arrange.
Details are from Medicare.gov. After the first six months, a hospice doctor or nurse practitioner must recertify eligibility in a face-to-face visit.
How hospice eligibility works under Medicare
- Your loved one has Medicare Part A.
- The hospice doctor, and the regular doctor if there is one, certify a life expectancy of six months or less if the illness runs its usual course.
- Your loved one, or the health care surrogate, accepts comfort care instead of treatment to cure the illness.
- An election statement is signed.
According to Medicare.gov, the benefit runs in two 90-day benefit periods followed by an unlimited number of 60-day periods, and you may change providers once in each period. Original Medicare still covers health problems that are unrelated to the terminal illness.
What helps at home
- Gentle touch, soft familiar music and a calm room.
- Mouth care and small sips or tastes if swallowing is unsafe; follow the nurse’s guidance.
- Watch for signs of pain: grimacing, moaning, restlessness.
- Keep the health care surrogate and family informed.
Our post on caring for a loved one in late-stage dementia covers this time with care.
When to talk to the doctor about hospice
Ask when your loved one has frequent infections or hospital stays, is losing weight, can no longer walk or speak meaningfully, or has trouble swallowing.
Recognizing pain when words are gone
In the late stage, the Alzheimer’s Association notes that people may still say some words but find it hard to tell anyone they hurt. Watch for:
- Grimacing, frowning or a tense jaw
- Moaning, sighing or calling out, especially when moved
- Guarding an arm, leg or belly
- Pulling away during bathing or dressing
- New restlessness, or unusual stillness
- Eating less or refusing a favorite food
Tell the nurse what you see and when it happens. A short written note, kept by the bed, helps every visitor report changes the same way.
Questions to ask a hospice provider
- How often will the nurse and aide visit, and how long do visits last?
- Who answers the phone at 2 a.m., and how fast can a nurse come?
- Do your staff have dementia training?
- How do you manage pain in someone who cannot describe it?
- Do you offer music, pet or massage programs?
- What respite can you arrange for the family?
- What bereavement support is offered afterward?
The Alzheimer’s Association recommends hospice in late-stage dementia to focus on comfort and dignity. If you are unsure where to start, the Elder Helpline at 1-800-963-5337 can connect you with your local Aging and Disability Resource Center.
Hospice vs. palliative care
Palliative care focuses on comfort at any stage of a serious illness and can continue alongside treatment. Hospice is palliative care for the final months, when curative treatment stops.
Companions alongside hospice
Because the team visits on a schedule, families often add companion visits for presence, reading aloud, music and giving the family a break. Our companions are not nurses and work alongside the care team. See respite care and costs in Florida.
Related terms
Presence when it matters most
Calm, consistent companions who work alongside medical teams. 3-5 profiles in 48 hours, $35/hour for 40+ hours a week.
Frequently asked questions
Still have questions?
Talk it through with us. A free call about your family's situation, with no obligation.
Call (689) 333-6079Send us a message- Screened for dementia care experience
- Florida ADRD training before the first visit
Does Medicare pay for hospice for dementia?
Yes, if a doctor certifies a life expectancy of six months or less and your loved one chooses comfort care. Medicare covers it at $0 with small copays for some drugs and respite.
Does hospice provide 24-hour care at home?
Hospice at home is usually delivered through scheduled team visits, and families still provide most day-to-day care. Medicare covers short-term inpatient care when the team arranges it; ask each provider what it offers.
Does Medicare hospice pay for nursing home room and board?
No. Medicare.gov states hospice does not cover room and board at home or in a nursing home, except short-term inpatient or respite stays the team arranges.
Can a companion visit while my loved one is on hospice?
Yes. Companions provide non-medical presence and support alongside the care team; they do not give medical care.
What is the difference between hospice and palliative care?
Palliative care focuses on comfort at any stage of a serious illness and can continue alongside treatment. Hospice is palliative care for the final months, when curative treatment stops. Learn more on our palliative care page.
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