The Pros and Cons of Hospice Care

Hospice care (sometimes called end-of-life care) can be an intimidating topic. For many families, even considering hospice care can introduce a lot of heavy emotions to what is often an already fraught situation. However, hospice care is a powerful tool towards improving quality of life, at the end of one’s life. Studies have shown that patients who enter hospice care during the last six months of life tend to have higher satisfaction with their care, better pain management, and reduced hospital stays, among other benefits. 

Only medical professionals can tell you whether the time is right to consider hospice care; usually doctors will recommend hospice care if they feel certain an individual has six months or less left of their life. We’ll explain some of the pros and cons of hospice care; why people choose to go into hospice and why they might decide against it. You should also keep in mind that if you want to, you can leave hospice care to start pursuing curative care again.

Briefly, hospice care is a type of care offered to people who are approaching the end of their lives. It focuses on their comfort, maximizing the time they have left with family members and loved ones. It means that curative treatments for their condition are stopped (unlike palliative care, where they continue alongside prioritizing comfort) and all focus shifts to treating symptoms, minimizing pain and discomfort. Hospice care can take place in care facilities or at home. Hospice care is not just for people with a terminal illness, like cancer, but for anyone, including older people approaching the end of their lives naturally.

Pros of hospice care:

• Comfort care and pain management: Instead of pursuing curative treatments that are unlikely to work, especially those that can be invasive and painful, hospice care provides pain relief and comfort care. This means that individuals have more time free of appointments, surgeries, and recovery, and, importantly, more time free of pain. Hospice focuses on symptom management rather than treatment.
• Fewer invasive procedures: Curative care can involve surgeries, chemo, and other treatments that are incredibly hard on the body, some with difficult or lengthy recovery periods. Hospice care means an end to these fatiguing treatments.
• Less time spent in hospitals: When a patient decides to stop pursuing curative care it frees them to leave hospitals, which have strict protocols for the well-being of patients and staff alike. Someone entering hospice care can choose to live the remainder of their life at home, with in-home care, or in a nursing home or specialized hospice facility that is not as sterile, busy, and strict as inpatient care at hospitals tends to be.
• Professionals trained in end-of-life care and support: Hospice staff and volunteers are trained to help patients and their family members through what can be a very emotional time. Chaplains and other spiritual leaders can help comfort loved ones and social workers can offer resources, information, or just a kind ear. Though some of these professionals are available in hospital settings, they will have more time in hospice to help your loved one and family to plan how to make the most of their time.
• Less expensive: In an ideal world, the cost of care would not need to be a consideration for families, but the long and short of it is that one of the advantages of hospice care is that it often costs less than curative care.

Cons of hospice care:

• No longer eligible for experimental treatments: Clinical trials and other experimental  medical treatments will not be available to hospice patients. This may not impact your family unless your loved one was enrolled in such a trial and felt they were benefiting from it in some way.
• Hospitalization and diagnostic tests discouraged: Since curative treatment is abandoned during hospice, hospice teams will argue against hospitalization, which can be traumatic. Moreover, hospice care costs will not cover certain diagnostic tests and medical care. This may seem obvious; of course forgoing curative care will mean forgoing these things. But if, for example, your loved one in hospice suffers a sudden steep decline in mental and/or physical ability, hospice staff are unlikely to recommend testing to, say, confirm a stroke or similar event. You’ll have to decide whether this is worth pursuing and paying for out of pocket.

The disadvantages of hospice care are very situational, and are not disadvantages as much as the simple reality of reaching the end of a life. If you or your loved one decide that hospice care is right for your situation, you'll be met with an interdisciplinary team that will help you determine how they'll help your family make the most of the time you have left, prioritizing the patient's needs and offering emotional support.

There are some less tangible advantages of hospice care, too. Hospice nurses and caregivers, whether they are caring for a loved one in your own home or at a hospice facility, are experienced in topics our culture often has difficulty discussing. You may be surprised at their compassionate insights in your loved one's final days, and take comfort in their expertise. Hospice agencies and providers are also well-versed in supporting family and friends through the passing of a loved one, and will have valuable resources to offer.

Works consulted:

Ruth Kleinpell, Eduard E. Vasilevskis, Louis Fogg, and E Wesley Ely. “Exploring the association of hospice care on patient experience and outcomes of care.” National Library of Medicine. August 16, 2016. https://pubmed.ncbi.nlm.nih.gov/27531840/.