The hospice team, role by role

Hospice can bring more people through the front door than families expect: a nurse, an aide, a social worker, a chaplain, a volunteer, and doctors behind them all. It helps to know who each one is and what they’re there to do. Medicare’s rules name the core team, who leads, and who checks on whom.^1,2 This note goes role by role, and ends with the family, who are part of the team too.

The short answer

• Every hospice team includes at least a doctor, a registered nurse, a social worker and a pastoral or other counselor, and one registered nurse coordinates the person’s care.²
• A hospice nurse and doctor are on call 24 hours a day, 7 days a week.¹
• The hospice medical director reviews the person’s clinical information and certifies that the illness is terminal.³
• Counseling for the family includes bereavement support for up to a year after the death.⁴
• A registered nurse checks on the aide’s care with a visit at least every 14 days.⁵
• Volunteers are part of every hospice, by Medicare’s rules.⁶

The doctors

Every hospice has a medical director, a doctor employed by or under contract with the hospice, who is responsible for the medical side of its care. The medical director or another hospice doctor reviews the person’s clinical information and certifies in writing that life expectancy is six months or less if the illness runs its normal course, and reviews it again before each new benefit period.³

The person can also choose to keep their regular doctor as part of their hospice care.¹ The hospice doctors and the person’s own doctor share responsibility for comfort and for managing the terminal illness.⁴

The registered nurse

Hospice nursing is given by, or under the supervision of, a registered nurse, and it has to meet the needs the team’s assessments find.⁴ One registered nurse on the team is named to coordinate the person’s care.² A hospice nurse is on call around the clock, every day.¹

The nurse’s visits are where comfort and symptoms get checked, medicines get reviewed, and the family learns what to do and what to watch for. When the plan needs to change, the nurse brings in the doctors.

The hospice aide

A hospice aide gives hands-on personal care, does simple procedures that extend the nurse’s or therapist’s care, helps with walking and exercises, and helps with medicines the person would usually take on their own.⁵

Aides train for at least 75 hours, including supervised practical training, and must pass a competency evaluation before they work with patients. A registered nurse writes the aide’s care instructions, and visits the home at least every 14 days to check on the aide’s care.⁵ Does hospice mean someone there 24 hours? explains how aide visits fit into a week.

The homemaker

Medicare’s hospice benefit includes homemaker services.¹ A member of the hospice team gives the homemaker instructions, and coordinates and supervises the work.⁵

The social worker

Medical social services come from a qualified social worker, working under a doctor’s direction.⁴ Ask the social worker about help at home, forms like an advance directive or a POLST, money worries, and the strain an illness puts on a family.

The spiritual counselor

The hospice must assess spiritual needs, offer spiritual counseling in keeping with the person’s and family’s own beliefs, and make all reasonable efforts to arrange visits by local clergy or other spiritual advisers.⁴ It follows your family’s beliefs, whatever they are.

Dietary counseling

When the plan of care calls for it, dietary counseling comes from someone qualified to do it, like a dietitian or a nurse.⁴ When someone stops eating or drinking covers what families ask about food and fluids.

Therapists and the pharmacist

Physical and occupational therapy and speech-language pathology are part of Medicare’s hospice benefit when the plan of care calls for them, and pharmacists can be part of the team.¹ Ask about therapy if moving around, using equipment or swallowing has become hard.

The volunteers

Medicare requires every hospice to use volunteers, in defined roles and under the supervision of a hospice employee. Volunteer time must equal at least 5% of the patient care hours of the hospice’s paid staff.⁶ Ask what volunteers can do for your family, like company for the person or a short break for the caregiver.

The bereavement team

Every hospice must have an organized bereavement program, led by a qualified professional, with support available for up to a year after the death.⁴ The care doesn’t stop at the death; the family is still the hospice’s to look after.

The family

Medicare’s booklet says it plainly: you and your family members are part of the hospice team.¹ The plan of care is written by the hospice team together with the attending doctor,² and the family’s questions and worries belong in it.

Keep a notebook by the bed. Ask each person who visits to write down what they did and what to watch for. It helps the next visitor, and it helps the family keep track on hard days.