by editor | Nov 9, 2025 | Blog, Care Keys - Nurses, Internal Marketing, Keys to Compassionate Care, Resources and Readings, Resources and Readings
Despite the clear benefits of hospice care, many patients are referred very late – sometimes in their final days of life – limiting the opportunity to benefit from its full scope. Two of the most commonly cited reasons for this delayed referral are:
- Clinician-related delays: Research shows that physicians often struggle with prognostication, lack of training in hospice eligibility and goals-of-care conversations, and uncertainty about when to refer. For example, a study found that physicians had difficulty determining prognosis and eligibility, which directly contributed to delayed hospice referral.
- Patient/family preference for curative treatment or denial of serious illness: Many families view hospice as “giving up,” and patients may seek more aggressive or curative treatments until very late. One review noted that among patients who delayed hospice, factors included desire to exhaust all treatment options and misunderstanding of hospice’s role.
Together, these barriers contribute to the pattern of late admission to hospice, which can undermine many of the benefits that hospice care is designed to provide.
Hospice care plays an essential role in ensuring patients with serious illness receive appropriate, coordinated, and compassionate care near the end of life. Yet, despite its well-documented benefits, hospice care is often initiated too late to deliver its full value to patients, families, and the healthcare system.
The Impact of Hospice Care on Outcomes and Cost
A 2023 analysis conducted by an independent research organization examined Medicare data to evaluate the impact of hospice care on outcomes and costs. The findings provide a clear picture of why timely hospice enrollment matters.
Patients who enrolled in hospice experienced lower rates of hospitalization, fewer emergency department visits, and reduced use of intensive medical interventions in the final months of life. These patients also reported higher satisfaction with care and better symptom management. Family members experienced fewer adverse emotional and financial effects during and after the end-of-life period.
From a systems perspective, hospice care was associated with significant cost savings. The study found that Medicare spending in the last year of life was approximately 3% lower for patients who used hospice than for those who did not. For patients enrolled for longer periods – particularly six months or longer – total costs were reduced by as much as 11%. The analysis also showed that after approximately 11 days of hospice enrollment, cost savings began to outweigh the costs of care, emphasizing the importance of timely referral.
These findings reinforce a central principle of hospice care: early involvement leads to better outcomes. Short hospice stays, often measured in days rather than weeks or months, limit the ability of interdisciplinary care teams to manage symptoms, provide counseling, and effectively coordinate family support. Early referral allows the full hospice model – which integrates medical, emotional, and spiritual care – to operate as intended.
Bringing the Findings Into Practice
For healthcare providers, this evidence highlights the need to normalize early discussions about hospice eligibility. For families, it underscores the importance of understanding that hospice is not a signal of giving up but a shift toward comfort, coordination, and quality of life. For policymakers and payers, it demonstrates that strengthening the hospice care model can deliver measurable value across the healthcare continuum.
Hospice care remains one of the few interventions that simultaneously improves outcomes, supports families, and reduces overall healthcare spending. Ensuring that patients are referred early enough to experience those benefits should be a shared goal for clinicians, organizations, and communities alike.
References
by editor | Nov 9, 2025 | Blog, Care Keys - Nurses, Internal Marketing, Keys to Compassionate Care, Resources and Readings, Resources and Readings
The New England Journal of Medicine recently published a Perspective titled “What Is Hospice?” – a piece that captures, in striking detail, what hospice truly means beyond the policies, programs, and checklists that are so often discussed in healthcare.
It begins with a familiar question from a patient: “What is hospice?” The physician’s answer is the one that is often received: hospice is a service for people with less than six months to live who choose comfort over cure. It provides care through a team of doctors, nurses, social workers, and counselors who guide patients and families through the final stage of life.
But as the Perspective unfolds, the author takes the reader deeper – into the emotional terrain that families, clinicians, and patients navigate together. Hospice, the physician reflects, isn’t just medical care. It is the quiet moments at home, the scent of a familiar meal, the sound of family laughter between tears. It’s the deep breath before goodbye.
The piece reminds us that hospice is not surrender. Rather, it is transformation. It shifts the focus from fighting disease to embracing the life that remains.
“Hospice is always sad; if all goes well, painless; and sometimes, heartbreakingly beautiful.”
That sentence, near the end of the essay, lingers long after you finish reading. Because it’s true. Hospice is complex and sacred. It’s where love and loss coexist. Where families learn that letting go can be an act of care.
The Everyday Reality of Hospice
For those who work in hospice, the author’s story feels achingly familiar. These are every day scenes: The bag of medications on the kitchen counter. The photo albums on the table. The phone calls to distant family members. The dog who refuses to leave the bedside.
These moments aren’t clinical data points. They are the essence of hospice care. They remind us that hospice happens not only in facilities or inpatient units but also in living rooms, bedrooms, and hearts.
And yet, even professionals sometimes struggle to explain hospice in a way that captures its full truth. This Perspective does what definitions cannot. It shows hospice as both a medical philosophy and a deeply human experience.
Reflections to Consider
This piece invites all of us – hospice professionals, caregivers, and community members – to pause and reflect:
- How do we talk about hospice to families who are afraid it means giving up?
- How can we help people see hospice not as an ending but as a way to live fully until the end?
- How can caregivers hold space for both grief and grace at the same time?
These are not easy questions but they are the ones that guide the sacred work of hospice professionals.
A Gentle Reminder
The New England Journal of Medicine Perspective is a beautiful reminder that hospice is not a destination; it’s a journey of presence, compassion, and understanding. It’s the place where medicine meets meaning.
Hospice workers are not just managing symptoms. Hospice workers are helping people find comfort, connection, and peace when life is at its most fragile.
Hospice, in the author’s words, is “safe harbor after an arduous journey.” Perhaps, that’s the best definition of all.
by hospicekeys | Nov 3, 2025 | Blog, Care Keys - Nurses, Internal Marketing, Keys to Compassionate Care, Resources and Readings, Resources and Readings
A shift is unfolding across the United States as more states are enacting Medical Aid in Dying (MAID) laws. This legislation allows terminally ill, mentally capable adults with a prognosis of six months or less to request medication to end their lives peacefully.
As of 2025, twelve U.S. jurisdictions have legalized this option in some form. Each has its own requirements, safeguards, and timelines. For those working in hospice and palliative care, these developments raise complex questions – not only about law and medicine, but about the very heart of the hospice mission: to bring comfort, dignity, and peace at the end of life.
The Shared Values Beneath Different Choices
At first glance, hospice and medical aid in dying may appear to represent opposing approaches. Hospice care emphasizes natural dying, symptom relief, emotional support, and holistic presence without hastening or prolonging life. MAID laws, by contrast, allow a terminally ill individual to take an active step toward death, usually when suffering feels unbearable.
Yet beneath those surface differences lies a shared foundation: autonomy, dignity, compassion, and the relief of suffering. Both hospice and MAID reflect the human desire to ensure that the end of life aligns with personal values and that suffering is minimized as much as possible.
For many patients, hospice care provides the compassionate path. It offers an opportunity to live fully until natural death, supported by a team focused on comfort and peace. For others, even with the best hospice care, fears about loss of control, prolonged suffering, or existential distress may lead them to explore the option of medical aid in dying.
The challenge for hospice professionals is not to judge these choices but to listen deeply and help each person make decisions consistent with their beliefs, hopes, and thresholds for suffering.
Why Hospice Voices Matter in This Conversation
The growing presence of medical aid in dying laws represents an inflection point for the hospice field. These laws are reshaping how the public, policymakers, and clinicians think about dying. Without hospice leadership in the dialogue, the conversation risks being defined without the nuance and humanity that hospice brings.
Hospice professionals possess an understanding of dying that few others share. They recognize that the experience of dying is not a policy debate or a philosophical abstraction. Rather, it is a lived, embodied, relational process. That experiential knowledge is precisely what is missing from most legislative and public discourse.
Hospice voices matter.
- They bring evidence and perspective about what high-quality end-of-life care can achieve.
Much of the public support for MAID arises from fear. Fear of pain, of abandonment, of a medical system that does not listen. Hospice clinicians can ground public understanding in the reality of what’s possible when comfort care is practiced with excellence, when suffering is addressed comprehensively, and when patients are genuinely seen. Without this grounding, MAID can be mistaken as the only path to control, rather than one among several options for a dignified death.
- They are positioned to help shape ethical and clinical standards at points of overlap.
In states where MAID is legal, hospice patients will inevitably raise questions about it. Clear guidance is needed on how hospice teams should respond, what boundaries exist between hospice practice and MAID protocols, and how organizations can protect staff conscience while respecting patient autonomy. These are operational, not theoretical, challenges and hospice leadership is uniquely suited to address them.
- They can advocate for equity in end-of-life care.
MAID conversations often assume equal access to symptom control, palliative expertise, and psychosocial support. Hospice professionals know that access is far from universal. If the right to die becomes easier to access than the right to high-quality hospice care, an ethical imbalance emerges. Hospice advocacy must insist that relief of suffering through care remains a guaranteed, accessible right, not a privilege.
- They model what compassionate neutrality looks like.
Within teams, families, and communities, opinions on MAID will vary. Hospice professionals have long practiced the discipline of presence. That unique ability to hold space without persuading or condemning. That skill is invaluable in a polarized cultural moment.
Hospice need not reassert its relevance; rather, it must assert its authority — not through moral argument, but through the wisdom earned from decades of walking beside the dying. The national dialogue about medical aid in dying will be stronger, safer, and more humane when informed by hospice experience.
What Hospice Leaders and Advocates Should Be Thinking About
As more states consider such legislation, several questions deserve careful consideration:
- Education and Training:
How can hospice organizations prepare staff to discuss MAID knowledgeably and compassionately, even when direct participation is not permitted?
- Ethical Consistency:
What guiding principles can help teams balance hospice’s philosophy of neither hastening nor postponing death with respect for patient autonomy in states where MAID is legal?
- Communication and Trust:
How can teams maintain open, nonjudgmental dialogue with patients and families, regardless of their decisions?
- Bereavement and Family Support:
What does bereavement care look like when MAID has been part of a loved one’s end-of-life journey?
- Institutional Policy:
Should hospice programs establish clear statements outlining their stance, participation limits, or referral procedures to prevent confusion among staff and families?
- Public Education:
How can hospice organizations help the public understand that hospice and MAID are not opposing forces and that hospice remains an essential resource for all who face serious illness, regardless of legal options?
A Call for Compassionate Dialogue
The legalization of medical aid in dying does not diminish hospice’s relevance. If anything, it amplifies hospice’s essential wisdom: that dying is not solely a medical event, but a profoundly human one.
The task before hospice professionals is to remain anchored in compassion. Laws and policies will continue to evolve, but the core of hospice – presence, empathy, and holistic care – is timeless.
Rather than withdrawing from the discussion, hospice professionals have an opportunity to shape it, ensuring that every conversation about dying – in any form – remains centered on love, respect, and the relief of suffering.
The future of end-of-life care will include many choices. Hospice ensures that compassion remains one of them.
by editor | Oct 27, 2025 | Blog, Grief & Loss - Aides, Grief & Loss - Chaplain, Grief & Loss - Nurses, Grief & Loss - Social Workers, Grief and Loss, Hospice Research Articles, Keys to Compassionate Care
Loss is inevitable when working in end-of-life care. But the grief that follows is not simply the family’s burden alone. The way care is delivered before, at, and after the death of a loved one significantly influences whether bereavement becomes a manageable process or a complex, prolonged struggle. Qualitative research highlights three influential domains: personal interactions with health-care workers, the quality and timing of information delivered, and system-level functions around death notification and bereavement support.
Understanding Bereavement: Not a Uniform Path
Grief is more than sadness. It manifests as emotional, physical, cognitive, social, psychological and behavioral responses. Its intensity and course depend on many factors: the relationship to the deceased, attachment style, mental-health history, whether death was sudden or expected, the setting of death, and social support available.
Protective factors exist: prior experience of loss, living support networks, strengths identified by the bereaved themselves, and practical support all improve outcomes. The role of healthcare workeris now seen as vital to activating these protective factors or mitigating risk.
How Healthcare Workers Influence the Bereavement Experience
Personal Interactions and Honor-Centred Care
The relational dimension matters: When families observe healthcare workers interacting with their sick family members “as if they are present and conscious”, it conveys recognition of personhood, respect and relational worth.
Conversely, when families experience dismissive language, unfamiliar faces at critical moments, or a change in staff that interrupts continuity, perceptions of care shift negatively: the sense of being “left behind” or disregarded can aggravate grief.
Information, Communication and Narrative Coherence
Families need clear, honest, timely information about prognosis, symptom progression, and what to expect in the dying process. When such information is absent, families report an emotional “hole” in their narrative of loss: “Dad went there, he passed away and that was the end of the story.”
Education about grief itself — helping families understand how different people grieve, what reactions may unfold, and what support is available — can normalize experiences and reduce distress. Healthcare workers who engage in anticipatory planning and family education serve a critical function in preventing complicated grief.
System-Level Issues and Bereavement Continuity
Even when individual clinicians do well, system problems can undermine outcomes. For example, hospital visiting-policy confusion, lack of inter-service communication, inadequate death-notification workflows, and absence of follow-up by care teams can all contribute to complicated grief.
Bereavement support must be embedded structurally and not left solely to goodwill. While many families will navigate grief with community/family supports, a moderate number require non-specialist professional help, and a small but significant minority will need specialist care for prolonged grief disorder.
Implications for Hospice and End-of-Life Practice
Training & Education: Healthcare workers benefit from communication skills training, anticipatory bereavement care education, and guidance in dignity-conserving care.
Protocols & Follow-Up: Organizations should implement clear workflows: condolence letters, follow-up calls, opportunity for family meetings after death, and referral pathways for those at risk of complex grief.
Integration of Bereavement into Care Continuum: Hospice care should explicitly view bereavement support as part of its service, not afterthought. The transition from life into death and then into community/family grief must be managed.
Organizational Systems: Review visiting policies, death-notification systems, documentation handovers, cross-service communication and ensure that families always know what to expect. Community resources and culturally-tailored supports must be flagged especially for vulnerable populations.
Conclusion
The dying process and what follows are inseparably linked. Healthcare workers do more than manage symptoms. They influence how families make sense of loss and build the next chapter of their lives. By prioritising dignified presence, transparent communication, and systemized bereavement support, we honor not just those who die but the ones left behind. The evidence is clear: when care ends, compassion must continue.
References
by editor | Aug 26, 2025 | Care Keys - Chaplains, Care Keys - Nurses, Care Keys - Social Workers, Patient Care
The profound impact of pet therapy in end-of-life care is not just a heartwarming story; it’s a clinically supported intervention that enhances patient well-being, supports family coping, and adds a vital dimension to a hospice’s care model. For clinical and administrative teams, a pet therapy program requires meticulous planning and a clear understanding of its benefits and protocols.
The Science Behind the Comfort
The comfort a therapy animal provides is rooted in a physiological response. The gentle act of petting a therapy animal can trigger a cascade of “feel-good” hormones in a patient’s brain, including serotonin, oxytocin, and prolactin. These neurochemicals are directly linked to reducing stress, soothing anxiety, and uplifting mood.
The effects extend to vital signs as well. Studies have consistently shown that interactions with a therapy animal can lead to a measurable reduction in blood pressure and heart rate, providing a non-pharmacological means of supporting cardiovascular health and overall physiological calm. This is a powerful benefit for patients who may be experiencing increased distress or anxiety.
Integrating Pet Therapy into the Clinical Care Plan
For a pet therapy program to be effective and compliant, its integration must be seamless and well-documented.
- Assessment and Care Plan: The decision to include pet therapy should be part of the patient’s comprehensive care plan. The interdisciplinary team (IDT)—including the RN, social worker, and medical director – evaluates a patient’s emotional, social, and physical needs to determine if they would benefit from pet therapy. Contraindications, such as allergies, phobias, or open wounds, must be carefully noted.
- Goal-Oriented Interventions: Pet therapy visits should be structured with specific, documented goals. For example, a goal might be to “reduce patient-reported anxiety scores from 7/10 to 4/10” or “increase patient engagement and conversation during visit.”
- Documentation: The clinical team must document each pet therapy session in the patient’s record. This includes the duration of the visit, the therapy animal’s name, the patient’s emotional and physical response (e.g., smiling, relaxed breathing, verbalizing memories), and any changes in symptoms or vital signs. This documentation is essential for demonstrating the intervention’s efficacy and for regulatory compliance.
The Administrative Blueprint: Managing Risk and Ensuring Quality
From an administrative and compliance perspective, a successful pet therapy program requires more than just good intentions. It demands a rigorous policy framework.
- Formal Certification and Vetting: All therapy animals and their handlers must be formally vetted and certified by a recognized organization. These organizations ensure the animals have the appropriate temperament, training, and health certifications (including up-to-date vaccinations).
- Safety Protocols: Clear policies are needed to protect both the patient and the therapy animal. This includes mandatory hand-washing before and after visits, establishing patient consent, and guidelines for managing any unforeseen patient reactions or animal behavior.
- Liability and Insurance: The hospice provider must ensure it has adequate liability coverage for its pet therapy program, which may require a specific rider on its existing insurance policy.
By establishing these clinical and administrative protocols, hospice providers can harness the undeniable power of pet therapy while ensuring the highest standards of safety, quality, and compliance. It allows the agency to deliver compassionate, evidence-based care that brings a unique form of healing and comfort to patients and their families.
Additional Resources
For a deeper dive into the science, clinical application, and administrative protocols of pet therapy, here are some additional resources:
- Organizations like Pet Partners provide the formal certification and vetting required to ensure therapy animals and their handlers meet rigorous safety and training standards.
- This video explores the unique benefits of pet therapy for hospice patients and people in long-term care settings.
- This systematic review and meta-analysis of pet therapy in geriatric populations offers a robust look at the benefits. The paper provides a comprehensive overview, noting that pet therapy promotes well-being in diverse populations, including the elderly. It confirms that pet therapy can lead to enhanced emotional well-being, reduced anxiety, and decreased stress levels.
- This study from the National Library of Medicine focuses on the impact of pet therapy on depression and anxiety, specifically within institutionalized elderly. The study found that dog-assisted therapy was effective in reducing symptoms of depression. It also noted that the presence of the dog facilitated social interaction with handlers, eliciting positive emotional responses from the patients.
- Focusing specifically on the terminally ill, this qualitative study focused on the benefit of pet therapy for hospice patients and their families.
- This article from BMC Palliative Care examines the feasibility and impact of pet therapy in a palliative care center.
by editor | Jun 28, 2025 | Grief & Loss - Aides, Grief & Loss - Chaplain, Grief & Loss - Nurses, Grief & Loss - Social Workers, Grief and Loss, Patient Care, Resources and Readings
In recent years, hospice bereavement care has undergone significant transformation. Early programs offered traditional service delivery models relying on limited offerings, and structured and uniform service delivery format.
Over time, however, researchers and clinicians have found that that a more individualized approach to bereavement support – customized to the needs of different cultural backgrounds, circumstances of death, and trauma history, for example – could be more effective.
Expanding the Definition of Grief and Loss
Modern hospice bereavement programs have expanded their understanding of grief beyond traditional death-related loss. Today’s programs recognize that grief encompasses losses of health, relationships, roles, independence, and future plans. This broader conceptualization has led to more inclusive and comprehensive support services, acknowledging that families often experience multiple, overlapping losses throughout the illness trajectory and beyond.
Contemporary programs also embrace a fundamental shift in perspective, acknowledging that grief is not a problem to be solved but a natural human experience that requires support rather than treatment. This movement away from pathology-based models toward strength-based approaches honors individual grief styles and timelines. It recognizes that there is no universal “right way” to grieve. Programs now focus on building resilience rather than moving people through predetermined stages.
Community-Centered Approaches
One of the most significant innovations in hospice bereavement care has been the expansion of grief support services. Rather than serving only families of former patients, modern programs often offer services to the broader community. They no longer restrict grief expertise to those who experienced grief through hospice care. This community-centered approach creates increased accessibility by making services available to anyone experiencing loss. It also reflects a practical understanding that larger, more diverse groups can provide richer support experiences for participants. As an additional benefit, it promotes resource efficiency, allowing organizations to serve larger numbers.
These programs also become focal points for community resilience and mutual support and offer early intervention for grief that can prevent more complex bereavement complications from developing. They also serve as educational resources for the broader community, helping to normalize conversations about death and grief while building community capacity for supporting those who are grieving.
Diversification of Service Modalities
Contemporary hospice bereavement programs have moved beyond traditional talk therapy and support groups to embrace diverse modalities. This diversification reflects a growing understanding that grief may transcend words and can be more effectively processed through various forms of expression.
Expressive arts programming has become a cornerstone of innovative bereavement care. Modern hospices offer support through art therapy, music therapy, writing workshops, and drama therapy. Research supports the effectiveness of these creative interventions, with studies showing evidence of the value of individual creative arts in helping people cope with bereavement.
Movement-based programming has also gained recognition as an effective grief intervention. Walking groups, yoga classes, and other physical activities acknowledge the embodied nature of grief. They provide opportunities for healing through movement and connection with others. These programs recognize that grief affects the whole person and that healing often requires attention to physical as well as emotional well-being.
Specialized programming for specific populations and types of loss has become increasingly sophisticated. Pediatric bereavement programs use age-appropriate approaches that incorporate play therapy, art activities, and developmental considerations suited to different age groups. Young adult programs acknowledge the unique challenges faced by this often-overlooked population, while loss-specific groups offer specialized support for suicide, overdose, sudden death, and prolonged illness, recognizing that different circumstances require different approaches.
Technology Integration and Virtual Programming
The integration of technology has revolutionized hospice bereavement care delivery, with changes accelerated significantly by the COVID-19 pandemic. Virtual support groups conducted through online platforms now allow participation regardless of geographic location or physical limitations.
Digital resource libraries offer online access to educational materials, guided meditations, and self-help tools that participants can access at their own pace and on their own schedule. Telehealth counseling provides individual sessions conducted via secure video platforms. Social media support through closed Facebook groups and other platforms creates opportunities for ongoing peer connection between formal programming sessions.
These technological innovations may be particularly valuable for reaching underserved populations, including those in rural areas, individuals with mobility limitations, and those whose work or family responsibilities make attending in-person programming difficult.
Trauma-Informed Care Integration
Modern hospice bereavement programs increasingly incorporate trauma-informed care principles, recognizing that many losses involve traumatic elements that require specialized approaches. This integration reflects growing awareness that different loss experiences may require different approaches to healing. Traditional grief models may not be adequate for supporting individuals who have experienced traumatic loss or who have histories of trauma that complicate their grief experience.
Trauma-informed approaches begin with screening for trauma history to understand how past experiences may impact current grief. They emphasize creating physical and emotional safety in all programming. Participants are empowered to direct their own healing process through choice and collaboration. Cultural responsiveness acknowledges how trauma and healing are understood differently across cultures. Comprehensive staff training ensures that all team members understand trauma impacts and responses.
These approaches recognize that traumatic loss often involves elements of sudden death, violence, suicide, overdose, or other circumstances that can complicate the grief process. Programs incorporating trauma-informed principles provide specialized support that addresses both the grief and the trauma, helping participants develop coping strategies that acknowledge the complexity of their experience.
Partnership and Collaboration Models
Contemporary hospice bereavement programs have moved away from operating in isolation to developing robust community partnerships that enhance their reach and effectiveness. Healthcare system integration has led to partnerships with hospitals and emergency departments, primary care practices, mental health providers, pediatric care centers, and nursing homes. These collaborations create seamless referral networks and ensure that bereavement support is available at critical transition points in the healthcare experience.
Community organization partnerships extend the reach of bereavement programs to schools and universities, faith communities, civic organizations, senior centers, community mental health centers, and first responder agencies. These partnerships recognize that grief support is most effective when it is embedded within existing community networks rather than operating as an isolated service.
Professional network development has become increasingly important as programs participate in multidisciplinary case consultations, professional development initiatives, research collaborations, quality improvement networks, and policy advocacy efforts. These networks facilitate sharing of best practices, collaborative problem-solving, and collective advocacy for improved policies and funding for bereavement care.
Conclusion: A Continual Evolution
The evolution of hospice bereavement care from traditional, clinic-based models to innovative, community-centered approaches represents a significant developments in end-of-life care. This transformation reflects a deeper understanding of grief as a normal human experience that requires community support rather than clinical intervention.
The journey from traditional bereavement care to today’s innovative approaches demonstrates the power of organizational learning, community engagement, and commitment to improving outcomes for some of our most vulnerable community members.
By embracing innovation and forming strategic partnerships these programs continue to evolve to meet the changing needs of grieving individuals and families. The future of hospice bereavement care will likely be characterized by even greater integration with community systems, increased use of technology, and continued expansion of the populations served.
Where Can You Find Out More
