Written and reviewed by the Lily Hospice clinical team. Updated September 30, 2026. 172 plain-language definitions of the words families hear from hospices, hospitals, Medicare and Michigan law. Lily Hospice serves Oakland, Macomb and Wayne counties; questions at any hour: (248) 955-5100.

How to use this glossary: each term has its own link (click a term to copy it) and a short definition you can quote. Medicare figures are the rules in effect for 2026 and the new federal year that starts October 1, 2026. This glossary explains terms; it is not medical or legal advice for a specific situation.

Jump to: The basics · The people on a hospice team · Care, visits, medicines and equipment · Paying for hospice · Documents, decisions and the law in Michigan · Medical terms and diagnoses · The last days, death and grief · Quality, rules and regulators · Veterans and Lily Hospice programs

The basics

Hospice
Care for a person whose illness is expected to end their life within about six months if it runs its normal course, focused on comfort, dignity and the family rather than cure. In the United States hospice is a service that comes to wherever the person lives, not a building. (People sometimes search for it as “hospis,” “hospise” or, by ear, “auspice.”)
Palliative care
Medical care that relieves the symptoms and stress of a serious illness at any stage, alongside treatment meant to cure or control it. Hospice is palliative care for the last stage of life; palliative care does not require a six-month prognosis or giving up curative treatment. Lily’s Pathways program is palliative care.
Terminal illness
In Medicare’s hospice rules, an illness with a life expectancy of six months or less if it runs its normal course, as certified by a physician. The phrase describes the prognosis, not a guarantee of timing.
Prognosis
A physician’s best estimate of how an illness will progress and how long a person is likely to live. Hospice eligibility rests on a prognosis of six months or less; people who live longer are not discharged as long as they still meet the criteria.
Hospice eligibility
The criteria a person must meet for the Medicare hospice benefit: a terminal illness with a prognosis of six months or less, certified by the hospice medical director and the attending physician, and the person’s election of comfort-focused care for that illness.
Certification of terminal illness (CTI)
The signed physician statement, required by Medicare, that a patient’s prognosis is six months or less. Two physicians certify at the start; the hospice physician recertifies at each benefit period.
Benefit period
The units Medicare uses for hospice coverage: two 90-day periods, then unlimited 60-day periods, each requiring recertification that the person still qualifies. There is no lifetime limit on hospice.
Face-to-face encounter
A visit by a hospice physician or nurse practitioner, required by Medicare before the third benefit period and each one after, to confirm the person still meets hospice criteria.
Election of hospice
The signed statement in which a patient (or their representative) chooses the hospice benefit and acknowledges that it covers comfort care for the terminal illness rather than curative treatment. It can be revoked at any time.
Revocation
A patient’s decision to leave hospice and return to regular Medicare coverage, for example to pursue a new treatment. Revocation is the patient’s right at any time and they may re-elect hospice later.
Live discharge
When a person leaves hospice alive, either by revoking, by moving out of the service area, by transferring to another hospice, or because they no longer meet the criteria. Medicare publishes each hospice’s rate of live discharge within seven days of admission; a high rate can signal poor admission decisions.
Comfort care
Care aimed at relieving pain, breathlessness, anxiety and other symptoms rather than curing the illness. Hospice is comfort care for the last months of life; the phrase is also used in hospitals when a family decides to stop treatments aimed at cure.
Curative treatment
Treatment intended to cure an illness or stop its progression, such as chemotherapy aimed at remission or dialysis. Choosing the Medicare hospice benefit means setting aside curative treatment for the terminal illness; treatment for unrelated conditions continues.
Serious illness
A health condition with a high risk of death that affects daily life or strains caregivers, such as advanced heart failure, COPD, dementia or cancer. Palliative care serves people with serious illness at any stage; hospice serves those in the last months.
Life-limiting illness
An illness that is expected to shorten a person’s life, even when the timing is uncertain. Not every life-limiting illness qualifies for hospice right away; eligibility depends on the six-month prognosis.
Goals of care
What matters most to the patient as the illness progresses, for example staying at home, avoiding the hospital, being comfortable, or seeing a family event. Hospice teams build the plan of care around these goals.
Goals-of-care conversation
A planned talk between the patient, family and clinicians about the illness, what to expect and what the patient wants. It is often the conversation that leads a family to ask about hospice. See how to talk to a parent about hospice.
End-of-life care
Care for a person in the last weeks to months of life and for their family. Hospice is the most complete form of end-of-life care in the United States because it brings a whole team, medications and equipment home.
Hospice evaluation (informational visit)
A free, no-obligation visit or call in which a hospice nurse explains hospice, reviews the person’s condition and answers the family’s questions. Families can ask for one before deciding; nothing is signed unless they choose to start care.
Hospice referral
A request for a hospice to evaluate someone. Anyone can make it: the patient, a family member, a doctor, a hospital discharge planner or a facility nurse. Admission itself still needs a physician’s certification. Refer a patient to Lily.
Admission visit (start of care)
The first hospice visit after the physician order, when the nurse reviews the patient’s history and medications, signs consents with the patient or patient advocate, orders equipment and sets up the comfort kit. See what happens on the first hospice visit.
Same-day admission
Starting hospice care on the day the family calls, when the physician order and consents can be completed quickly. Many hospices, including Lily, can admit evenings and weekends. See same-day hospice admission.
Transfer between hospices
Switching from one hospice to another. Medicare allows a patient to change hospices once in each benefit period without revoking the benefit; the new hospice coordinates the paperwork. See can you switch hospice providers.
Discharge for cause
A rare hospice discharge when a patient’s or household’s behavior seriously disrupts care or endangers staff, allowed by Medicare only after the hospice tries to resolve the problem and documents it.
Concurrent care
Receiving curative treatment and hospice at the same time. Under the Affordable Care Act, children under 21 with Medicaid or CHIP can have both; adults on the Medicare hospice benefit generally cannot for the terminal illness.
Pediatric hospice
Hospice care for infants, children and teenagers, often provided alongside curative treatment under concurrent-care rules and delivered by teams with pediatric training.
Hospice house (inpatient hospice unit)
A home-like building where hospice patients can stay for general inpatient care, respite or, in some cases, longer residential care. In Michigan, residential hospice buildings are licensed separately as hospice residences.
Hospice residence (Michigan)
A facility licensed by Michigan to provide room, board and hospice care to patients who cannot stay at home. Room and board in a hospice residence is usually not covered by Medicare.

The people on a hospice team

Attending physician
The doctor or nurse practitioner a hospice patient names to direct their care, usually their own primary care physician or specialist. The attending works alongside the hospice team and bills Medicare separately; a patient may instead name the hospice medical director.
Hospice medical director
The physician responsible for the medical component of a hospice’s care: certifying eligibility, overseeing plans of care, and consulting with attending physicians. Medicare requires every hospice to have one.
Interdisciplinary team (IDT)
The group that plans and delivers hospice care: physician, registered nurse, social worker, chaplain or spiritual counselor, hospice aide, volunteers and bereavement staff. Medicare requires the team to review each patient’s plan of care at least every 15 days.
Plan of care
The written, individualized plan the interdisciplinary team creates with the patient and family, covering symptoms, medications, visits, equipment, goals and spiritual and emotional support. It is updated as needs change.
Case manager (hospice nurse)
The registered nurse who coordinates a hospice patient’s care, visits regularly, manages symptoms with the physician, teaches the family, and is the family’s main clinical contact.
Hospice aide
A certified nursing assistant with hospice training who provides personal care such as bathing, grooming, repositioning and light help around the bed, under the nurse’s supervision, typically several times a week.
Hospice social worker
A licensed social worker on the hospice team who helps with practical and emotional matters: advance directives, benefits, family decisions, placement, caregiver stress, and planning for what comes after.
Chaplain (spiritual care)
A member of the hospice team who offers spiritual support to patients and families of any faith or none, coordinates with the family’s own clergy, and often leads memorials and pinning ceremonies.
Hospice volunteer
A trained, unpaid person who visits patients for companionship, gives caregivers a break, or helps in other ways. Medicare requires hospices to use volunteers for at least five percent of patient-care hours.
Bereavement support
Grief support the hospice provides to the family for up to a year after a death, as Medicare requires; Lily’s continues for more than a year and is open to the community.
Hospice physician
A doctor employed by or under contract with the hospice who, with the medical director, oversees medical care, recertifies eligibility and can make home visits. The patient’s own attending physician can stay involved.
Hospice nurse practitioner (NP)
An advanced-practice nurse who can serve as a patient’s attending clinician and perform face-to-face encounters for recertification. Under Medicare rules an NP cannot certify the terminal illness itself; only a physician can.
Registered nurse (RN)
The licensed nurse who leads day-to-day hospice care: assessing symptoms, adjusting the plan with the physician, teaching the family and answering after-hours calls. Most hospices assign each patient an RN case manager.
Licensed practical nurse (LPN)
A licensed nurse who provides hands-on nursing visits under the direction of an RN, for example checking vital signs, giving medications and changing dressings.
Primary caregiver
The family member or friend who provides most of the day-to-day care at home. Hospice does not replace the primary caregiver around the clock; it teaches, supports and visits so the caregiver is never alone with a problem.
Bereavement coordinator
The hospice staff member who organizes grief support for the family after a death: calls, letters, visits, memorial events and referrals to support groups.
Volunteer coordinator
The staff member who trains and schedules hospice volunteers. Medicare requires volunteers to provide at least five percent of a hospice’s patient-care hours.
Hospital discharge planner
The hospital nurse or social worker who arranges what happens after a patient leaves the hospital, including hospice referrals. Families can ask the discharge planner for a specific hospice by name. See going home on hospice from the hospital.
End-of-life doula
A non-medical companion who offers emotional and practical support to a dying person and family, such as vigils and legacy projects. Doulas are not licensed clinicians and are not covered by Medicare; they can work alongside a hospice.
Complementary therapies
Music, massage, pet visits, aromatherapy and similar support some hospices offer alongside medical care to ease anxiety and improve comfort. Offerings vary by hospice; ask what is available.

Care, visits, medicines and equipment

Routine home care
The most common level of hospice care: regular visits from the team wherever the patient lives, with a nurse on call 24 hours a day. Medicare pays the hospice a daily rate for it.
Continuous home care
A level of hospice care for a short crisis, such as uncontrolled pain or agitation, in which nursing care is provided for eight or more hours in a day at home to avoid a hospital stay.
General inpatient care (GIP)
A short-term level of hospice care in a hospital, hospice facility or skilled nursing facility for symptoms that cannot be managed at home. Lily arranges it with partner facilities when needed.
Respite care
Up to five consecutive days of care for a hospice patient in a facility so that the family caregiver can rest. Covered by Medicare as a hospice level of care.
Levels of care
Medicare’s four categories of hospice care: routine home care, continuous home care, general inpatient care and respite care. The hospice moves a patient between them based on need.
Comfort kit (emergency kit)
A small set of medications the hospice places in the home at admission for symptoms that may arise suddenly: pain, shortness of breath, anxiety, nausea, secretions. The nurse teaches the family when and how to use each.
Symptom management
The core clinical work of hospice: relieving pain, breathlessness, nausea, agitation, constipation and other symptoms so the person is comfortable, using medications, positioning, oxygen and non-drug measures.
Durable medical equipment (DME)
Hospital beds, oxygen, wheelchairs, commodes, walkers and similar equipment, supplied and delivered by the hospice at no cost to the family for the terminal illness.
Hospice in assisted living
Hospice care delivered in a resident’s own apartment in an assisted living or memory care community, in addition to the community’s usual care; the hospice team and the community’s staff work together and the resident does not move.
Hospice in a nursing home
Hospice care delivered to a resident of a skilled nursing facility, coordinated with the facility’s nurses. Medicare pays the hospice; the facility is paid for room and board by the resident, Medicaid or another source.
Visit frequency
How often each hospice team member comes, set in the plan of care and adjusted as needs change. There is no single national number; families should ask each hospice how often the nurse and aide will visit and what happens on weekends.
After-hours (on-call) nurse
The hospice nurse who answers calls and makes visits at night, on weekends and on holidays. Medicare requires hospices to make nursing services available 24 hours a day, seven days a week. See a hospice nurse at night.
Aide supervisory visit
A registered nurse’s check on the care a hospice aide provides, which Medicare requires at least every 14 days.
Pain management
Assessing and treating pain so a patient is as comfortable as possible, using scheduled medications, as-needed doses for breakthrough pain, positioning and non-drug measures.
Breakthrough pain
A flare of pain that breaks through a regular pain medicine schedule. Hospice nurses usually leave an as-needed dose for these moments and teach the family how to use it.
Opioids (such as morphine) in hospice
Medicines used to relieve pain and shortness of breath. Given at carefully adjusted doses by a hospice team, they ease suffering; fear that they hasten death is common but not supported when they are used this way. See morphine in hospice: myths and facts.
Medication management
The hospice nurse’s review of every medicine the patient takes, keeping those that help comfort, stopping those that no longer help, and arranging delivery of hospice-covered drugs.
Deprescribing
Stopping medicines that no longer serve the patient’s goals, such as cholesterol pills or some vitamins near the end of life, to reduce pill burden and side effects. Always done with the care team, never abruptly on one’s own.
Sublingual medication
Medicine given under the tongue, often as a few drops of liquid, so it can work when a person can no longer swallow pills. Common in comfort kits.
Oxygen therapy
Supplemental oxygen delivered by a concentrator or tanks, covered by hospice when it relieves breathlessness related to the terminal illness. A fan on the face often helps as well.
Hospital bed
An adjustable bed the hospice delivers to the home, usually within a day of admission, with rails and a pressure-relieving mattress if needed. Covered by the hospice benefit when related to the terminal illness.
Hoyer lift (patient lift)
A mechanical lift that lets caregivers move a person who cannot bear weight from bed to chair safely. The hospice supplies it and teaches the family to use it.
Incontinence supplies
Briefs, pads and skin-care products for loss of bladder or bowel control. Hospices supply them as part of care related to the terminal illness.
Pressure injury (bedsore)
Skin damage from staying in one position, most common over the tailbone, hips and heels. Hospice teams prevent and treat pressure injuries with turning schedules, special mattresses and wound care.
Personal care
Help with bathing, grooming, dressing and toileting. Hospice aides provide personal care on scheduled visits; around-the-clock personal care at home is usually the family’s or a private-duty agency’s role.
Caregiver training
The hands-on teaching a hospice gives the family: giving medications, turning and repositioning, recognizing changes and knowing when to call.
Legacy work
Projects that help a person leave something for loved ones, such as recorded stories, letters, handprints or a memory book. Often led by hospice volunteers, social workers or chaplains.
Life review
A guided reflection on one’s life, memories and meaning, offered by hospice chaplains, social workers or volunteers, which many patients find comforting.
Unrelated conditions
Health problems not related to the terminal illness, such as a broken bone in a person with heart failure. Medicare continues to cover care for unrelated conditions outside the hospice benefit.
Hospice election statement addendum
A written list of items, services and drugs the hospice has decided are not related to the terminal illness and therefore will not cover. Under the FY 2027 Medicare hospice rule, hospices must give every patient this addendum, not only on request.
Custodial care
Non-medical help with daily living, such as supervision, meals and bathing, provided around the clock. The hospice benefit does not pay for custodial care; families arrange it themselves, through private-duty home care or through Medicaid programs.

Paying for hospice

Medicare hospice benefit
Medicare Part A coverage for hospice care, paid directly to the hospice at a daily rate. It covers the team’s visits, medications for the terminal illness, equipment, supplies and bereavement support; it does not cover room and board in assisted living.
Medicaid hospice benefit
Michigan Medicaid’s coverage of hospice, mirroring Medicare’s, for people who do not have Medicare or who have both. In a nursing facility, Medicaid may also continue to pay room and board.
Room and board
The cost of living in an assisted living, memory care or nursing facility, separate from hospice care. Medicare never pays it; Michigan Medicaid can for nursing-facility residents who qualify.
Medicare Part A
The part of Original Medicare that covers hospital, skilled nursing and hospice care. Hospice is paid under Part A, even for people enrolled in a Medicare Advantage plan.
Medicare Advantage and hospice
When a Medicare Advantage member elects hospice, Original Medicare pays the hospice directly while the Advantage plan keeps covering unrelated care and extra benefits. The 2021 to 2024 test that let some plans cover hospice ended December 31, 2024. See Medicare Advantage and hospice.
Medigap (Medicare supplement)
Private insurance that fills gaps in Original Medicare. Most Medigap plans cover the small hospice cost-sharing: prescription copays and respite coinsurance.
Hospice copays and coinsurance
Under the Medicare hospice benefit, the patient may owe up to $5 for each prescription for pain and symptom control and 5% of the Medicare-approved amount for inpatient respite care. Most families pay nothing else. See how much hospice costs in Michigan.
Per diem (daily rate)
The fixed daily amount Medicare pays a hospice for each day a patient is enrolled, whatever services are used that day. The rate depends on the level of care and is adjusted for local wages.
Medicare hospice payment rates (FY 2027)
Starting October 1, 2026, Medicare’s national base rates are $236.35 a day for routine home care in days 1 to 60 and $186.35 a day from day 61; $1,726.50 a day ($71.94 an hour) for continuous home care; $545.98 a day for inpatient respite; and $1,231.63 a day for general inpatient care, before local wage adjustment. Source: CMS FY 2027 hospice final rule (CMS-1851-F).
Hospice aggregate cap
A yearly limit on the average Medicare payment a hospice can receive per patient. It is $35,361.44 for the year ending September 30, 2026 and $36,174.75 for October 1, 2026 to September 30, 2027. The cap applies to the hospice’s totals, never to an individual patient’s care.
Hospice Quality Reporting Program (HQRP)
Medicare’s program that requires hospices to submit quality data. A hospice that does not report loses four percentage points of its annual payment update.
Michigan Medicaid and hospice
Michigan Medicaid covers hospice with benefits that mirror Medicare’s and, for nursing-facility residents who qualify, can continue paying room and board. See hospice and long-term-care Medicaid.
Dual eligible
A person who has both Medicare and Medicaid. For hospice, Medicare pays the hospice; Medicaid may pay nursing-facility room and board and cover some costs Medicare does not.
MI Choice Waiver
A Michigan Medicaid program that pays for in-home services for adults who qualify for nursing-home care but want to stay at home. It can often be coordinated with hospice so the family keeps both kinds of help.
Hospice without insurance
People without insurance can still receive hospice; some hospices provide charity care and help families apply for Medicaid. See hospice with Medicaid or no insurance in Michigan.
Private insurance hospice benefit
Most employer and marketplace health plans include a hospice benefit, often modeled on Medicare’s; details such as prior authorization and copays vary by plan.
VA hospice benefit
Veterans enrolled in VA health care can receive hospice at no cost through the VA or a community hospice authorized under VA Community Care; many veterans use their Medicare hospice benefit instead. See Michigan veteran end-of-life benefits.
VA Community Care Network
The VA’s network of community providers that can serve veterans with VA authorization, including hospices, so a veteran can receive VA-paid care close to home.
Medicare Administrative Contractor (MAC)
The company that processes Medicare claims for a region. For home health and hospice in Michigan it is National Government Services (NGS), Jurisdiction 6.

Documents, decisions and the law in Michigan

Advance directive
A written document stating a person’s wishes for medical care if they cannot speak for themselves. In Michigan the main forms are the durable power of attorney for health care (naming a patient advocate) and a living will.
Patient advocate (Michigan)
The person named in a Michigan durable power of attorney for health care to make medical decisions when the patient cannot. The patient advocate can sign hospice consent on the patient’s behalf.
Do-not-resuscitate order (DNR)
A physician’s order that CPR not be attempted if the heart or breathing stops. Michigan has a specific out-of-hospital DNR form; hospice does not require a DNR, though most patients choose one.
POLST / MI-POST
Michigan’s Physician Orders for Scope of Treatment, a portable medical order for seriously ill people that records treatment preferences such as CPR, hospitalization and feeding tubes, signed by a physician and the patient or advocate.
Durable power of attorney for health care (Michigan patient advocate designation)
The Michigan legal document naming a patient advocate to make medical decisions if the patient cannot. It must be signed with two qualified witnesses, and the advocate must accept the role in writing; the advocate acts only after the attending physician and another physician or licensed psychologist find the patient unable to decide.
Living will
A written statement of a person’s wishes about life-sustaining treatment. Michigan has no living-will statute, but a living will is still useful evidence of wishes and pairs well with a patient advocate designation.
Michigan out-of-hospital DNR order
A do-not-resuscitate order under Michigan’s Do-Not-Resuscitate Procedure Act that tells emergency responders not to start CPR outside a hospital. It should be kept where responders will see it, and the person may wear an identifying bracelet.
Guardianship
A court appointment, in Michigan through the probate court, of someone to make decisions for a person who cannot and has no valid patient advocate. A guardian can consent to hospice when authorized.
HIPAA authorization
A signed permission that lets doctors and the hospice share health information with named family members or others.
Code status
The medical order that says whether CPR and other resuscitation should be attempted if the heart or breathing stops, for example Full Code or DNR. Hospice patients choose their code status; hospice does not require a DNR.
Funeral pre-planning
Choosing a funeral home and making arrangements before death. It spares the family decisions in the first hours and lets the hospice know whom to call.
Death certificate (Michigan)
The official record of a death, filed with the state through Michigan’s electronic death registration system. The funeral home files it, and the physician or other authorized clinician completes the medical cause of death.
Pronouncement of death
The formal confirmation that a person has died. For an expected death at home under hospice, the hospice nurse usually comes, confirms the death and helps the family with next steps. See what to do when someone dies at home in Michigan.
Medical examiner
The county official who investigates sudden, unexpected or violent deaths. An expected death of a hospice patient at home generally does not require a medical examiner’s investigation.

Medical terms and diagnoses

Dementia and hospice
People with advanced Alzheimer’s disease or other dementias can qualify for hospice when they reach a late stage (typically unable to walk, dress or speak meaningfully) and have complications such as infections or weight loss.
FAST scale
The Functional Assessment Staging Tool for dementia, from stage 1 (normal) to 7 (severe). Medicare hospice guidelines generally look for stage 7 along with medical complications.
Activities of daily living (ADLs)
The basic tasks of self-care: bathing, dressing, eating, toileting, moving from bed to chair and continence. Needing help with more of them is one of the signs of decline that doctors weigh for hospice eligibility.
Palliative Performance Scale (PPS)
A scale from 100% (fully active) down to 0% (death) in 10% steps that describes how much a person can do for themselves. Hospices use it to track decline; a PPS of 70% or less is one common marker in eligibility guidelines.
Karnofsky Performance Status (KPS)
An older 0 to 100 scale of how well a person can carry out ordinary activities, still used, especially in cancer care, to describe functional decline.
NYHA class IV (heart failure)
The most severe New York Heart Association heart-failure class: symptoms such as breathlessness even at rest. Class IV despite optimal treatment is a key hospice eligibility marker. See hospice for heart failure.
End-stage COPD
Advanced chronic obstructive pulmonary disease with breathlessness at rest, frequent emergency visits and low oxygen levels. See hospice for COPD and lung disease.
End-stage kidney disease
Kidney failure that needs dialysis or a transplant to sustain life. People who decide to stop or not start dialysis are often eligible for hospice. See hospice for kidney failure.
End-stage liver disease
Advanced cirrhosis or liver failure with complications such as fluid in the abdomen, confusion or bleeding. See hospice for liver disease.
Metastatic cancer
Cancer that has spread from where it started to other parts of the body. Hospice is appropriate when treatment no longer controls the cancer or the person chooses to stop it. See hospice for cancer.
Frailty (adult failure to thrive)
A pattern of weight loss, weakness, falls and declining function in older adults without one single cause, which can qualify for hospice when decline is documented. See hospice for frailty.
Dyspnea (shortness of breath)
The feeling of not getting enough air. Hospice treats it with positioning, a fan, oxygen when helpful, and medicines such as low-dose opioids and anti-anxiety drugs. See breathing changes at the end of life.
Delirium
Sudden confusion that comes and goes, common near the end of life and sometimes caused by infection, medicines or dehydration. Some causes can be treated; the hospice nurse should be called when it starts.
Dysphagia (trouble swallowing)
Difficulty swallowing food, drink or pills, common in advanced dementia, stroke and ALS. Hospices adjust food textures and switch medicines to liquids or other routes.
Aspiration pneumonia
A lung infection caused by food, drink or saliva going into the airway, common when swallowing weakens. Repeated episodes are a sign of advancing illness.
Cachexia
Severe weight and muscle loss from an advanced illness that eating more does not reverse. It is part of the illness, not a failure of care.
Edema
Swelling from fluid build-up, often in the legs or abdomen, common in heart, kidney and liver failure. Hospice manages it for comfort with positioning, skin care and medicines.
Mottling
Blotchy, purplish skin on the knees, feet or hands as circulation slows, often seen in the last days or hours of life.
Cheyne-Stokes breathing
A breathing pattern of deeper breaths followed by pauses that can last several seconds, common as death approaches. It is usually not distressing to the person.
Opioid-induced constipation
Constipation caused by pain medicines such as morphine, which hospices prevent with a regular bowel regimen from the day an opioid starts.
Stroke and hospice
A large or repeated stroke with loss of consciousness, inability to swallow or rapid decline can make a person eligible for hospice. See hospice after a stroke.
ALS and hospice
Amyotrophic lateral sclerosis patients often qualify for hospice when breathing or swallowing becomes severely impaired, including when they decline a ventilator or feeding tube. See hospice for Parkinson’s, ALS and neurological disease.

The last days, death and grief

Transitioning (actively dying)
The final days or hours of life, when breathing, circulation and consciousness change in recognizable ways. Hospice nurses prepare families for these signs and increase visits during this time.
Terminal restlessness (terminal agitation)
Restlessness, confusion or agitation that can occur in the last days of life. It is common, has physical causes, and is treatable with medication and calm surroundings; the hospice nurse should be called.
Death rattle (terminal secretions)
Noisy breathing near the end of life caused by saliva the person can no longer swallow. It is usually not distressing to the patient; repositioning and medication from the comfort kit reduce it.
Anticipatory grief
Grief that begins before a death, as family members begin to mourn what is coming. It is normal, and hospice social workers and chaplains support families through it.
Caregiver burnout
Physical and emotional exhaustion in a family member who is providing care. Hospice addresses it with aide visits, respite care, volunteers and social work support.
Palliative sedation
The carefully monitored use of medication to lower consciousness in a dying person whose suffering cannot otherwise be relieved. It is distinct from euthanasia, which is illegal in Michigan, and is rarely needed.
Hospice and life expectancy
Hospice does not shorten life; studies of some conditions have found hospice patients live as long or longer than similar patients who continue aggressive treatment, with better comfort.
Signs of approaching death
Common changes in the last days and hours: more sleep, little interest in food or drink, confusion, cool or mottled skin, and changes in breathing. See signs death is near.
Stopping eating and drinking
A natural part of dying in which the body gradually stops needing food and fluid. It is not usually painful, and mouth care keeps the person comfortable. See when a dying person stops eating and drinking.
Nearing-death awareness
When a dying person speaks of travel, sees loved ones who have died or seems to know death is near. Hospice teams encourage families to listen calmly rather than correct.
The rally (end-of-life surge)
A short burst of energy, appetite or clarity some people have in the days before death. It can be a gift for the family, and it does not mean the illness has turned around.
Vigil
Keeping company with a person in the last hours or days so they are not alone. Some hospices offer volunteers to sit with a patient when family cannot.
Postmortem care
Care of the body after death: bathing, positioning and allowing time for the family to say goodbye before the funeral home arrives. Hospice nurses help with this at home.
Prolonged grief disorder
Intense, disabling grief lasting at least a year after a loss for adults, recognized as a diagnosis since 2022. Hospice bereavement teams can help identify it and refer to counseling.
Grief support group
A regular gathering, in person or online, of people who have lost someone. See Lily’s directory of metro Detroit grief support groups.

Quality, rules and regulators

Care Compare
Medicare’s public website (medicare.gov/care-compare) that reports quality measures for every certified hospice, including visits in the last days of life, family survey results and the Hospice Care Index. Lily’s is CCN 231684.
CAHPS Hospice Survey
The family survey Medicare sends to caregivers after a hospice death, asking about communication, timely help, symptom relief and whether they would recommend the hospice. Results become the star rating on Care Compare once a hospice has enough completed surveys.
Hospice Care Index (HCI)
A Medicare score from 0 to 10 combining ten claims-based indicators of hospice quality, such as visits near death, live discharges and skilled nursing on weekends. Lily’s is 9.
Hospice Visits in the Last Days of Life (HVLDL)
A Medicare measure of the share of patients who received a nurse or social worker visit in at least two of the last three days of life. National average about 48 percent; Lily’s is 71.3 percent.
CMS Certification Number (CCN)
The six-digit identifier Medicare assigns to a certified provider. Lily Hospice’s is 231684; it distinguishes Lily from two other hospices named Lily in Wisconsin and Colorado.
NPI (National Provider Identifier)
The ten-digit number every health care provider uses on claims. Lily Hospice’s organizational NPI is 1881234862.
ACHC accreditation
Voluntary accreditation by the Accreditation Commission for Health Care, which surveys a hospice against standards beyond Medicare’s minimum. Lily Hospice is ACHC-accredited.
Hospice license (Michigan)
The state license issued by Michigan’s Department of Licensing and Regulatory Affairs that a hospice program must hold in addition to Medicare certification.
Nonprofit vs. for-profit hospice
Ownership types reported by Medicare. Both can provide excellent or poor care; quality measures and family ratings are better guides than ownership. Lily is family-owned.
HOPE (Hospice Outcomes and Patient Evaluation)
The standard patient assessment every Medicare hospice has completed since October 1, 2025, replacing the older Hospice Item Set. HOPE data will feed future quality measures on Care Compare.
Conditions of Participation (CoPs)
The federal rules a hospice must meet to be paid by Medicare, covering the team, the plan of care, patient rights, drugs and equipment, bereavement and more (42 CFR Part 418).
Hospice survey (inspection)
An unannounced on-site inspection by the state agency or an accrediting organization that checks compliance with Medicare rules. Hospices must be surveyed at least every 36 months.
LARA (Michigan Department of Licensing and Regulatory Affairs)
The Michigan agency that licenses hospices and performs Medicare surveys on behalf of CMS. Families can file a complaint with LARA about any licensed hospice.
Special Focus Program (hospice)
A CMS program to monitor poorly performing hospices more closely. CMS paused it in February 2025 to re-evaluate how hospices are selected.
Early live discharge rate
The share of a hospice’s live discharges that happen within seven days of admission, published by Medicare. A high rate can signal that patients were admitted who should not have been. See Lily’s quality scores.
Nursing minutes per routine home care day
A Medicare-reported measure of how much skilled nursing time a hospice provides, on average, for each day of routine home care. It is one part of the Hospice Care Index.
Family caregiver rating (CAHPS stars)
The one-to-five-star rating Medicare publishes from its family survey, when a hospice has enough completed surveys. Newer or smaller hospices often have no rating yet. Nationally, 83% of caregivers rate their hospice 9 or 10 out of 10.

Veterans and Lily Hospice programs

Journey Program
Lily Hospice’s program that uses virtual-reality headsets to let patients revisit places, travel, or experience things they can no longer reach physically.
Veteran Rapid Response
Lily Hospice’s program for getting veterans evaluated and admitted quickly, led by a nurse who served as a Navy Hospital Corpsman.
We Honor Veterans
A national program of the National Alliance for Care at Home with the Department of Veterans Affairs that gives hospices a framework for veteran-centered care. Lily follows it.
Pinning ceremony
A short ceremony in which a hospice veteran is thanked for their service with a pin and certificate, often with family, a veteran volunteer and a chaplain present. Lily offers one to every veteran it serves; see a Navy veteran’s pinning ceremony.
Aid and Attendance
A VA pension supplement for eligible wartime veterans or surviving spouses who need help with daily activities, sometimes used to pay for assisted living or home care alongside hospice.
Pathways
Lily Hospice’s palliative program for people with serious illness who are not ready for hospice or do not yet qualify, focused on symptom relief and planning.

Related: How to choose a hospice · What Medicare covers · Is It Time? guide · Metro Detroit Hospice Directory · Hospice in Michigan: key numbers for 2026 · Facts about Lily Hospice

Hospice isn’t giving up. It’s showing up.