hospiceAsk The Expert: Hospice Care

Dr. Stephen Marsh, M.D., Medical Director for Heartland Home Health Care and Hospice in Raleigh, NC



Q: Is Hospice a place?

A: Hospice is a philosophy of care, not a place. Hospice Care can be provided in any place the patient calls home, whether it is a personal home, a skilled nursing center, Assisted Living Facility or anywhere else.


Q: Do you have to have a DNR before you can receive Hospice?

A: A patient can receive Hospice without having a DNR. The hospice regulation actually says that hospice cannot discriminate against patients because of any advance directives.


Q: Does Hospice mean giving up hope?

A: In order to receive Hospice the patient must be eligible and have an understanding that hospice focuses on comfort care (palliative) not a cure. But, patients and families do not have to be “ready to die” before getting the care they need and deserve. Hospice helps patients and families deal with what is happening to them on their own terms and their own time frame. It is important to get Hospice early so that the benefit can help prepare and support families during their journey. It is not required that patients “be ready” prior to receiving care.


Q: Does Hospice have to be recommended by the doctor?

A: Patients can choose for us to meet with them and discuss the benefit of Hospice at any time. We cannot provide hands on care to a patient without a physician’s order. We work with each patient’s physician to identify each patient’s individual needs.


Q: How much does Hospice Cost?

A: The Medicare and Medicaid Hospice Benefits cover services at 100% so there is no cost to the patient. If patients have private insurance or managed care, Heartland assists in checking their benefit coverage to make sure patients and families understand any potential medical out of pocket costs.


Q: Is Hospice only for Cancer Patients?

A: More than 60% of hospice patients nationwide have a diagnosis other than cancer. Many patients have other diagnoses or advanced stages of chronic disease like pulmonary disease, Alzheimer’s Disease, renal disease, HIV/AIDS and cardiovascular disease.


Q: Do you have to have 24 hour caregivers in place before receiving the benefit of Hospice?

A: While some hospices require caregivers prior to the patient being admitted, Heartland does not. We help coordinate community resources to keep the patients at home as long as possible and then help the patient find an alternative location to receive care when care at home is no longer possible.


hospiceDr. Stephen Marsh was born in Charlotte, NC. He graduated from UNC Chapel Hill with a Bachelor’s Degree in History and then NC State with a degree in Animal Science. Dr. Marsh attended Medical school at Wake Forest University/Bowman Gray School of Medicine. He completed his Family Practice Residency at East Carolina University and was a Family Practice Physician for 13 years in Zebulon, NC. Dr. Marsh is Board Certified in Hospice and Palliative Medicine and has been the Medical Director for Heartland Home Health Care and Hospice since 2004.

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