Hospice Care Guide — Choices and Process for End-of-Life Care

Hospice care is still a relatively new concept in China. Many people first hear the term after a family member has been moved to the ICU, when a doctor asks: 'There is no longer any hope of a cure — would you like to transition to hospice?' — and the family has no idea what that means. This article explains what hospice care is, how to choose it, and how to apply. Further reading: Complete Digital Will Guide.

Hospice, Palliative Care, and End-of-Life Care — How They Relate

These three terms are often used interchangeably, but there are nuances. Palliative care is the broadest: it can begin at diagnosis of a serious illness, relieving symptoms and improving quality of life alongside curative treatment. End-of-life care and hospice care focus more on the terminal phase — when curative treatment is no longer beneficial, care shifts to comfort-oriented holistic support. Chinese official documents uniformly use the term 安宁疗护 (hospice care).

Hospice Care vs. ICU

• Different goals — ICU aims to prolong life; hospice aims to improve quality of remaining life
• Different methods — ICU uses ventilators, ECMO, CRRT; hospice relies mainly on medication for pain and symptom management
• Different costs — ICU costs thousands to tens of thousands per day; hospice is significantly cheaper
• Different experience — ICU is noisy with many invasive procedures; hospice is quiet and allows family presence
• Different stages — ICU suits critical conditions with a chance of reversal; hospice suits medically terminal illness

The State of Hospice Care in China

China launched its first hospice pilot program in 2017 (5 cities), expanded to 71 cities in 2019, and further to over 100 districts by 2023. But overall coverage remains low — many prefecture-level cities still lack hospice facilities. The National Health Commission published the Hospice Care Practice Guidelines (Trial), standardizing symptom control, psychological support, and ethical decision-making. Some pilot regions have begun including hospice in medical insurance billing.

When Should You Consider Hospice

This is the most agonizing question for families. The medical criteria typically include: an incurable terminal illness (late-stage cancer, end-stage heart failure, end-stage COPD), a limited life expectancy (generally six months or less), and a situation where the burden of continued aggressive treatment outweighs the benefit. The final decision should involve the doctor, the patient (if conscious), and the family together. If the patient signed a living will expressing their wishes in advance, the decision becomes much smoother.

How to Apply for Hospice Care

• Step 1: Medical assessment — A secondary-level or higher hospital confirms the terminal condition and issues a diagnosis certificate
• Step 2: Find a facility — Consult your doctor or local health commission to find a facility offering hospice services
• Step 3: Submit application — Provide medical records, diagnosis certificate, patient and family IDs, and sign informed consent
• Step 4: Develop a care plan — The hospice team (doctor, nurse, social worker, counselor) creates a personalized care plan
• Step 5: Family participation — Family receives guidance on companionship and psychological support

Hospice Is Not Doing Nothing

Many people assume hospice means doing nothing and waiting to die. The opposite is true — hospice involves a great deal: pain assessment and pharmacological relief, breathing difficulty management, nausea and vomiting control, anxiety and depression intervention, bereavement counseling for families, and support for religious or spiritual needs. It simply does not perform CPR, intubation, and other invasive procedures that hold no benefit for terminal patients. Pairing these arrangements with end-of-life planning in advance helps families face the terminal phase with far more composure.

This article is for end-of-life medical knowledge only and does not constitute medical or legal advice. Eligibility, insurance coverage, and application procedures for hospice vary by region — consult your attending physician or local health authority. The decision to choose hospice should be based on medical assessment, the patient's wishes, and family consensus, guided by qualified professionals.