Hospice care focuses on comfort and quality of life rather than curative treatment. Hospice does provide oxygen, but only when it is clinically ordered to relieve a specific symptom, such as shortness of breath. Oxygen is not provided as a standard life-prolonging measure, aligning with the core philosophy of palliative care. The decision to use oxygen therapy is governed solely by its ability to manage distressing symptoms.
Oxygen’s Role in Comfort Care
In hospice, oxygen is viewed as a medication intended to treat the symptom of breathlessness, medically known as dyspnea. The goal is to provide relief and improve comfort, not to reverse the underlying disease or achieve a specific oxygen saturation number. This distinction separates its use in palliative care from acute care settings.
The most distressing sensation for many patients is “air hunger,” a feeling of not being able to take a satisfying breath. Oxygen therapy can help alleviate this anxiety-inducing symptom, improving the patient’s overall sense of well-being. Hospice teams prioritize the patient’s subjective experience of comfort over objective readings from a pulse oximeter.
If a patient reports that the oxygen helps them feel less anxious or more comfortable, its use is validated. The relief of discomfort is the sole measure of its effectiveness in the hospice setting, even if saturation levels were not severely low.
Clinical Indications for Oxygen Use
Oxygen must be prescribed by a physician or authorized provider as part of the plan of care. The most important indication for oxygen therapy in hospice is the patient’s subjective report of dyspnea, or the sensation of labored breathing. While low blood oxygen levels (hypoxemia) often accompany dyspnea, the patient’s discomfort is the primary driver for the prescription.
Oxygen is often beneficial for patients with advanced respiratory or cardiac conditions, such as Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF), or advanced lung cancer. In these cases, the underlying illness has compromised the body’s ability to efficiently move air. A trial of supplemental oxygen is initiated to see if it reduces the patient’s work of breathing.
If the patient reports no noticeable relief after a trial period, the oxygen may be discontinued. This reinforces that oxygen is a symptom-management tool; if the symptom is not relieved, the intervention is deemed ineffective for comfort. The decision to continue or discontinue therapy is always guided by the patient’s preference and comfort level.
Delivery, Equipment, and Setup
The hospice agency is responsible for coordinating the delivery and setup of all necessary Durable Medical Equipment (DME), including oxygen. Equipment is typically delivered directly to the patient’s home or care facility shortly after the physician’s order is received. The hospice team ensures that the patient and caregivers are trained on its proper and safe use.
The most common device is an oxygen concentrator, a machine that plugs in and filters nitrogen from the air to provide concentrated oxygen. Since concentrators are stationary, they are often paired with portable oxygen tanks or cylinders for patient mobility. Liquid oxygen systems are sometimes used as an alternative for patients requiring higher flow rates or more frequent portability.
Safety around oxygen equipment is a serious consideration because oxygen supports combustion, making fires a risk. Smoking is prohibited in any room where oxygen is being used or stored. It is also recommended to use only water-based lubricants and lotions, avoiding petroleum-based products like petroleum jelly, which could ignite if exposed to a spark or flame near the oxygen flow.
Cost Coverage and Patient Responsibility
The financial burden of oxygen therapy is eliminated when a patient is enrolled under the Medicare Hospice Benefit. Medicare Part A covers hospice care, and this comprehensive benefit includes all necessary medications, supplies, and DME related to the terminal illness, including oxygen and its equipment. The patient or family typically incurs no copayments, deductibles, or out-of-pocket costs for the oxygen itself.
This 100% coverage extends to the oxygen concentrator, portable tanks, tubing, masks, and any required maintenance or repairs. The hospice agency manages the contract with the DME supplier and handles all logistics and payments.
This comprehensive coverage contrasts with standard Medicare Part B coverage for oxygen, where patients are typically responsible for a 20% coinsurance. Under the hospice model, oxygen is treated as an integrated part of the palliative treatment plan, ensuring seamless access to necessary comfort measures.
Non-Oxygen Strategies for Breathing Comfort
Oxygen is just one tool in the hospice approach to managing dyspnea, and it is not always the most effective. Since breathlessness often involves anxiety, pharmacological interventions are frequently employed to manage the distress.
Low-dose opioids, such as immediate-release morphine, are a mainstay of treatment for refractory dyspnea, regardless of the patient’s oxygen saturation. Opioids work by dampening the central nervous system’s perception of air hunger, reducing the sensation of struggling to breathe. Benzodiazepines, like lorazepam, may be used with opioids to alleviate the intense anxiety that often accompanies severe shortness of breath. These medications help calm the patient and break the cycle of panic that can worsen dyspnea.
Non-pharmacological techniques are also highly effective and are used alongside medication. A simple handheld fan directed toward the patient’s face can stimulate the trigeminal nerve, creating a sensation of moving air that reduces the perception of breathlessness. Positioning the patient upright or encouraging the use of pillows to lean forward can also ease the work of breathing, offering immediate comfort.