Choosing hospice does not have to mean stopping every treatment you rely on today. If you are weighing dialysis, chemotherapy, or another ongoing therapy, this guide helps you sort through what can continue for comfort and what is better to pause. You will learn how intent, side effects, and coverage shape these decisions, and how your hospice team coordinates with specialists to keep the focus on quality of life.
What Hospice Covers When Treatments Continue
When you elect hospice, Medicare asks you to focus on comfort for the illness that your doctor certifies as terminal. That means treatments aimed at cure are usually not covered by hospice. Some therapies can still continue if the goal is symptom relief rather than cure. Examples include:
- Palliative Radiation to reduce pain, bleeding, or pressure.
- Low-Dose Chemotherapy or Hormonal Therapy to shrink tumors that are causing distressing symptoms.
- Procedures that drain fluid or open airways to improve breathing and comfort.
The key is intent. If a treatment is primarily for comfort, your hospice team can consider it and coordinate authorization when appropriate. If the intent is cure or life prolongation, it is usually not compatible with the hospice plan of care. Your hospice physician and your specialists should document the goal clearly so coverage can be determined.
Related reading: See Hospice Care Meaning for explanations, goals, timing, and coverage.
Dialysis And Hospice: Special Considerations
Dialysis is often considered life-prolonging treatment. Under Medicare, you can receive both the hospice benefit and the ESRD benefit at the same time only when dialysis is unrelated to the terminal diagnosis. If your terminal diagnosis is renal failure, Medicare typically will not pay for dialysis and hospice together.
This is why many patients feel forced to choose. There are exceptions in specific situations, and policies can vary by payer and diagnosis, so your team should review eligibility carefully.
What this means for you:
- If your terminal diagnosis is cancer and you also have chronic kidney disease, dialysis may sometimes continue if it is not related to the terminal diagnosis.
- If your terminal diagnosis is renal failure, dialysis is usually not covered with hospice under Medicare. Some families still choose hospice and stop dialysis when the burdens outweigh the benefits.
- Comfort-focused alternatives may include home support for symptom control, fluid management, and spiritual and psychosocial care.
Chemotherapy During Hospice: When It May Continue
Chemotherapy can continue during hospice when the dose and drug are chosen for symptom relief and not cure. Examples include:
- Low-Intensity Regimens to reduce pain from tumor pressure.
- Hormonal Therapy when it eases symptoms with minimal side effects.
- Short Courses with a clear comfort goal and close monitoring of side effects.
Your oncologist and hospice medical director decide together whether a regimen is palliative. Some agents, like certain immunotherapies, are not compatible with hospice goals due to side effects or the intent of treatment. Documentation should state that the goal is comfort and quality of life.
Decision Points: Continue Or Pause
Use these checkpoints with your family and clinicians to decide whether to continue or pause a therapy while on hospice.
- Goals Of Care.
- What matters most right now, comfort or more time, or both in balance?
- Does the treatment reduce a symptom that truly limits daily life, such as pain, breathlessness, or bleeding?
If comfort is the priority, hospice can include therapies that relieve symptoms. If your priority is disease control or life extension, consider palliative care while continuing treatment before electing hospice.
- Burden Versus Benefit.
- How many clinic trips, lab checks, or side effects are involved each week?
- Are there safer alternatives that provide similar comfort, like nerve blocks, palliative radiation, or targeted medications?
Hospice teams can simplify regimens and provide many therapies at home, which often reduces treatment burden.
- Coverage And Cost.
- Will Medicare or your health plan cover the therapy within the hospice plan of care?
- If the therapy is not covered under hospice, is there a way to receive it under a different benefit, or would that require pausing hospice?
Your hospice will review coverage rules with you. If you revoke hospice to pursue treatment, you can return to hospice later when ready.
- Safety And Setting.
- Can the therapy be delivered safely at home, or does it require frequent hospital visits?
- Will the side effects increase symptoms like nausea, fatigue, or confusion?
Hospice focuses on comfort, safety, and reducing avoidable hospital time. Treatments that create more distress than relief are usually paused.
- Timeframe And Milestones.
- Agree on a short trial with clear comfort goals.
- Reassess at a specific date or after a defined number of sessions.
If the goal is not met, pause the therapy and return to comfort-only measures. Your plan can change as needs change.
If You Are Not Ready For Hospice Yet
If you are not ready for hospice, start by talking with your primary doctor or specialist about symptom management options that fit your current treatment plan. Your health plan case manager can explain what is available through your benefits, including disease-specific support from oncology or nephrology clinics, home health nursing for short-term needs, or community programs that focus on pain and symptom control while treatment continues.
Talking With Your Specialists
Good decisions happen when everyone is on the same page. Ask your oncologist, nephrologist, and hospice physician:
- What is the goal of this therapy in my situation?
- How will we measure success, and how soon?
- What side effects matter most for my comfort?
- If this therapy is not covered within hospice, what are my options?
Bring a simple one-page plan to each visit. Your hospice nurse can help coordinate.
Frequently Asked Questions About Continuing Or Pausing Treatment
- Can I Try One More Treatment And Still Start Hospice?
Yes, if the intent is symptom relief and the plan is consistent with hospice goals. Your hospice physician and specialist decide together and document the plan. - What If I Pause Treatment And My Symptoms Worsen?
Your hospice team can adjust medications, offer palliative procedures, or revisit a short trial of symptom-focused therapy. - Can I Leave Hospice To Resume Treatment And Return Later?
Yes. You can revoke hospice, resume disease-directed care, and re-elect hospice when ready. Coverage resumes when you qualify again. - Is There Help If I Want Symptom Control But Also Need Dialysis?
This is complex. If dialysis is part of the terminal diagnosis, Medicare usually will not cover both. Ask about palliative care programs or other payer options.
What Families In Burbank And Los Angeles County Can Expect
Journey Palliative and Hospice coordinates with your specialists throughout Los Angeles County, including Burbank, Santa Monica, Long Beach, Santa Clarita, and nearby communities. We also support families in Riverside County, Ventura County, Kern County, and Orange County. Our team helps you:
- Clarify goals that match your values.
- Review benefits, coverage, and out-of-pocket considerations.
- Plan trials of palliative therapies when they align with comfort.
- Create a home plan that reduces clinic trips and hospital time.
Ready To Talk Through Your Options? Call us at (818) 748-3427for a local hospice team with close coordination with oncologists and nephrologists. You can also send us a message for same-week start of care whenever possible, and compassionate support across Los Angeles County, Burbank, and surrounding areas.
