The oncologist’s words hung in the air. “We can keep trying, but if you want hospice, you’ll have to stop the chemo.” Sarah looked at her seven-year-old daughter, Mia, who was drawing pictures in the corner of the exam room. Stopping treatment meant giving up. But Mia’s pain was getting worse, and Sarah couldn’t manage it alone anymore.
Across town, 68-year-old Marine veteran Tom faced the same impossible choice. His heart failure specialist suggested hospice. But Tom wasn’t ready to stop dialysis—those three-times-a-week treatments kept him alive to see his grandkids. Choose treatment or comfort care. Never both.
That terrible choice no longer exists for two groups: children covered by Medicaid or CHIP, and veterans receiving care through the VA system. Concurrent care allows these patients to receive hospice support while continuing treatments aimed at their disease. Mia can keep receiving chemotherapy while a hospice nurse visits three times a week to adjust her pain medications and teach Sarah new comfort techniques. Tom can continue dialysis while hospice provides a home health aide to help with showering and a social worker to support his wife through the emotional toll.
This article explains what concurrent care is, who qualifies, how to access it, and why starting hospice earlier can actually extend life while improving its quality.
What Is Concurrent Care?
The Traditional Hospice Choice
Medicare hospice rules have always required patients to stop curative or life-prolonging treatments. Picture this: A 14-year-old boy with cystic fibrosis needs his vest treatments twice daily to clear his lungs and IV antibiotics when infections flare. His doctor says hospice could help manage his pain and give his exhausted parents respite care. But enrolling means stopping the treatments that keep him breathing comfortably. His mother shakes her head. “Not yet. We’re not there yet.”
That “not yet” lasts months. By the time the family finally says yes to hospice, the boy has five days left. The hospice team barely has time to learn his name before he’s gone.
Traditional hospice still works this way for most adults. The median length of stay remains just 17 to 21 days. Families wait too long because the price of admission—stopping all treatment—feels like giving up.
How Concurrent Care Changes Everything
Now picture the same boy under concurrent care. He starts hospice at 14, continues his vest treatments and IV antibiotics, and receives hospice visits at home. A respiratory therapist from the treatment team coordinates with the hospice nurse. When he develops a new infection, both teams collaborate on the care plan. His mother gets respite care—a hospice aide stays with her son while she goes to her daughter’s soccer game for the first time in months. The boy lives another year, attending school part-time, playing video games with friends, and dying at home with his symptoms well-managed and his family supported.
That’s concurrent care. Treatment continues as long as it aligns with the patient’s goals, even when those goals shift day by day. A hospice social worker helps the family process each change while medical teams adjust the care plan.
Who Qualifies for Concurrent Care?
Children Under Medicaid and CHIP
The Affordable Care Act changed everything for children in 2010. Section 2302 created a new rule: any child under 21 who qualifies for hospice through Medicaid or the Children’s Health Insurance Program can receive concurrent care.
Eight-year-old Marcus has a rare genetic condition causing progressive muscle weakness. He’s on a feeding tube and a ventilator at night. His prognosis is six months, maybe less. Under old rules, hospice would mean stopping the ventilator and feeding tube—essentially watching him suffocate and starve. His parents couldn’t do it. Under concurrent care, Marcus keeps both, while hospice provides a nurse who specializes in pediatric symptom management, equipment to make transfers easier, and counseling for his two older brothers, who are terrified of losing him.
This applies regardless of diagnosis—cancer, heart defects, neurological conditions, anything life-limiting.
Veterans Through the VA System
The VA launched its Comprehensive End-of-Life Care Initiative between 2009 and 2012, making concurrent care available to all veterans receiving VA healthcare. Vietnam veteran James, 72, has lung cancer that’s spread to his bones. He’s receiving radiation to shrink a tumor pressing on his spine, which causes excruciating pain. Without radiation, he can’t walk. Without hospice, his wife can’t manage his medications, oxygen equipment, and middle-of-the-night crises alone. She’s 70 and exhausted.
Under concurrent care, James goes to the VA for radiation twice a week while a hospice nurse visits his home every other day. When he develops a medication side effect at 2 a.m., his wife calls the hospice hotline instead of driving him to the ER. The nurse adjusts his medications over the phone and visits first thing in the morning. James walks his daughter down the aisle at her wedding three months later—something that wouldn’t have happened without the radiation, and couldn’t have happened without the hospice support keeping him stable at home.
The results have been remarkable—veteran hospice patients now have a median length of stay around 45 days, more than double the national average.
Basic Eligibility Requirements
To qualify for concurrent care, patients must meet standard hospice criteria:
A terminal diagnosis from a physician
A prognosis of six months or less if the disease follows its expected course
Understanding of the diagnosis and prognosis (age-appropriate for children)
Choice to focus on quality of life
That “six months or less” timeline confuses people. Eleven-year-old Emma had a brain tumor. Her oncologist certified her for hospice in January, saying she likely had four to six months. Emma enrolled in concurrent care, continued low-dose chemotherapy to slow tumor growth, and received hospice support at home. She lived until October, ten months, not six. Her hospice recertified her twice because she was stable. When she finally declined, hospice was already there. Her parents didn’t scramble for help in a crisis.
What Treatments Can Continue?
Disease-Directed Therapies
Five-year-old Aiden has leukemia that’s no longer responding to treatment. His oncologist suggests a low-dose chemotherapy protocol—not to cure the cancer, but to slow its growth enough that Aiden can attend his brother’s birthday party and go to Disney World with his family. Concurrent care makes this possible. Aiden receives chemo at the hospital every two weeks while hospice manages his nausea at home with medication patches, his pain with a liquid morphine his mom can adjust, and his anxiety with play therapy sessions.
Veteran Maria, 65, has kidney failure and receives dialysis three times a week. Without dialysis, she’d become confused and weak within days. Her nephrologist says her heart is also failing—prognosis is six months. She wants to keep doing dialysis as long as she can function. Concurrent hospice provides oxygen at home, medications to manage her shortness of breath, and a social worker who helps her adult children understand what’s happening. When Maria finally becomes too weak for dialysis, hospice is already in place to manage her comfort.
Other treatments that can continue include immunotherapy, radiation, blood transfusions, IV antibiotics, ventilator support, feeding tubes, and any intervention that serves the patient’s goals.
Symptom Management Approaches
Concurrent care often means adjusting how aggressively treatments are given. Ten-year-old Carlos was receiving high-dose chemotherapy every week, which left him vomiting and exhausted. Under concurrent care, his oncologist and hospice team collaborated on a new plan: lower-dose chemo every two weeks instead. Carlos’s tumor still shrank slowly, but he had energy to play soccer with his cousins and eat his grandmother’s tamales. The goal shifted from maximum tumor kill to maximum quality time.
What Hospice Services Are Provided?
Physical Symptom Management
Twelve-year-old Sophia’s brain tumor causes seizures and severe headaches. Before hospice, her parents rushed her to the ER three times a month. Now, a hospice nurse visits twice a week, teaches Sophia’s parents exactly how to give rescue seizure medication, adjusts her headache protocol, and provides a 24-hour hotline. Last week, when Sophia had a breakthrough seizure, her dad gave her the rescue medication and called the nurse, who talked him through the episode and visited an hour later to check on Sophia. No ER. No ambulance. No trauma for the whole family.
Veteran Robert, 71, has COPD and can barely walk from his bedroom to the kitchen without gasping for air. Hospice delivered an oxygen concentrator, showed his wife how to adjust the flow, taught him breathing techniques, and prescribed medications to reduce his air hunger and panic. Now Robert sits on his porch every morning watching birds, oxygen tube trailing behind him, breathing still difficult but no longer terrifying.
Emotional and Spiritual Support
Nine-year-old twins lost their older sister to the same genetic condition that’s now killing their seven-year-old brother, Liam. The boys are angry. One refuses to talk. The other has nightmares. Hospice sends a child life specialist twice a week who plays games with all three boys together, helping them express feelings they can’t say out loud. She brings art supplies, and the twins draw pictures of their sister. Liam draws pictures of his funeral—not morbid, but a way to process. Their parents, who barely have energy to brush their teeth, don’t have to find a child therapist or figure out how to help their kids grieve while their other child is dying.
Marine veteran Cynthia, 58, hasn’t been to church since her diagnosis six months ago. She’s angry at God. The hospice chaplain visits weekly, sits on her back deck, and listens while Cynthia rages. Doesn’t offer platitudes. Doesn’t try to fix her faith. Just witnesses her anger and her fear. After two months, Cynthia starts asking questions instead of just yelling. The chaplain doesn’t push—just keeps showing up.
Practical Help at Home
Army veteran Daniel, 66, has been bathing himself for 66 years. Now he can’t stand in the shower without falling. His wife is 5’2″ and can’t catch him. Pride made him refuse help until hospice gently explained that a home health aide isn’t about weakness—it’s about safety. Now Marcus comes three mornings a week, helps Daniel shower, shaves him, and treats him with the dignity one veteran to another. Daniel’s wife uses those 45 minutes to go to the grocery store alone, and if she needs to, she cries in the car.
Six-year-old Bella needs a hospital bed, a wheelchair, a special toilet seat, and oxygen equipment. Her parents’ insurance would cover some of it eventually, maybe, after paperwork and appeals. Hospice delivers everything within 48 hours. No bills. No fighting with insurance. When Bella outgrows the wheelchair a month later, hospice exchanges it for a bigger one. Simple, but transformative.
Care Coordination
Fourteen-year-old Noah has appointments with his oncologist, cardiologist, pain specialist, and gastroenterologist. Four different doctors. Four different medication lists. His mother carries a three-ring binder, trying to keep everyone informed. Under concurrent care, the hospice nurse attends key appointments, updates all providers, maintains a master medication list, and ensures everyone works toward the same goals. When Noah’s pain med conflicts with his heart med, the hospice team catches it before Noah takes a dose. His mother stops feeling like she’s managing a medical center.
Why Concurrent Care Matters
Starting Hospice Earlier
Before concurrent care, Veteran Patricia watched her husband deteriorate for eight months before finally agreeing to hospice. He died 12 days later. “If I’d known he could keep his treatments,” she said, “we would have started six months earlier. Those 12 days were good, but we needed those six months”.
Data tells Patricia’s story thousands of times over. Before concurrent care, veterans enrolled in hospice at a median of 17 to 21 days before death. After the VA initiative, the median jumped to 45 days. Pediatric concurrent care shows similar patterns—when families don’t have to give up treatment, they say yes to hospice months earlier instead of days.
Three-year-old Zoe enrolled in concurrent care 14 months before she died. Her parents have 14 months of memories with manageable symptoms instead of two weeks of crisis management.
Better Quality of Life
Eight-year-old Jayden spent his last six months under traditional care in and out of hospitals—14 ER visits, four ICU admissions, intubated twice. His parents have photos from those months. Every single one shows hospital walls.
Eight-year-old Grace spent her last six months under concurrent care at home—one planned hospital admission for a blood transfusion, zero ER visits, zero ICU stays. Her parents have photos from those months. Grace at the beach. Grace is meeting a therapy dog. Grace is doing art projects with her hospice child life specialist. Grace is asleep in her own bed, surrounded by her stuffed animals.
Both children died. One died having lived. Research demonstrates that concurrent care changes the experience—fewer ICU admissions, fewer emergency department visits, fewer hospitalizations for crises that could have been managed at home. More time doing what matters.
Removing the Terrible Choice
Veteran Luis sat in his car in the VA parking lot for 30 minutes after his doctor suggested hospice. He called his daughter. “Hospice means I have to stop dialysis. I’m not ready.” His daughter researched concurrent care and found information about it. Luis walked back inside and asked different questions. He enrolled two days later, continues dialysis, and has hospice support at home. “I thought hospice meant surrender,” he said. “It means backup”.
Parents Michelle and David describe the moment they learned about concurrent care for their daughter: “We’d been avoiding hospice for three months because it meant stopping her infusions. When her doctor explained concurrent care, we both cried. Not sad crying—relief crying. We could get help without abandoning her”.
Support During Decline
Air Force veteran Susan could walk a mile when she enrolled in concurrent care hospice eight months ago. Now she walks from her bed to her recliner. That functional decline happened whether hospice was involved or not. But with hospice, Susan’s home has equipment for every stage—first a cane, then a walker, now a wheelchair. Her symptoms stay controlled as her body weakens. Her husband has a hospice social worker he calls when he feels overwhelmed, which is often. Susan is declining, but she’s not suffering, and her husband isn’t collapsing.
The Science Behind Early Hospice Enrollment
Living Longer with Better Support
Four-year-old Emma enrolled in concurrent care with a prognosis of three to six months. She lived two years and three months. Her oncologist said later, “The hospice support kept her stable through infections that might have killed her in the hospital. She was home, comfortable, and that mattered”.
Studies show this pattern repeatedly—patients who start hospice earlier often live longer than those who delay until the final days. Navy veteran Thomas enrolled in concurrent care 11 months before he died. His identical diagnosis put him at six months. “The hospice team managed symptoms I didn’t even know could be managed,” his wife said. “He had energy for living instead of just surviving”.
Better symptom management reduces physical stress. Proper nutrition support maintains strength. Infection prevention decreases medical crises. Emotional support reduces the physiological burden of anxiety and depression. The body doesn’t have to fight quite so hard on every front simultaneously.
Avoiding Crisis Care
Ten-year-old Marcus without hospice: Fever spikes at midnight. Panic. ER visit. Eight-hour wait. Admission for IV antibiotics. Three days in the hospital. Home exhausted. Two weeks later, repeat.
Ten-year-old Marcus with concurrent care hospice: Fever spikes at midnight. Call the hospice hotline. The nurse talks to the parents through the assessment, and is authorized to start oral antibiotics from the emergency med kit at home. Nurse visit first thing in the morning. Fever controlled within 24 hours. No ER. No hospital. No trauma.
Concurrent care with early hospice enrollment dramatically reduces these crisis situations because problems get addressed before they become emergencies. Veteran James had seven ER visits in the three months before hospice. He’s had zero in the five months since concurrent care started. “The hospice nurse sees trouble coming, and we fix it early,” his wife explained.
How to Access Concurrent Care
For Parents of Seriously Ill Children
Jennifer’s daughter has a rare metabolic disorder. Jennifer called three hospice agencies before finding one with pediatric concurrent care experience. Her questions:
“Does my daughter’s prognosis qualify her for hospice?” The first agency said yes.
“Can she keep her weekly enzyme treatments?” The first agency said no—they didn’t provide concurrent care. Jennifer called the second agency.
“Do you have experience with pediatric concurrent care?” The second agency said they’d done it twice but felt uncomfortable. Jennifer called the third agency.
“How many pediatric concurrent care patients do you currently have?” The third agency said six. “How will you work with her metabolic specialist?” They already had a relationship with him. Jennifer enrolled the next day.
Start with insurance confirmation—Medicaid and CHIP provide concurrent care coverage. Private insurance typically does not, though some plans are beginning to offer similar benefits. Then ask your child’s specialist for hospice certification and recommendations for pediatric agencies. Finally, interview hospice agencies until you find one that enthusiastically embraces concurrent care, not reluctantly.
For Veterans and Their Families
Marine Corps veteran Andre called the VA after reading about concurrent care online. He said to his physician, “I’m interested in concurrent care hospice. I want to keep my immunotherapy going, but I need help at home.”
His doctor said, “Let me make a referral today. You’ll hear from our palliative care coordinator within 48 hours.”
Andre met with the coordinatoron Friday. Enrolled on Monday. Had his first hospice visit on Wednesday. Continued his immunotherapy infusion on Thursday. “I thought it would be complicated,” Andre said. “It was the easiest thing I’ve done in six months”.
Start by saying those specific words to your VA physician: “I’m interested in concurrent care hospice.” The VA system has established processes, so this isn’t an unusual request. You can also contact the VA hospice and palliative care coordinator at your facility directly—they understand concurrent care thoroughly and can guide you through enrollment.
Finding Hospice Providers Who Participate
Not every hospice agency actively offers concurrent care even when patients qualify. Parent Rachel called seven agencies before finding two that said yes to concurrent care for her son. “Five of them said they ‘technically’ could but didn’t really do it. I wanted someone who’d done it a hundred times, not someone figuring it out with my kid,” Rachel explained.
Ask these questions:
“How many concurrent care patients—pediatric or veteran—do you currently serve?” If they say zero or one, keep calling.
“Can you give me a reference from a family whose child received concurrent care?” If they can’t, they don’t have enough experience.
“What happens if my insurance initially denies coverage for a treatment?” You want an agency that will advocate, not give up.
Don’t settle for vague answers or agencies that seem uncertain. You deserve hospice providers who’ve traveled this road many times.
What Healthcare Providers Should Know
Coordination Between Teams
Dr. Patterson is an oncologist who’s treated children for 20 years. He resisted concurrent care at first. “I thought hospice meant I’d failed,” he admitted. Then his patient Emma enrolled in concurrent care while continuing his low-dose chemo protocol. The hospice nurse called him weekly with updates. They adjusted Emma’s anti-nausea meds together when side effects worsened. When Emma developed a fever, the hospice team managed it at home, then called Dr. Patterson to report. Emma lived eight more months—longer than predicted—with a good quality of life.
“Now I suggest concurrent care early,” Dr. Patterson said. “I’m not giving up—I’m giving my patients more support”.
Successful concurrent care requires weekly communication between hospice teams and disease-directed treatment teams. Phone calls, shared electronic records, or quick emails—whatever works. Patients suffer when their providers work in silos. They thrive when everyone shares information and collaborates.
Adjusting Treatment Goals
Nine-year-old Sofia’s goal in March: Attend every day of school. Her treatment plan: Aggressive pain management, steroids for energy, weekly chemo to control tumor growth.
Sofia’s goal in June: Go to her best friend’s birthday party at the pool. New plan: Reduce chemo to every two weeks to decrease nausea, adjust pain meds so she’s alert enough to swim, hospice nurse teaches the friend’s parents how to manage Sofia’s emergency meds just in case.
Sofia’s goal in August: Be comfortable at home with her family. New plan: Stop chemo completely, increase comfort medications, hospice visits daily.
Same child. Same disease. Different goals require different treatment approaches. Concurrent care allows this flexibility. Hospice teams and treatment teams must revisit goals monthly, recognizing that what mattered in March might not matter in August. This fluidity makes concurrent care more complex than traditional hospice, but also more responsive to real human needs.
Common Implementation Challenges
Dr. Ramirez, a VA physician, describes his first concurrent care patient: “The billing alone took me hours to figure out. Who pays for what? The VA paid for dialysis. Hospice paid for home nursing. But who paid for the medications he needed for both conditions? I spent more time on phone calls with billing than I did with my patient that first month”.
He learned. Now he has templates. But honest truth: concurrent care isn’t always easy to implement. Insurance billing can be complicated when multiple providers serve one patient. Communication breakdowns happen when teams don’t establish clear processes. Families sometimes struggle with conflicting advice from different providers.
Nurse practitioner Williams works for a pediatric hospice. “We had a family where the oncologist wanted to try one more treatment, and we felt it would cause more suffering than benefit. We all met—oncologist, hospice team, parents, child life specialist. We talked through goals. The treatment was modified to a half-dose. The child tolerated it, got another month of good time, then we stopped. But that meeting was crucial. Without it, we would have been pulling the family in different directions”.
These challenges don’t mean concurrent care isn’t worthwhile—they mean the healthcare system needs to keep improving how we deliver it. Learn from early adopters. Share knowledge. Ask for help. Keep the patient at the center of every decision.
Your Next Steps
For Parents
Your six-year-old daughter lies in her bed upstairs. The medications aren’t controlling her pain anymore, and you don’t know what to do. You’ve been avoiding hospice because it meant stopping the treatment that’s been her lifeline. Now you know that’s not true—not for children.
Tomorrow morning, call a pediatric hospice agency. Say these words: “My daughter has [condition]. I’d like to learn about concurrent care. Can she continue her current treatments while receiving hospice support?”
Write that down. Practice saying it. Make the call.
You’re not giving up. You’re opening a door to help you’ve desperately needed.
For Veterans
You’ve been getting sicker for months. Your spouse is exhausted. You want to keep fighting, but you also need support you’re not getting. You’ve earned both.
Call your VA physician today or tomorrow. Say these exact words: “I’m interested in concurrent care hospice. I want to know if I’m eligible and how it would work with my current treatments.”
The VA system understands concurrent care. You don’t need to convince anyone or argue your case. Just ask.
Fighting doesn’t mean fighting alone.
For Healthcare Providers
Dr. Chen didn’t know concurrent care existed until a patient’s mother asked about it. He spent three hours researching, made connections with two hospice agencies in his area, and now suggests it routinely to families whose children have life-limiting conditions. “I thought hospice meant I was giving up on my patients,” he said. “It means I’m giving them more layers of support while I keep treating them”.
Learn about concurrent care this week. Identify hospice agencies in your area that provide it competently. Attend a training or call a hospice to understand their process. When you have pediatric patients with Medicaid or CHIP, or veteran patients with the VA, who might benefit, bring up the option proactively. Most families don’t know concurrent care exists—you can change that.
Starting the Conversation
Maria sat in the exam room, her husband beside her, and asked her doctor: “Does my situation qualify for concurrent care hospice?” That one question opened a conversation that led to eight months of better support, better symptom management, and better quality of life.
Carlos’s mother asked: “Which treatments could my son continue while receiving hospice support?” That question led to a care plan that gave Carlos six more months to play soccer and eat his favorite foods.
Jennifer asked the hospice agency: “How many pediatric concurrent care patients do you currently have?” That question helped her find an agency with the experience to provide competent care for her daughter.
One conversation. One question. That’s all it takes to start. Children and veterans deserve every possible day of comfort and hope. Concurrent care makes that possible. Ask your question today.
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Compassion Crossing Academy — Free and paid online courses are available to teach caregivers, nurses, social workers, chaplains, end-of-life advocates, and educators, including death doulas, how to confidently coordinate complex care.
Currently, there is no official organization regulating end-of-life doulas (EOLDs). Keep in mind that some listed EOLDs in directories might no longer be practicing, so verifying their current status is essential.
End-of-Life Doula Schools
The following are end-of-life (aka death doula) schools for those interested in becoming an end-of-life doula:
Compassion Crossing Academy: While it’s not a dedicated death-doula school, it offers distinctive classes that can help a death doula expand their business. It’s a valuable resource for those eager to grow and deepen their knowledge in this meaningful field.
Remember that there is no official accrediting body for end-of-life doula programs. Certification only shows you’ve completed an unaccredited program and received a graduation certificate. It’s advisable to have discovery sessions with any death doula school you’re considering — regardless of whether it’s listed here — to see if it meets your needs. Also, ask questions and contact references, such as former students, to assess whether the school gave you a solid foundation to start your own death doula practice.
