Can You Have a Catheter on Hospice?

Yes, you can have a urinary catheter on hospice, and you do not have to remove one to enroll. A catheter can stay in, be placed after admission, or be avoided altogether, depending on what keeps your loved one most comfortable. When it is part of the plan of care for the terminal illness or related conditions, the hospice provides the catheter supplies and the nursing care that goes with it.

Bladder problems are common late in a serious illness: leaking, being unable to empty the bladder, or being too weak to get to the toilet. Families often wonder whether a catheter is "allowed," whether it is a medical intervention hospice avoids, or whether they will have to manage it alone. Here is how it works.

Catheters and hospice can coexist

Hospice is comfort-focused care, and a catheter is a comfort tool when it solves a problem the person is suffering from. Medicare's hospice rules (42 CFR 418.202) cover nursing care and the medical supplies that are part of the written plan of care for palliation and management of the terminal illness or related conditions. CMS rules for the plan of care (42 CFR 418.56) require it to include the medical supplies and treatments necessary to meet the patient's needs. Catheters and related supplies are among the items hospices commonly provide; see what equipment and supplies hospice covers.

The types of catheters you may hear about

MedlinePlus, the National Library of Medicine's consumer site, describes several kinds:

When a catheter may help

The hospice nurse and physician will look at why the person is having trouble and what would ease it. Common reasons a catheter comes up include:

• Urinary retention: the bladder is full but cannot empty, which can be painful. A full bladder is also one of the physical causes the team checks when someone becomes agitated; see what terminal restlessness is.
• Frequent changes that hurt: when every turn or change of bedding causes pain, a catheter may reduce how often the person has to be moved.
• Skin protection: keeping skin clean is part of comfort care at the end of life, and constant wetness can make that harder.
• The person's own preference: some people would rather have a catheter than depend on others for toileting.

When a catheter may not be the best choice

Catheters carry real risks. MedlinePlus lists urinary tract, kidney, and bloodstream infections, bladder stones, blood in the urine, and injury to the urethra among possible complications, and notes that urine can leak around a catheter. Insertion can be uncomfortable. For someone who is only occasionally incontinent, briefs and underpads may be gentler. The team will weigh these trade-offs with you rather than defaulting to one answer, and the choice can change as your loved one's condition changes.

Who takes care of it

Under Medicare's rules, hospice nursing care is provided by or under the supervision of a registered nurse, and the hospice must teach family caregivers what they need to know for the care in the plan. In practice that usually means:

• The hospice nurse inserts or changes the catheter when needed, checks for problems on visits, and can be called through the hospice's 24-hour line.
• The hospice aide helps with personal care and hygiene around the catheter during visits; see how much aide time hospice provides.
• Family caregivers usually empty the drainage bag, keep the tubing free of kinks, keep the bag below the bladder, and report changes.

MedlinePlus advises contacting a provider for fever or chills, bleeding, bladder spasms that do not go away, large leaks around the catheter, cloudy or strong-smelling urine, or very little or no urine draining into the bag, which can mean the catheter is blocked or kinked. On hospice, that call goes to the hospice line first, not 911.

The misconception to correct

Some families assume hospice means "no more tubes" and that a loved one's catheter will be pulled out at admission. That is not how hospice works. Nothing in the hospice benefit requires removing a catheter. What changes is the reason behind every decision: the team keeps, places, or removes a catheter based on comfort and the person's wishes, and records the decision in the plan of care.

Frequently asked questions

Will hospice remove my loved one's catheter?

Not as a condition of enrollment. If the catheter is keeping your loved one comfortable, it can stay. If it is causing infections, pain, or spasms, the team may suggest changing it or trying a different approach, and they will talk it through with you first.

Can hospice put in a catheter after admission?

Yes, when it serves comfort, such as relieving a bladder that cannot empty. A standard urinary catheter is typically placed by the hospice nurse at home. A suprapubic catheter is different: MedlinePlus notes it is placed in a hospital or provider's office, so a new one is less common late in an illness.

Does hospice pay for catheter supplies?

When the catheter is part of the plan of care for the terminal illness or related conditions, the hospice provides the supplies, such as catheters, drainage bags, and related items. Ask the hospice how to reorder before you run low.

Is a catheter needed in the last days of life?

Not always. The National Cancer Institute notes that near the end of life people may pass less urine, and it may be dark in color. Some families and nurses choose a catheter in the final days to avoid moving the person often; others use pads. Either can be appropriate, so ask the nurse what fits your loved one.

Questions to ask the hospice

• Would a catheter make my loved one more comfortable, and what are the risks for them specifically?
• Who changes the catheter and how often will the nurse check it?
• What signs should I call about, and what number do I call at night?
• How do I reorder bags and supplies?

What to do next

If your loved one has a catheter, or bladder problems are making daily care hard, mention it at the first hospice evaluation so the plan covers it from day one. When you are ready, compare hospices near you by city.