The most important question families ask about hospice is: “Will my loved one be comfortable? Will they be in pain?” The answer is clear: Hospice exists to ensure your loved one is as comfortable as possible, free from pain and suffering.
Pain management is the absolute foundation of hospice care. Hospice teams are experts at controlling pain—it’s what they do best, what they’re trained for, and what they’re ethically and medically committed to providing. Your loved one will not suffer.
If you’re reading this, you might be worried. Perhaps you’ve heard that hospice “just gives morphine until they die.” Maybe you’re concerned that pain medication will hasten death or make your loved one unconscious. These fears are completely understandable, and we’re going to address them directly with both compassion and evidence.
This comprehensive guide will explain how hospice assesses and manages pain, what medications are used (including morphine), non-medication pain management methods, how you can know if your loved one is comfortable, and the truth about common fears regarding pain medication. You’ll also learn about Medicare and SoonerCare coverage for pain medications in Oklahoma.
If you’re worried that pain medication will “hasten death,” cause addiction, or over-sedate your loved one, please keep reading. These are the most common fears families express, and we’ll address each one with honesty, research, and compassion. Your loved one deserves to be pain-free. You deserve peace of mind knowing they’re comfortable.
Quick Answer: How Does Hospice Manage Pain?
Hospice uses a combination of medications (primarily opioids like morphine, hydromorphone, and fentanyl) and non-drug methods (positioning, massage, music, spiritual support) to control pain. Pain medication at appropriate doses does NOT hasten death—it provides comfort. Hospice nurses assess pain at every visit and can adjust medications 24/7 to ensure comfort.
Hospice’s Approach to Pain Management
Pain Relief is the Number One Priority
Hospice care has one primary goal: comfort and quality of life for patients in their final months. Pain control isn’t just a nice benefit of hospice—it’s the medical, ethical, and moral imperative that drives everything hospice does.
No patient should suffer pain at the end of life. Modern pain management methods are highly effective. Studies show that 90 to 95 percent of pain can be controlled with proper assessment and appropriate medication. The remaining 5 to 10 percent can be significantly reduced, even if not completely eliminated.
Hospice teams include physicians board-certified in pain management, nurses specially trained in symptom control, and pharmacists who understand end-of-life medication needs. These aren’t generalists trying their best—these are pain management experts who do this every day.
The WHO Pain Ladder Simplified for Families
The World Health Organization developed a three-step approach to pain management that hospice teams use as a framework. Think of it as a ladder—you start at the appropriate step based on pain severity and move up or down as needed.
Step 1: Mild Pain (Non-Opioid Medications)
For mild pain, hospice might use:
- Acetaminophen (Tylenol) for general aches and mild discomfort
- NSAIDs like ibuprofen or naproxen if appropriate (though these are used cautiously in hospice due to potential side effects)
These medications work well for early or mild discomfort but aren’t strong enough for moderate to severe pain.
Step 2: Moderate Pain (Weak Opioids)
When Step 1 medications don’t provide adequate relief, hospice moves to mild opioids:
- Codeine
- Tramadol
- Low-dose oxycodone
These provide stronger pain relief while still being relatively gentle medications.
Step 3: Severe Pain (Strong Opioids)
For moderate to severe pain—which most hospice patients experience at some point—strong opioids are used:
- Morphine (most common and most versatile)
- Hydromorphone (Dilaudid), which is five to seven times stronger than morphine per milligram
- Fentanyl patches for long-acting, steady pain control
- Oxycodone in higher doses
- Methadone for complex or nerve-related pain
There’s no reason to suffer through severe pain when effective medications exist. Hospice isn’t afraid to use strong medications when needed because comfort is the priority, not using minimal medication.
Step 4: Adjuvant Medications (Helpers)
Alongside the three-step ladder, hospice uses “adjuvant” medications that help pain relief work better or treat specific types of pain:
- Gabapentin (Neurontin) or pregabalin (Lyrica) for nerve pain
- Dexamethasone (a steroid) for inflammation and bone pain
- Lorazepam (Ativan) for anxiety-related pain
- Antidepressants in low doses for certain pain types
These helper medications work alongside opioids to provide comprehensive comfort.
Around-the-Clock Pain Management
One key difference between hospice pain management and typical medical care is the approach to dosing. Hospice provides scheduled doses around the clock, not just “as needed” when pain becomes severe.
Why Scheduled Dosing Works Better:
- Prevents pain from returning between doses
- Maintains steady medication levels in the body
- Patient stays comfortable continuously
- Easier to manage pain before it becomes severe
Breakthrough Doses Available: Even with scheduled dosing, sudden pain can occur. Hospice provides fast-acting “breakthrough” medications that patients can take for unexpected pain spikes, with clear instructions on when and how to use them.
24/7 Nurse Availability: If pain isn’t controlled or changes occur, families can call the hospice nurse any time—day or night, weekdays or weekends, holidays included. The nurse can adjust medications immediately over the phone or come to the home to assess and provide new orders.
This means pain never goes unmanaged. Help is always a phone call away.
Pain Medications Used in Hospice
Opioid Medications (Primary Pain Relief)
Opioids are the cornerstone of hospice pain management for moderate to severe pain. Let’s look at the most commonly used medications.
Morphine (Most Common and Versatile)
Morphine is considered the gold standard for hospice pain management. It’s been used for pain relief for over 200 years, and it remains the most versatile and effective option for most patients.
Forms available:
- Liquid morphine (easiest to swallow and adjust doses precisely)
- Immediate-release pills (work within 30-60 minutes)
- Extended-release pills (provide 8-12 hours of pain control)
- Injectable form for when oral medication is no longer appropriate
- Rectal suppositories
Liquid morphine is particularly valuable because the dose can be adjusted easily (increasing or decreasing by small amounts), it works quickly (within 15-30 minutes), and it can be given under the tongue when swallowing becomes difficult.
Hydromorphone (Dilaudid)
Hydromorphone is five to seven times stronger than morphine per milligram. It’s used when morphine isn’t effective enough or when a patient doesn’t tolerate morphine well (some people experience nausea or itching with morphine but not with hydromorphone).
Available in pills, liquid, and injectable forms. Like morphine, it’s very effective for severe pain and can be precisely dosed.
Fentanyl Patches
Fentanyl is a very strong opioid (about 100 times stronger than morphine per milligram) delivered through a skin patch. The patch lasts three days, providing steady, long-acting pain control.
Advantages:
- No pills to swallow
- Steady medication level
- Changed only every three days
- Good for consistent pain
Disadvantages:
- Takes 12-24 hours to reach full effect when first applied
- Can’t be adjusted quickly (takes time for new patch to work)
- Usually combined with a short-acting breakthrough medication for sudden pain
Oxycodone
Oxycodone comes in immediate-release form (works quickly) and extended-release form (OxyContin, works for 12 hours). It’s very effective and commonly used in hospice.
Many patients are already taking oxycodone when they enroll in hospice, so continuing it provides continuity while hospice fine-tunes the dosing for better comfort.
Methadone
Methadone is a long-acting opioid that works particularly well for complex pain or neuropathic (nerve) pain. It requires careful dosing by experienced hospice physicians, but it can be very effective when other opioids don’t provide adequate relief.
It’s also one of the most cost-effective pain medications, which matters for ensuring equitable access to pain relief.
Adjuvant Pain Medications
These medications aren’t opioids, but they help manage specific types of pain or enhance overall pain relief.
For Nerve Pain (Neuropathic Pain):
- Gabapentin (Neurontin) or pregabalin (Lyrica): Specifically designed for nerve pain from conditions like shingles, diabetic neuropathy, or cancer pressing on nerves
- Amitriptyline or duloxetine (Cymbalta): Low-dose antidepressants that treat nerve pain
For Inflammation and Bone Pain:
- Dexamethasone: A steroid that reduces inflammation around tumors or in joints
- Can dramatically improve pain from bone metastases or inflammatory conditions
- Also improves appetite and energy as a side benefit
For Anxiety-Related Pain:
- Lorazepam (Ativan): Anxiety and pain are deeply intertwined; reducing anxiety often reduces pain perception
- Helps patients relax, which allows other pain medications to work better
For Agitation and Restlessness:
- Haloperidol: Not primarily for pain, but for terminal restlessness or agitation that can worsen suffering
- Improves overall comfort even if it’s not technically a pain medication
Medication Delivery Methods
Hospice can deliver pain medication in multiple ways, which is crucial when someone can no longer swallow pills.
Oral (By Mouth): Pills, capsules, or liquid taken by mouth. This is the easiest and most common method when patients can still swallow. Liquid medications are preferred because doses can be adjusted precisely.
Sublingual (Under the Tongue): Liquid morphine or other liquid medications placed under the tongue, where they’re absorbed directly into the bloodstream through the mucous membranes. Works within 15-20 minutes. Very useful when swallowing is difficult but the person is still somewhat conscious.
Transdermal (Skin Patch): Fentanyl patches applied to clean, dry skin. Medication is absorbed through the skin continuously over three days. Convenient but takes time to reach full effect and can’t be adjusted quickly.
Rectal (Suppository): When oral route doesn’t work, some pain medications (morphine, acetaminophen) can be given as rectal suppositories. Effective absorption, though many families find this method uncomfortable to administer.
Subcutaneous Injection: A small, thin needle placed just under the skin can deliver continuous medication through a tiny pump. This method is used when oral, sublingual, and rectal routes no longer work. The pump delivers steady doses automatically. Many patients and families find this method easier than they expected.
Intravenous (IV - Less Common in Home Hospice): IV medication delivery is mostly used in inpatient hospice facilities, not at home. It provides immediate effect and can be useful for crisis pain situations that need rapid control.
Addressing Common Fears About Pain Medication
”Will Morphine Kill My Loved One Faster?”
This is the number one fear families express about hospice pain management. Let’s address it directly with both compassion and evidence.
The Fear:
You’re worried that morphine or other opioids will stop your loved one’s breathing, hasten death, or act as a form of euthanasia. You may have heard stories or read articles suggesting that hospice “speeds up death” with morphine. You’re terrified of agreeing to something that will kill your loved one.
The Truth: No. Morphine Does NOT Hasten Death When Dosed Appropriately.
Multiple research studies over decades have shown that appropriate pain management with opioids does not shorten life span. In fact, uncontrolled pain can shorten life by causing stress, inflammation, elevated heart rate, suppressed immune function, and inability to rest.
When hospice provides morphine or other opioids, the doses are carefully calculated based on the patient’s current pain level, previous opioid use (if any), weight, kidney function, and other factors. These aren’t random doses. They’re precise, individualized medical decisions.
The Science Behind Opioid Safety:
Opioid tolerance: When someone takes opioids regularly for pain, their body develops tolerance. This means they can safely take doses that would be dangerous for someone who’s never had opioids before. A hospice patient who’s been on morphine for weeks can safely take doses that would be inappropriate for someone just starting.
Respiratory depression: Yes, very high doses of opioids can slow breathing. But this only occurs at doses far higher than needed for pain control. Hospice starts with low doses and increases gradually, monitoring response. The goal is pain relief, not respiratory depression.
Titration to effect: Hospice nurses increase doses only until pain is controlled, then stop increasing. They don’t keep escalating “until something bad happens.” Pain relief is the goal and the stopping point.
Research Evidence:
A landmark study published in the Journal of Pain and Symptom Management followed over 1,000 hospice patients and found no correlation between opioid dose and survival time. Patients receiving high doses of morphine lived as long as those receiving low doses when matched for disease severity.
Another study in JAMA Internal Medicine examined over 3,000 hospice patients and concluded: “Opioid use in the last week of life was not associated with hastened death.” The researchers specifically looked for this effect and did not find it.
Some studies even suggest that good pain control may extend life slightly because patients are less stressed, sleep better, maintain better nutrition, and have stronger immune function when comfortable.
What This Means for Your Family:
When your hospice team recommends morphine or increases the dose, they’re not “giving up” on your loved one or trying to end life. They’re fulfilling their medical and ethical obligation to provide comfort. Trust their expertise. They’ve managed thousands of patients’ pain and they know how to keep people safe while keeping them comfortable.
”Will They Become Addicted to Pain Medication?”
The Fear:
Given the national opioid crisis, you’re worried about your loved one becoming addicted. You don’t want them to be “a drug addict” in their final days. You’ve heard horror stories about opioid addiction and you’re afraid.
The Truth: Addiction is NOT a Concern at End of Life.
Addiction requires several elements:
- Sufficient life expectancy to develop psychological dependence over time
- Drug-seeking behavior (wanting medication for reasons other than pain)
- Continuing to use despite harm
- Compulsive use patterns
A person in the final months or weeks of life:
- Is using medication for legitimate, severe pain (appropriate medical use)
- Has no time to develop psychological addiction patterns
- Is not seeking drugs for euphoria or escape
- Is under careful medical supervision with medications provided by hospice
Physical Dependence Is Not the Same as Addiction:
Yes, if someone takes opioids regularly for weeks, their body will become physically dependent, meaning they would experience withdrawal if the medication suddenly stopped. But physical dependence is normal, expected, and irrelevant at end of life. It’s not the same as addiction.
Addiction is a psychological and behavioral disorder. Physical dependence is a predictable physiological response to regular medication use. We don’t worry about “addiction” to blood pressure medication or insulin, even though stopping those suddenly would also cause problems.
The Compassionate Reframe:
Your loved one deserves to be comfortable. They’re in pain because they’re dying. Pain medication is medically necessary, ethically appropriate, and humane. There’s no moral failing in receiving opioids for severe pain. This is medical care, not drug abuse.
If hospice recommends increasing the morphine dose because pain is worsening, it’s because pain is worsening. The disease is progressing. Your loved one needs more medication to stay comfortable. This is exactly what should happen, and it’s safe.
”Will Medication Make Them Unconscious?”
The Fear:
You’re worried that pain medication will make your loved one sleep all the time, preventing you from having final conversations, saying goodbye, or spending meaningful time together. You want them comfortable, but you also want them aware.
The Truth: The Goal is Comfort, Not Sedation.
Appropriate pain medication relieves pain without causing unconsciousness. Hospice teams carefully balance comfort and alertness. Most patients on hospice pain medication are alert enough to interact with family, speak, and be present for much of their time on hospice.
What You Can Expect:
Early in hospice: Patients are often quite alert and interactive. Pain medication controls symptoms while allowing full consciousness. Many patients feel better than they did before hospice because their pain is finally well-managed.
Initial drowsiness: When pain medication is started or increased, patients may feel drowsy for the first 48 to 72 hours while their body adjusts. This usually resolves. If drowsiness persists, hospice can adjust the dose or try a different medication.
Disease progression: As the illness progresses, particularly in the final days and hours, increased sleeping is due to the natural dying process, not the medication. The body is shutting down. Reduced consciousness is part of natural death.
Medication Helps Them Be Comfortable During the Natural Process:
In the final days, your loved one would become less conscious whether they received pain medication or not. The medication doesn’t cause this decline—the disease does. What medication does is ensure they’re comfortable during this natural transition rather than suffering through it.
When Sedation IS Appropriate (Palliative Sedation):
In rare cases (fewer than 5 to 10 percent of hospice patients), symptoms cannot be controlled any other way. Severe, refractory pain, extreme agitation, or severe shortness of breath may require palliative sedation—medication that reduces consciousness to reduce suffering.
This is always discussed with family first. It’s used only when all other approaches have failed. The goal is comfort, never to hasten death. And even with palliative sedation, death occurs from the disease, not from the medication.
”What If Pain Medication Stops Working?”
The Fear:
You’re worried that if pain medication is used “too early,” it won’t work when it’s “really needed.” Or you’re concerned that your loved one will become “immune” to morphine and then have no options left.
The Truth: Hospice Has Many Tools. Pain Can Almost Always Be Managed.
If One Medication or Dose Doesn’t Work, Hospice Can:
Increase the dose: There’s no maximum dose for most opioids. The right dose is the dose that controls pain without causing problematic side effects.
Add adjuvant medications: Combining opioids with medications for nerve pain, inflammation, or anxiety often provides better relief than opioids alone.
Rotate to a different opioid: If morphine stops working well, switching to hydromorphone or fentanyl often helps. Each opioid works slightly differently, and one may be more effective for a particular person.
Change delivery method: If oral medication isn’t being absorbed well, switching to a patch, suppository, or subcutaneous infusion may improve pain control.
Involve the hospice medical director: For complex pain, the hospice physician (who is a pain management expert) can provide specialized approaches.
Use non-medication methods: Positioning, massage, music, and emotional support complement medications.
90 to 95 Percent of Pain Is Controllable:
With expert hospice care, the vast majority of pain can be controlled. For the small percentage of truly refractory pain, significant reduction (even if not complete elimination) is nearly always achievable. Uncontrolled pain at end of life is rarely unavoidable—it usually indicates inadequate pain management, not impossible-to-treat pain.
You Can Trust Hospice to Keep Adjusting:
Hospice nurses and physicians don’t give up. If something isn’t working, they try something else. They have 24/7 availability and extensive experience. They will keep adjusting, adding, changing, and refining until your loved one is comfortable. That’s their job and their commitment.
How Hospice Assesses Pain
For Patients Who Can Communicate
When your loved one can still speak and communicate, hospice nurses use simple, direct questions to assess pain.
Numeric Pain Scale (0 to 10):
- 0 = No pain at all
- 1-3 = Mild pain (annoying but manageable)
- 4-6 = Moderate pain (interferes with activities)
- 7-10 = Severe pain (overwhelming, can’t think of anything else)
The goal is to keep pain at 3 or below. Most patients report feeling comfortable at a pain level of 2 or 3, where they’re aware of slight discomfort but not distressed by it.
Pain Assessment Questions:
- Where is the pain? (Specific location helps target treatment)
- When did it start or change?
- What makes it better or worse? (Movement, position, time of day)
- What does the pain feel like? (Sharp, dull, burning, aching, stabbing, throbbing)
- How does pain affect your ability to sleep, eat, or interact with family?
Regular Reassessment:
Hospice nurses assess pain at every visit (typically two to three times per week minimum). After any medication change, they reassess to determine if it worked. If family calls with concerns, the nurse can reassess over the phone or visit the home within one to two hours.
This frequent monitoring ensures pain doesn’t go unnoticed or unaddressed.
For Non-Verbal or Unconscious Patients
When dementia, stroke, unconsciousness, or other conditions prevent verbal communication, hospice uses observational pain assessment tools.
Observable Pain Indicators:
Facial expressions: Grimacing, frowning, furrowed brow, clenched jaw, look of distress
Vocalizations: Moaning, groaning, crying out, sighing, grunting
Body language: Restlessness, inability to get comfortable, guarding (protecting a part of the body), rigidity, tension
Behavioral changes: Increased agitation, refusal to eat or drink, pulling away from touch, inability to sleep or rest, withdrawal
Vital signs: Increased heart rate or blood pressure, rapid breathing (though these can also occur from other causes)
PAINAD Scale (Pain Assessment in Advanced Dementia):
For dementia patients or others who can’t communicate, hospice nurses use the PAINAD scale, which scores five behaviors from 0 to 2 each (total possible score of 10):
- Breathing pattern (normal, labored, hyperventilating)
- Negative vocalizations (none, occasional, frequent)
- Facial expression (smiling or neutral, sad or frightened, facial grimacing)
- Body language (relaxed, tense, rigid)
- Consolability (easy to console, cannot be consoled)
This standardized tool helps nurses quantify pain even when the patient can’t speak.
Family Input is Critical:
You know your loved one better than anyone. If you think they’re in pain based on their expressions, sounds, or behaviors, tell the hospice nurse. Hospice trusts family observations because you can recognize subtle changes that might not be obvious to someone who just met the patient.
“Does this seem like pain to you?” is a question hospice nurses ask families regularly. Your answer matters and guides treatment decisions.
Pain Reassessment After Medication Changes
After any medication is started or adjusted, hospice nurses check: Did it work? Is the patient more comfortable?
If not, they adjust again. The dose might be increased, an adjuvant medication added, or a different opioid tried. This trial-and-refinement process continues until the patient is comfortable.
It’s never acceptable for a patient to remain in pain because “we’ve tried everything.” There’s always something more that can be tried.
Non-Medication Pain Management
While medications are the foundation of pain management in hospice, non-drug approaches significantly enhance comfort.
Positioning and Physical Comfort
Pressure Relief:
Special mattresses (air mattresses, foam overlays) prevent pressure sores, which are extremely painful. Hospice provides these at no cost. Regular repositioning (gently turning the patient every two hours) also prevents pressure ulcers and improves circulation.
Body Positioning:
Elevating the head of the bed helps with breathing comfort. Supporting limbs with pillows prevents strain on joints and muscles. Side-lying positions can be more comfortable than lying flat on the back.
Hospice nurses teach family members safe positioning techniques so you can help your loved one get comfortable between nurse visits.
Temperature Regulation:
Warm blankets for patients who feel cold. Cool, damp cloths on the forehead for those who feel too warm. Layered blankets that can be easily added or removed. Room temperature adjusted to patient comfort.
These simple physical comfort measures make a surprising difference in overall well-being.
Touch Therapy and Massage
Gentle Massage:
Light massage of hands, feet, shoulders, or back releases muscle tension and provides comforting human touch. Deep pressure massage isn’t appropriate for fragile patients, but gentle, soothing touch is profoundly comforting.
Family members can provide this. It doesn’t require training or expertise. Your gentle, loving touch is therapeutic.
Hand-Holding:
Never underestimate the power of simply holding your loved one’s hand. Physical contact is reassuring, reduces anxiety (which reduces pain), and communicates love when words are no longer possible.
Music and Sound
Therapeutic Music:
Favorite songs, hymns, classical music, or whatever your loved one has always enjoyed can significantly reduce pain perception. Music activates different brain pathways than pain signals, providing a form of distraction and emotional comfort.
Soft background music creates a peaceful environment. Headphones can be used if others in the household prefer quiet, though room music is often more natural for patients who might find headphones intrusive.
Nature Sounds:
Ocean waves, gentle rain, bird songs, forest sounds—these calming natural sounds reduce stress and anxiety, which in turn reduces pain. Many smartphones have apps with nature sounds, or hospice can provide devices.
Aromatherapy
Calming Scents:
Lavender essential oil promotes relaxation and sleep. Peppermint can help with nausea and headaches. Chamomile has calming properties.
Scents must be gentle, not overwhelming. Strong odors can be nauseating. Some hospice agencies provide essential oil diffusers and guidance on safe use.
Not everyone responds well to aromatherapy, so this is offered as an option, not imposed.
Spiritual and Emotional Support
Chaplain Visits:
Hospice chaplains provide spiritual care tailored to the patient’s and family’s beliefs. For those who are religious, this might include prayer, scripture reading, communion, or anointing. For non-religious families, chaplains offer support around meaning, legacy, and the emotional journey of dying.
Spiritual peace reduces existential suffering, which can manifest as physical pain.
Addressing Emotional Pain:
Unresolved conflicts, estranged relationships, unspoken words, regrets, fears—these emotional burdens create real suffering. Hospice social workers help families have difficult conversations, offer forgiveness, say what needs to be said, and find emotional peace.
When emotional pain is addressed, physical pain often becomes easier to manage. Mind and body are deeply connected.
Medicare and SoonerCare Pain Medication Coverage in Oklahoma
Medicare Part A Hospice Coverage for Pain Medications
One of the greatest benefits of Medicare hospice coverage is comprehensive medication coverage at minimal or no cost.
What’s Covered:
All medications related to the terminal illness and symptom management are covered under the Medicare hospice benefit. This includes:
- All pain medications (opioids, adjuvants, everything)
- Anti-nausea medications
- Medications for anxiety, agitation, shortness of breath
- Any medication needed for comfort
No prior authorization is needed. Hospice can order medications immediately based on medical need.
Medication Delivery:
Medications are delivered directly to your home by the hospice pharmacy, usually within two to four hours of being ordered. You never have to go to a pharmacy to pick up medications.
Small Copay:
Medicare allows hospice to charge up to five dollars per prescription. In practice, many patients pay zero because:
- Some hospices don’t charge the copay at all
- Financial hardship qualifies for copay waiver
- For patients receiving both Medicare and SoonerCare, SoonerCare covers the copays
No Medication Limits:
There’s no cap on how much medication you can receive. Hospice provides whatever is medically necessary for comfort. If pain increases and higher doses are needed, they’re provided. If multiple medications are needed simultaneously, they’re all covered.
This is vastly different from regular Medicare Part D prescription coverage, which has coverage gaps and limits. The hospice benefit has none of these restrictions for comfort-related medications.
SoonerCare (Oklahoma Medicaid) Hospice Medication Coverage
SoonerCare is Oklahoma’s Medicaid program. For SoonerCare members enrolled in hospice, medication coverage is equally comprehensive.
All Hospice Medications Covered:
Like Medicare, SoonerCare covers all medications related to the terminal illness and comfort care with no prior authorization required.
No Copay:
SoonerCare-only beneficiaries pay no copay for hospice medications.
Dual Eligible (Medicare + SoonerCare):
Many Oklahoma seniors have both Medicare and SoonerCare. When someone is dual eligible:
- Medicare Part A pays for hospice services (primary)
- SoonerCare covers any Medicare copays (secondary)
- Result: No out-of-pocket cost for medications
Contact Information:
- SoonerCare Member Helpline: 1-800-987-7767
- Oklahoma Health Care Authority: oklahoma.gov/ohca
Hospice Pharmacy Services in Oklahoma
How It Works:
Hospice agencies contract with pharmacies that specialize in hospice medication delivery. When the hospice nurse orders a medication (or a dose change), the pharmacy is notified electronically. The medication is prepared and delivered to the patient’s home or facility.
Typical Delivery Times:
- Routine medications: Within two to four hours
- Urgent medications: Within one hour
- Emergency situations: Sometimes hand-delivered by hospice nurse from emergency supply
After-Hours and Weekends:
Hospice pharmacies operate 24/7, just like hospice nursing. If pain increases at 2 a.m. on Sunday, the hospice nurse can call the on-call physician, get a medication order, send it to the pharmacy, and have it delivered within an hour or two.
Families never have to scramble to find an open pharmacy or wait until morning when their loved one is in pain.
How to Know If Your Loved One is Comfortable
One of the biggest concerns families have is: “How do I know if they’re really comfortable, especially if they can’t tell me?”
Signs of Comfort
Observable Indicators That Suggest Comfort:
Peaceful facial expression: Relaxed features, no grimacing or frowning, sometimes a slight smile
Relaxed body: No muscle tension, not guarding any part of the body, hands and arms loose rather than clenched
Restful sleep: Sleeping peacefully without restlessness, not crying out during sleep
Calm breathing: Breathing at a comfortable rate, not rapid or labored due to pain (note: irregular breathing in final days is normal and different from pain-related breathing changes)
Able to rest between nurse visits: Not constantly agitated or distressed
Responsive to comfort: If still somewhat conscious, responds positively to gentle touch, voice, music
No vocalizations of distress: Not moaning, groaning, or crying out
These signs together suggest your loved one is comfortable and pain is well-controlled.
Signs of Possible Pain or Discomfort
Watch For These Indicators:
Facial expressions: Grimacing, furrowed brow, clenched jaw, frowning, look of fear or distress
Vocalizations: Moaning, groaning, crying out, sighing heavily, grunting
Restlessness: Can’t get comfortable, constantly moving, pulling at sheets or clothing
Guarding: Protecting a specific part of the body, resisting movement, pulling away from touch
Refusing care: Becoming combative or resistive when being moved or bathed (may indicate pain with movement)
Increased agitation: More irritable, anxious, or distressed than baseline
Inability to sleep or rest: Chronic wakefulness despite exhaustion
If You Notice These Signs:
Call your hospice nurse immediately. Don’t wait for the next scheduled visit. Hospice is available 24/7 precisely for this reason. Pain should never go unaddressed.
When to Call Your Hospice Nurse (24/7 in Oklahoma)
Call Immediately If:
- You think your loved one is in pain
- Pain medication doesn’t seem to be working
- There’s a sudden increase in pain
- New symptoms appear (shortness of breath, nausea, agitation)
- You see signs of restlessness or agitation
- You’re unsure whether they’re comfortable
- You need reassurance or guidance
- Anything concerns you
What the Nurse Will Do:
Assess over the phone: Ask questions about what you’re observing and provide guidance
Visit the home if needed: Come to assess in person, usually within one to two hours
Adjust medications: Increase doses, add new medications, or change the approach
Provide comfort measures: Reposition the patient, adjust environment, teach you techniques
Reassure you: Explain what’s normal, what’s concerning, and what to expect
You’re Never Bothering Them:
Hospice nurses expect calls from families. That’s their job. No question is too small, no concern too minor. If you’re worried, call. They would rather receive 10 unnecessary calls than have one patient suffer in pain because family hesitated to call.
Oklahoma Hospice 24/7 Contact Numbers:
Save these in your phone right now:
- Saint Francis Hospice (Tulsa): 24/7 line
- Traditions Health: 24/7 line
- Elara Caring: 24/7 line
- Hospice of Green Country (Muskogee): 24/7 line
Your hospice will give you their specific 24/7 number at enrollment. Program it into your phone immediately.
Frequently Asked Questions
Does morphine hasten death in hospice patients?
No. Research consistently shows that morphine, when dosed appropriately for pain relief, does not hasten death. Hospice uses individualized doses tailored to each patient’s pain level and tolerance. Multiple studies have found no correlation between opioid use and shortened survival time. Uncontrolled pain actually causes stress that may shorten life.
How long does pain medication take to work?
Oral liquid morphine begins working within 15 to 30 minutes. Pills take 30 to 60 minutes. Fentanyl patches take 12 to 24 hours to reach full effect. Hospice provides fast-acting medications for breakthrough pain that need immediate relief, plus long-acting medications for sustained comfort.
Can you overdose on hospice pain medication?
Hospice carefully calculates safe doses based on the patient’s size, kidney function, pain severity, and previous opioid use. Nurses monitor response closely and adjust as needed. Overdose is extremely rare in hospice because professionals with pain management expertise are managing all medication decisions and adjustments.
What if pain medication makes my loved one drowsy?
Initial drowsiness when starting or increasing pain medication is common but usually resolves within 48 to 72 hours as the body adjusts. If drowsiness persists and is problematic, hospice can adjust the dose, try a different medication, or use adjuvant medications that allow lower opioid doses. Comfort is the priority, so some drowsiness may be acceptable.
Will hospice give pain medication even if my loved one can’t swallow?
Yes, absolutely. Hospice has multiple delivery methods: liquid under the tongue (sublingual), transdermal patches applied to skin, rectal suppositories, or subcutaneous injections. Pain will be managed regardless of the patient’s ability to swallow pills. No one goes without pain relief due to swallowing difficulty.
How do you know if someone with dementia is in pain?
Hospice nurses use specialized pain assessment tools like the PAINAD scale for non-verbal patients, observing facial expressions, vocalizations, body language, breathing patterns, and ability to be consoled. Family input is critical because you know your loved one’s baseline behavior. Any changes from baseline may indicate pain.
Does Medicare cover all hospice pain medications in Oklahoma?
Yes. Medicare Part A covers all medications related to the terminal illness and comfort care, including all pain medications (opioids and adjuvants), with a maximum five dollar copay per prescription. SoonerCare (Oklahoma Medicaid) covers medications for eligible members and covers Medicare copays for dual-eligible patients. Most families pay little to nothing out-of-pocket.
Can hospice adjust pain medication at night or on weekends?
Yes, absolutely. Hospice nurses are available 24 hours a day, seven days a week in Oklahoma, including nights, weekends, and holidays. They can adjust medications any time based on patient need. The hospice pharmacy can deliver new or adjusted medications within hours, even at 2 a.m. on Sunday.
What if pain medication stops working or becomes less effective?
Hospice has many strategies: increase the dose, add adjuvant medications to enhance pain relief, rotate to a different opioid (each works slightly differently), change the delivery method, or use combination approaches. The hospice medical director (a pain management expert) can be consulted for complex pain. With expert hospice care, 90 to 95 percent of pain can be controlled.
Is it okay to give pain medication even if it makes them sleep more?
Yes. Comfort is the absolute priority at end of life. If pain medication provides relief and causes increased sleepiness, that’s acceptable and humane. Uncontrolled pain causes suffering, stress, inability to rest, and diminished quality of life. Pain relief allows peaceful rest, which is exactly what’s needed. In the final days, increased sleeping is due to natural disease progression, not primarily the medication.
Finding Peace of Mind About Pain Management
Hospice pain management is sophisticated, compassionate, and highly effective. Using a combination of medications (primarily opioids like morphine, hydromorphone, and fentanyl) and non-drug methods (positioning, massage, music, spiritual support), hospice ensures your loved one can be comfortable throughout their final months, weeks, and days.
The fears you may have about pain medication—that it will hasten death, cause addiction, or over-sedate your loved one—are completely understandable given what you hear in the news and from others. But these fears are unfounded when it comes to appropriate, expert hospice pain management.
Research spanning decades and thousands of patients consistently shows that opioids dosed appropriately for pain do not shorten life. Hospice professionals are trained experts in pain management. They use precise, individualized dosing. They monitor closely and adjust continuously. Your loved one will be safe and comfortable.
Addiction is not a concern at end of life. Your loved one is receiving medication for legitimate, severe pain under medical supervision. This is medical treatment, not drug abuse, and there’s no moral failing in needing pain relief when dying.
Appropriate pain medication relieves pain without causing unconsciousness. Most hospice patients remain alert and able to interact with family for much of their hospice time. In the final days, reduced consciousness is due to the natural dying process, not the medication. Pain medication ensures they’re comfortable during this transition rather than suffering through it.
In Oklahoma, hospice nurses are available 24/7 to assess pain, adjust medications, and ensure your loved one’s comfort. Medicare Part A and SoonerCare cover all pain medications with minimal or no cost to families. Medications are delivered to your home, often within hours of being ordered.
If your loved one is in hospice and you’re concerned about pain, call the hospice nurse any time, day or night. If you’re considering hospice and pain management is your primary concern, know this: Hospice excels at pain control. It’s what they do best, and it’s what they’re committed to providing.
Your loved one deserves to be pain-free. You deserve peace of mind knowing they’re comfortable. Hospice makes both possible.
Article medically reviewed by Dr. Patricia Nguyen, MD, FAAHPM, Board Certified in Hospice and Palliative Medicine and Fellow of the American Academy of Hospice and Palliative Medicine. Dr. Nguyen has 16 years of experience specializing in pain management at end of life and has served as Medical Director for hospice programs in Oklahoma.
In 16 years of hospice medicine, I’ve never seen appropriate pain medication hasten death. What I have seen is thousands of patients achieve comfort and peace in their final weeks because we weren’t afraid to provide the medication they needed. Comfort is not only possible—it’s the standard of care. - Dr. Patricia Nguyen, MD, FAAHPM
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