How Mental Health Shows Up in Hospice Patients & Loved Ones

Hospice of the Fisher Home
May 16
4 min read

When someone enters hospice care, most of the focus naturally turns to physical comfort like pain management, daily care, and making sure things are as peaceful as possible. But there’s another layer to the experience that doesn’t get talked about nearly enough: the emotional and mental toll it takes on both patients and the people who love them.

Hospice is about dignity, of course, but it’s also about navigating a lot of big feelings. And sometimes, those feelings are too heavy to carry alone. Mental health is equally as important as physical health when it comes to healthcare, and during this phase of a person’s life it should be considered.

The Emotional Weight of a Terminal Diagnosis

There’s no roadmap for facing the end of life, and for many hospice patients, the emotional journey can be overwhelming. Depression, anxiety, fear, and grief all show up—and not always in predictable ways.

In fact, research has found that around 25%-77% of terminally ill patients experience depression, and up to 70% deal with anxiety during this stage of life. These feelings often center around dying. But, they’re about saying goodbye, losing independence, and reflecting on everything that won’t be finished.

Support from counselors, social workers, chaplains, or even just being able to talk openly without needing to “stay strong,” can make a real difference. And in some cases, holistic therapies like music, massage, or legacy projects (like recording life stories) help patients find peace and meaning.

Family Members Feel It, Too

When someone you love is in hospice, your world shrinks around them. You might be juggling care duties, fielding tough conversations, managing medical decisions (and trying not to fall apart at the same time).

It’s no surprise that 40 to 70% of family caregivers show signs of depression, and about one in four meet the criteria for major depression. Caregiver burnout is real. And when anticipatory grief is added to the mix it becomes even more emotionally complicated.

Hospice does often provide support for families, but many caregivers don’t know how much they’re entitled to (or feel guilty about asking for help). It's okay to not be okay. And it’s more than okay to lean on the support systems that are available like counselors, spiritual leaders, healthcare teams, therapists, and more.

When Children Are Involved

Kids and teens process loss in their own way. If a grandparent or parent is in hospice, it can be incredibly hard for younger family members to understand what’s happening—or why the adults around them are so emotional.

Children’s grief often shows up through behavior: withdrawal, acting out, trouble at school. They might not know how to express what they’re feeling, but they are feeling it.

According to the National Alliance for Children's Grief, 1 in 14 kids in the U.S. will lose a parent or sibling by age 18. When hospice is part of that journey, extra care is given – whether through child-focused grief counseling, open conversations, or simply being there to listen when they’re ready to talk.

Grief Isn’t Just for After Death

One of the most misunderstood parts of hospice care is how early grief begins. It doesn’t start with death, it starts with the diagnosis. It starts the moment someone realizes their time is limited.

This kind of grief, known as anticipatory grief, affects patients and families in different ways. Some people pull closer together. Others become quieter, more internal. There’s no “right way” to feel.

What helps most is creating space for those feelings, whether that’s talking with a hospice counselor, joining a support group, or just having honest conversations with people you trust.

Meeting Mental Health Needs, Not Just Medical Ones

Hospice care is evolving, and more providers are recognizing that mental and emotional health need just as much attention as physical care. Many teams now include licensed counselors, spiritual care coordinators, and even virtual therapy options for patients and families.

There’s also growing use of:

Narrative therapy (reviewing life stories and making peace with the past)
Mindfulness and meditation for anxiety relief
Pet therapy, music, and art as nonverbal emotional outlets

These approaches make the experience more comfortable while helping people feel heard, understood, and emotionally supported during one of life’s hardest chapters.

There’s no easy way to prepare for hospice. But understanding the mental health side of the journey can make the load a little lighter for everyone involved.

Whether you’re a patient, a caregiver, a grandchild, or a friend, your emotional wellbeing matters. Hospice is about comfort, compassion, connection, and care that reaches deeper than medicine alone.

If you are in the Western Massachusetts area and have a loved one who requires hospice care, Hospice of the Fisher Home provides both in-residence or at-home (or wherever you reside) care through our community program. Contact us to find out more.