If you or yours are up against a serious illness, you will likely hear the terms “palliative care” and “hospice care” — and may even be asked to choose between them while being confused by the question.
There’s good reason for the confusion.
By most lights, “palliative” is just a multi-syllabic word for “comfort” — the very thing hospice care promises to deliver. And hospice care is designed to honor patients’ wishes to sustain the highest quality of life and keep pain and suffering to a minimum — the same goals palliative care providers hope to achieve.
In reality, there are often distinctions made between the two types of care without true differences. While hospice is generally considered to be end-of-life care, some hospice providers allow what are traditionally considered “life-prolonging” treatments, such as chemotherapy. And some palliative care programs, allegedly established to treat patients of all ages and stages, focus on end-of-life care.
For people who are confused by the nuances, the pat wisdom, “Ask your doctor,” often points the finger back to the source of the confusion. Many medical experts reveal that doctors confuse the bounds of care, too.
There may be some hope on this horizon — although it’s wordy hope. An initiative recently introduced by the Centers for Medicare and Medicaid Services proposes “to provide a new option for Medicare beneficiaries to receive palliative care services from certain hospice providers while concurrently receiving services provided by their curative care providers.” The model, which will be strictly monitored and analyzed for its efficacy and possible replication for other insurance benefit programs, will be folded into the healthcare system in two phases: Phase 1 hospices began delivering services under the model on January 1, 2016; Phase 2 will begin on January 1, 2018. The project’s end date is December 31, 2020.
So in the future, perhaps the medical world will find a way to help stop the madness and blend the two types of care to be less flummoxing to the patients who want it. But for now, knowing the differences can determine not only what kind of medical care you receive, but where you get it, who provides it, and how costs can be covered.
By any definition, there are several similarities between palliative and hospice care. Both strive to:
- Provide compassionate care for those facing life-limiting illnesses
- Focus on the individual patient’s wishes for fitting care
- Deliver a team-centered approach and holistic approach to care—tending to the physical, social, psychological, and spiritual needs of a patient, and
- Provide emotional and psychological support for the patient’s caregivers.
Differences at a Glance
There are, however, some differences in the mechanics and delivery of palliative care and hospice care.
Palliative Care: While patients receiving palliative care generally have serious or “terminal” illnesses, there is no time-specific prognosis required to begin care, which can last for many years. Care can begin at any stage of an illness.
Hospice Care: Hospice is generally deemed end-of-life care. A patient must usually be diagnosed by two doctors — a primary care and hospice doctor — as having an illness or condition likely to result in death within six months. A twist adding murkiness is that many older patients are admitted to hospice after the diagnosis of “failure to thrive” — though insurance providers, including Medicare, have recently cut back on coverage where this is the sole diagnosis given for hospice eligibility.
Types of Care
Palliative Care: No treatment or therapy is excluded. Curative treatments may be pursued, including aggressive ones — such as chemotherapy, radiation, blood transfusions, and dialysis. While caregiving family members and friends are offered support and information during an illness, bereavement and grief therapy services are not usually included for them after a death occurs.
Hospice Care: The emphasis is on providing comfort. Patients have generally exhausted or opted not to partake in therapeutic treatments or those meant to cure the underlying condition. Those involved in caregiving are usually offered the option of receiving grief counseling for up to a year after a patient’s death.
Who Delivers the Care
Palliative Care: The care is delivered by a team of medical experts, and generally begins during a hospitalization. Team members often include doctors, nurses, and social workers trained in delivering palliative care—along with pharmacists, nutritionists, chaplains, and other medical professionals.
Hospice Care: In addition to the professionals offering medical and social services who are also commonly involved in palliative care, trained volunteers as well as family members and friends are often part of the team offering comfort and solace.
Where the Care is Received
Palliative Care: Much of palliative care is received sometime between admission and discharge in a hospital or acute care facility, and is closely overseen by the attending physician — though it is often continued at home, under medical supervision. Not all hospitals have palliative care teams available, so patients seeking to secure it must sometimes scramble to be transferred to a facility that can deliver.
Hospice Care: The great majority of hospice care is received in what is considered the patient’s home: a private residence, assisted living facility, or nursing home — though some hospice groups run their own freestanding hospice facilities, and some hospice care is given to hospital patients.
How Costs Are Covered
Palliative Care: Some treatments and medications involved in palliative care are covered by private insurance, Medicare, and Medicaid, called Medi-Cal in California. Patients who invoke Medicare coverage need not meet specialized “palliative care eligibility requirements” first, since there is no specific benefit dedicated to it. Since the care is likely provided by a hospital or regular doctor, the services and supplies will be billed as they are for general care, with each item listed separately.
Hospice Care: Most people who are covered by Medicare — the majority of those receiving hospice care — get coverage under a specialized Medicare Hospice Benefit as long as the provider has been certified by the Centers for Medicare and Medicaid Services. Coverage may also be provided through private insurance, Medicaid or Medi-Cal (in California), or charitable funds — with a tiny percentage of hospice patients paying out of pocket. Since it is considered “all-inclusive” care, individual visits and supplies are not generally itemized separately.
If Medicare is paying hospice costs, coverage is doled out in two 90-day “benefit periods” followed by an unlimited number of 60-day extensions; a doctor must certify that the underlying medical condition is considered “terminal” at the start if each new period. Hospice coverage generally includes the services of the doctors, nurses, therapists, and counselors as well as the equipment such as adjustable beds, wheelchairs and canes, and prescription drugs required for relieving or controlling pain.