PALLIATIVE CARE
The goals of palliative care are to provide symptom management, pain control, and spiritual, emotional, and social support to patients and families facing the stresses of serious illness.
Palliative care differs from hospice as it is provided early and across the course of the illness.
A patient is not required to have a terminal illness to receive palliative care. Palliative care can be provided when patients are seeking aggressive life prolonging and curative treatment.
Palliative care is provided in the hospital and in outpatient clinics. Recently, some home health agencies have begun to provide palliative services in the home. Palliative care is not strictly regulated as is hospice. Services vary from one health care provider to another. Ideally, palliative care should be provided by an interdisciplinary team.
Medicare covers palliative services. The level that services are reimbursed by private insurance varies from one company to another.
What is the difference between hospice and palliative care:
All hospice is palliative care, but not all palliative care is hospice.
HOSPICE
The goal of hospice is to provide alleviation of pain and other symptoms which accompany life limiting illness at the end of life. Hospice strives to also provide social, spiritual and emotional support of the patient and family during the stresses caused by dealing with life limiting illness.
Hospice is a Medicare benefit which must be elected by the participant. When the hospice benefit is elected it is billed under Medicare part A, which is the hospital benefit. Under the hospice benefit, all durable medical equipment and medications are supplied. Hospice is mandated to provide a core interdisciplinary team. This team includes a physician, registered nurse, social worker, chaplain and home health aid. Hospice is covered 100% by medicare. Hospice benefits under private insurance varies from one plan to the other.
Hospice is a program, not a place. Hospice services are provided where ever the patient calls home. This could be in their home, a relative’s home, a skilled nursing facility or assisted living. There are some hospices who have provided services in homeless shelters.
Hospice has four levels of care.
1) Routine level of care is care provided in the home, skilled nursing facility or assisted living when a patient’s symptoms are managed and the family is coping well.
2) General Inpatient is a level of care that a patient is moved to when a patients symptoms are out of control or no longer manageable in their home. This level of care is provided in a skilled nursing facility or an inpatient hospice unit.
3) Continuous Care is similar to general inpatient level of care. This is when the patient is provided care in their home 24 hours a day when a patient has symptoms requiring constant nursing management. The nursing management continues in the home until symptoms are managed.
4) Respite Care is provided when the patient care giver is overwhelmed or is in need of a respite. The hospice will provide a short stay in a skilled nursing facility or board and care residence. This respite usually lasts no more than 5 days.
In order to qualify for hospice a patient must have two physicians who agree that the patient has a limited life expectancy of six months or less. This being said, if a patient continues to qualify for hospice after six months the patient may continue to have hospice benefits.