Hospice | Palliative Care

Hospice and palliative care are sometimes used interchangeable. But they are not the same thing. Palliative care, according to the National Institutes of Health (NIH), provides for the treatment of the discomfort, symptoms and stress of serious illness. It does not replace your primary treatment. The goal is to ease your discomfort from the symptoms of your illness and improve your quality of life. Receiving palliative care does not necessarily mean you're dying.

The National Institute on Aging (NIA) says the term palliative care has come to mean more than just treating symptoms. Palliative care now often refers to a comprehensive approach to improving the quality of life for people who are living with potentially fatal diseases. It provides support for more than just the patients, but for family members as well, very similar to the more familiar concept of hospice care.

In a palliative care program, a multidisciplinary health care team works with both the patient and family to provide any support - medical, social, and emotional - needed to live with a serious illness. The healthcare team may be made up of doctors, nurses, therapists, counselors, social workers, and others as needed.

Palliative care can be provided in hospitals, nursing homes, outpatient palliative care clinics, certain other specialized clinics, or at home. Medicare covers some of the treatments and medicine, according to NIA. Veterans may be eligible for palliative care through the Department of Veterans Affairs. Private health insurance might pay for some services. Health insurance providers can answer questions about what they will cover.

In palliative care, you aren't asked to make a choice between treatment that might cure a terminal disease and comfort care. In time, if the doctor believes the patient is not responding to treatment and is likely to die within 6 months, there are two possibilities. Palliative care could transition to hospice care. Or, the palliative care could continue, with increasing emphasis on comfort care and less focus on medical treatment aimed at a cure.

You don't have to be in hospice or at the end of life to receive palliative care. People in hospice always receive palliative care, but hospice focuses on a person's final months of life. To qualify for some hospice programs, patients must no longer be receiving treatments to cure their illness.

Hospice

Hospice is a concept of care that involves health professionals and volunteers who provide medical, psychological and spiritual support to terminally ill patients and their loved ones. Hospice stresses quality of life - peace, comfort and dignity. A principal aim of hospice is to control pain and other symptoms so the patient can remain as alert and comfortable as possible. Hospice services are available to persons who can no longer benefit from curative treatment; the typical hospice patient has a life expectancy of 6 months or less. Hospice programs provide services in various settings: the home, hospice centers, hospitals, or skilled nursing facilities. Patients' families are also an important focus of hospice care and services are designed to provide them with the assistance and support they need.

The National Cancer Institute (NCI) says that often a family member serves as the primary caregiver and, when appropriate, helps make decisions for the terminally ill individual. Members of the hospice staff make regular visits to assess the patient and provide additional care or other services. Hospice staff is on call 24 hours a day, seven days a week.

With both hospice and palliative care, a team develops a care plan that meets each patient's individual needs for pain management and symptom control. The National Hospice and Palliative Care Organization (NHPCO) says the team usually consists of:

• the patient' s personal physician
• hospice physician (or medical director)
• nurses
• home health aides
• social workers
• clergy or other counselors
• trained volunteers
• speech, physical and occupational therapists, if needed

The services provided vary by the needs of the patient and the type of program. According to NHPCO, services can include:

• management of the patient's pain and symptoms
• helping the patient with the emotional, psychosocial and spiritual aspects of dying
• needed drugs, medical supplies and equipment
• coaching for the family on how to care for the patient
• delivery of special services like speech and physical therapy when needed (Read about "Rehabilitation")
• short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time
• bereavement care and counseling to surviving family and friends (Read about "Helping the Bereaved")

NCI says for many people, some hospice expenses are paid by private or employer sponsored health insurance plans. (Read about "Health Insurance Terms Glossary") Information about the types of medical costs covered by a particular policy is available from an employee's personnel office, a hospital or hospice social worker, or an insurance company. Medical costs that are not covered by insurance are sometimes tax deductible.

Medicare, the health insurance program for the elderly or disabled that is administered by the Centers for Medicare & Medicaid Services (CMS) of the Federal Government, provides payment for hospice care. When a patient receives services from a Medicare-certified hospice, Medicare hospital insurance pays almost the entire cost, even for some medications that would not be paid for outside a hospice program. For information about the location of Medicare-certified hospice programs, people can call their state health department; the telephone number may be found in the state government section of a local telephone directory. The Medicare Hotline can answer general questions about Medicare benefits and coverage; it can also refer people to their regional home health intermediary for information about Medicare-certified hospice programs. The toll-free telephone number is 1-800-MEDICARE (1-800-633-4227); deaf and hard of hearing callers with TTY equipment may call 1-877-486-2048.

Medicaid, a Federal program that is part of CMS and is administered by each state, is designed for patients who need financial assistance for medical expenses. Information about coverage is available from local state welfare offices, state public health departments, state social services agencies or the state Medicaid office. In addition, local civic, charitable or religious organizations also may be able to help patients and their families with hospice expenses.

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