Hospice vs Palliative Care

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It is often difficult for patients to understand the difference between hospice care and palliative care. Each distinction has several levels, which can add to the confusion. Many patients and family members are perplexed by how charges are billed or paid for by private insurance and the Medicare Hospice Benefit. Palliative Care is treatment that relieves suffering and improves quality of life for people of any age and at any stage in a serious illness, whether that illness is curable, chronic, or life-threatening. Treatments are paid for in same way you would pay for regular medical service. Medicare, Medicaid, and most insurance plans cover all or part of the services provided.

Hospice care is palliative in nature, but patients no longer receive curative treatments for their underlying disease. The focus is on comfort. A doctor has to certify that the patient is expected to have a life expectancy of six months or less, under "normal conditions".  It is difficult to account for the strength of the human spirit, and the exact date of death, just like the exact date of birth, is uncertain.

There is a specific Medicare Hospice Benefit, which has a per diem rate that covers treatment, services, and equipment. The first two benefit periods last 90 days, then an unlimited amount of 60 day benefit periods follow.  The hospice team reviews the patient's medical history following set clinical guidelines. If it looks as if the patient is still near the end of life, they are approved for recertification. If they have improved, they may be discharged back into palliative care.

Does your insurance pay for acupuncture?

If so, how much?

Health insurance claim formThe World Health Organization (WHO) recognizes acupuncture as an adjunctive therapy for palliative care patients, and some studies have recommended it for insurance reimbursement in end-of-life (EOL) care. The WHO has approved acupuncture for many other conditions found in EOL and hospice patients including: cardiovascular, dermatological, eye/ear/throat-related, gynecological/obstetric, musculoskeletal, neurological, psychological/emotional, and respiratory symptoms.

Why hospice acupuncture?

Acupuncture Alternative MedicineOriental Medicine, much like hospice, embraces a whole-person pattern approach of mind, body, and spirit. It is unique in that the system utilizes a multitude of therapies including (but not limited to) acupuncture, Asian bodywork (e.g. shiatsu, acupressure, tui na), Chinese herbal medicines, cupping, coining, electrostimulation, heat therapies, meditation, moxabustion, nutrition, qi gong, and tai chi. Most of these therapies are useful in terminal disease treatments, though there are some contraindications depending on the individual patient’s condition. In particular, acupuncture, using specific point combinations, can serve to calm and release emotional and spiritual concerns for hospice patients.

Many hospice patients experience physical discomfort along with the emotional reality of the dying process. Acupuncture is a safe and inexpensive treatment for physical conditions that are common among hospice and palliative care patients. Most Oriental Medicine research in the United States has been limited, using acupuncture as the sole modality. In one group of studies, acupuncture was found to be useful for treating xerostomia (dryness of the mouth), nausea, vomiting, dyspnea (shortness of breath), and most importantly pain, in a drug-free way, without side effects.

Ten Easy Ways to Reduce Stress for Caregivers of Hospice Patients:

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You have faced the reality that your loved one is not going to get better. While you are not giving up hope, you have made the decision to change the focus from trying to find a cure, to obtaining maximum comfort and a higher quality of life for the time they have left. This act can relieve a great deal of the decision-making stress. Being the primary caregiver for someone brings other forms of stress, and grieving the daily losses can be overwhelming. So keep this list handy, and remember caregiving means taking care of yourself as well as your loved one.

  1. Breathe! Most people employ only the top half of their lungs, robbing the internal organs of precious oxygen. Take a few minutes at the start of every hour to focus on your breath and consciously fill your belly full of air when you inhale.
  2. Check in with your body! A good posture aligns the spine and increases the abilities of the central nervous system. This means your organs (including your brain) function better and you become less fatigued.
  3. Drink water. Many people walk around dehydrated because of our love affair with caffeine, which actually dries you out more. By drinking caffeinated beverages you add to your fatigue, so you want more caffeine. Caffeine is an addictive drug often added to soft drinks, which because of their corrosive nature, have been shown to leach calcium from your body. Drinking enough water is sometimes all it takes to increase energy, decrease joint pain, and rejuvenate your skin.
  4. Take a break. Set a timer so at the end of every hour you take a three to five minute break (you deserve it). Studies show that people who take regular breaks actually work more efficiently overall.
  5. Stretch. Every 15 to 20 minutes, try checking in with your body. Freeze your frame and look at yourself. Are you in a truly comfortable position? If not, stand, stretch, breathe (and don’t forget to bend at the knees, not at the waist).
  6. Go for a walk. We are not meant to be sedentary. Our bodies were created for movement and they crave it. A 20-minute walk just one time a day has been proven to significantly reduce depression. According to the Mayo Clinic, prolonged sitting liked to obesity and metabolic syndrome. http://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/sitting/faq-20058005
  7. Get some body work. Acupuncture, massage therapy, acupressure, reflexology can all release toxins from your body and help you feel rejuvenated. If you can’t leave or don’t want to have someone else treat you, go to http://www.holdmegently.com/ . They have a self-treatment booklet on hospice acupressure points. You can download for a fraction of the price of a regular massage, and use it to treat yourself and the person you are caregiving.
  8. Rub your hands together briskly and hold them over your eyes. We take in the majority of our information through our eyes. Pollen, sun glare, reading, looking at computer and phone screens, and pollution add to eye strain. Having regular exams, wearing sunglasses, and giving your eyes regular mini-breaks will help reduce their stress. Cucumber slices applied on top of closed eyelids at the end of the day are refreshing, and help combat inflammation.
  9. Put up relaxing images where you can see them regularly. This can be a conscious reminder of a person, place or thing that gives you a sense of comfort. Thinking about, or seeing baby animals or humans can produce oxytocin, serotonin, and prolactin - the "love" or "feel good" hormones. Some people make mini collages with multiple images and affirmations like, “Everything is fine” or, “I am safe and life is good”.
  10. Go to the bathroom and run cold water over the inside of your wrists for 30 to 60 seconds. In Chinese medicine this is known as ‘cooling the pulses’, and is particularly good any time you feel distressed. It has been known to lower the blood pressure, and it gives you some quiet place to escape and let your trouble go down the drain.