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.

You’ve seen one hospice, you’ve seen them all. Or…

...have you? Ask most folks who work in hospice and palliative care and they will say, “You’ve seen one hospice, you’ve seen one hospice”.

Elderly woman and her daughterThere are more than 3,200 hospices today with different working models – some are independent, others are non-profit agencies. Profit hospice companies are often part of hospitals or health systems. According to the National Hospice and Palliative Care Organization, their patient population is grossly underserved. They estimate that only one in three patients who could benefit from hospice services are actually receiving care.

In 2011, approximately 47 percent (or 1,059,000 patients) died in the US receiving hospice care at the end of lives. That is less than the percentage of people in this country who have written instructions or advance directives for their end-of-life care, such as a living will, a health care power of attorney, or a do not resuscitate (DNR) order. Despite the fact that it has been more than 50 years since Elizabeth Kübler-Ross wrote her groundbreaking work, On Death and Dying, Americans are very reluctant to talk to their aging parents about end-of-life decisions. Research shows parents are more willing to talk with their children about safe sex and drugs than about their own end-of-life decisions.