Regardless of whether it’s you or a family member who is suffering from an illness or disease, it can be an extremely difficult and trying time, especially when you don’t have support around you. Curative treatments are of course important, but comfort and care are equally vital—both during the illness and as death approaches. With a huge 30% of all Medicare dollars being spent during the last twelve months of a patient’s life[1], it’s time we re-evaluated our approach to illness and put a greater focus on palliative and hospice care.
The terms ‘palliative care’ and ‘hospice care’ are often used interchangeably, but they are in fact different and they’re used at different times during the course of an illness. Understanding the importance of treatments and the differences between the two are vital if you or your loved one want to get the right care at the end of life.
Palliative Care
The term ‘palliative’ comes from the Latin word ‘palliare’, meaning to cloak, and the purpose of palliative care is to provide as much comfort, pain relief, and support as possible. It’s designed to work in tandem with curative treatments and often begins at the point of diagnosis[2]. It is offered to those suffering serious and potentially life-threatening illnesses such as cancer, heart disease, AIDS, and dementia, and is used to prevent or treat the side effects and symptoms of both the original illness and of the curative treatment itself. As well as offering pain relief and help with any resulting subsidiary illnesses, support with emotional, social, practical, and spiritual issues are also offered[3]. This means that palliative care provides a holistic approach to the patient’s health, well-being, and comfort, and it can help patients and their families to understand their illnesses and the choices they have ahead of them[4].
Palliative care, moreover, can be provided in a variety of situations, not just as part of in-hospital treatment. Many outpatient and community-based services are offered within most palliative care packages, and these are provided by doctors, nurses, dieticians, social workers, psychologists, and even massage therapists and chaplains[5].
Research shows communities that offer more palliative care schemes have fewer patients die in hospital and a lower intensive care admissions rate than communities that don’t[6]. However, palliative care programs can be financially difficult for the patient as there is no specific reimbursement code of palliative care, and whilst some aspects of care are covered by Medicare, Medicaid, and private insurance policies, the onus is often on the patient to cover the costs[7].
Hospice Care
Hospice care focuses on many of the same things as palliative care, with comfort and pain relief being primary concerns. The main difference between the two, however, is that hospice care begins when curative treatment ends, whether that is because the illness is no longer responding to treatment or because the patient has decided not to continue with treatment. When this happens, and a doctor pronounces the patient has six months or less left to live, they can transition to either inpatient or outpatient hospice care to take place in the patient’s own home, a nursing home, an assisted living facility, or in the hospital itself[8].
These programs are designed to make the patient’s remaining time as comfortable and meaningful as possible by providing pain relief, nursing, emotional support, and help with every day, practical tasks[9]. And whilst life-lengthening and curative treatments may have ended, treatment for subsidiary illnesses or for side effects may continue, in order to provide as much comfort to the patient as possible. For example, chemotherapy may end in the case of cancer, but treatments for high blood pressure may continue, in order to make the patient’s remaining days as easy as possible.
What’s more, hospice care programs take into consideration the needs of the family, friends, and caregivers of the patient, meaning that loved ones can receive respite care if they need a break. If hospice care takes place in the home, caregivers visit the patient regularly and there is usually someone available to take phone calls for assistance 24-hours a day[10].
The key thing to remember with hospice care, especially with Medicare programs, is that they do not begin until the patient has six months or left to live. If curative treatment is not working or if the patient decides to end treatment but the doctors declare they are likely to survive more than six months, palliative care continues but with a greater focus on providing comfort rather than on searching for a cure[11].
However, it can be difficult to predict how much time a patient has left. If a patient enrolled in a hospice care program survives longer than the predicted six months, and if a doctor continues to certify them close to death, Medicare and other insurance policies may continue to cover the cost of hospice care. Alternatively, the patient can investigate other ways of paying, or they can leave the hospice care program and return at a later date. In order to receive Medicare Hospice Benefit, two physicians must certify that a patient has six months or less to live, and once enrolled in hospice care, the patient must sign off Medicare part A—hospital insurance[12].
When it comes to health care, there is no doubt that there are a lot of options and some confusing choices to make. Whatever you decide is best for yourself and your loved ones, staying informed and educated will give you the best chance of receiving the best possible care, whether that involves palliative care and curative treatment, or comfort and hospice care at the end of life.
[1]Turnkey Health, 2018, Palliative Care and Hospice: Understanding the Differences Part 1 [online]. Available at: https://turn-keyhealth.com/understanding-the-differences-of-palliative-care-and-hospice/, accessed 06.26.2018
[2]Angela Stringfellow, 2018,Palliative Care Vs. Hospice: Key Differences, Coverage Options, and Benefits[online]. Available at: https://blog.caregiverhomes.com/palliativecare-hospice, accessed 26.06.2018
[3]Ibid.
[4]National Institute on Aging, 2018, What Are Palliative Care and Hospice Care?[online]. Available at: https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care, accessed 06.26.2018
[5]Medline Plus, 2016, What is Palliative Care? [online]. Available at: https://medlineplus.gov/ency/patientinstructions/000536.htm, accessed 06.26.2018
[6]Angela Stringfellow, 2018,op. cit.
[7]National Institute on Aging, op. cit.
[8]Ibid.
[9]Center for Hospice Care, 2018, What is Hospice Care?[online]. Available at: https://www.hospicesect.org/hospice-and-palliative-care/what-is-hospice-care, accessed 06.26.2018
[10]National Institute on Aging, op. cit.
[11]Ibid.
[12]Angela Stringfellow, op. cit.
