Nobody wants to discuss their own death, or the death of a loved one. These are tough conversations to have. However, decisions made in the last year of life can impact the types of procedures the patient receives and their level of comfort. Should you consider hospice or palliative care for your yourself or loved one?
Hospice care provides comfort and support which can make these difficult times a bit easier for the patient and family. However, many people who could benefit from hospice care are not receiving it. Additionally, many people are confused about the difference between hospice care and palliative care, and/or don’t understand the full benefits of either.
What exactly is hospice care?
Hospice focuses on caring, not curing. A hospice care team provides pain management, as well as emotional and spiritual support specifically designed around the patient’s needs and wishes. The patient’s loved ones receive support as well. Hospice care is frequently provided in the patient’s home, but can also be provided in freestanding hospice centers, hospitals, and nursing homes and other long-term care facilities. Hospice care is covered under Medicare, Medicaid, most private insurance plans, HMOs, and other managed care organizations.
What is palliative care?
Palliative care is centered on the patient and family to optimize the quality of life throughout an illness by preventing and treating suffering. A palliative care team addresses a patient’s physical, intellectual, emotional, social, and spiritual needs. Patients can receive palliative care services at home or in the hospital. Most insurance plans, as well as Medicare and Medicaid cover all or part of the expenses of palliative care.
What’s the difference between hospice and palliative care?
Palliative care is available for anyone with a serious illness – it is not dependent on a terminal diagnosis. Palliative care is for patients of any age and any stage of an illness, and importantly, you can have it along with curative treatment.
Hospice provides palliative care for terminally ill patients who are close to the end of life. Hospice patients do not receive curative treatment for their underlying disease.
Why use hospice care?
Studies have shown that hospice care can significantly lower hospitalization rates, ICU admissions, and the number of invasive procedures performed at the end of life. Additionally, hospice care can significantly lower the total costs of care during the last year of life.
How do you get hospice care?
If you think your loved one could benefit from hospice care, talk to your doctor. Doctors may not recommend hospice care unless patients/families specifically ask; it turns out that doctors are often uncomfortable talking about end of life issues. One survey found that 46% of doctors frequently or often felt unsure about what to say during end of life conversations, and only 29% had received formal training on how to have these difficult conversations. An additional roadblock can be determining when a patient can/should receive hospice care. Medicare and most private insurance companies require that patients are terminally ill with less than 6 months to live in order to qualify for hospice coverage. This can be hard for doctors to determine, as all patients differ in their health trajectory.
Unfortunately, all of these stumbling blocks mean that many people who could benefit from weeks or months of hospice care are not getting the care until the last few days of their lives.
How do you get palliative care?
Ask for it! Ask your doctor to write you a referral for palliative care services. It’s a good idea to call your insurance company to learn what services are covered, the duration of coverage and expected co-payments.
Want to learn more?
Visit these websites to learn more:
- Compassion and Choices
- Hospice Foundation of America
- National Hospice and Palliative Care Organization
- The Conversation Project