October 27, 2021
Palliative Care or Hospice?
The right service at the right time for seriously ill individuals
Do you know the difference between palliative care & hospice? And when to use either service? Read more to learn what the differences are and how each can help you and your loved ones.
What is the focus?
Palliative Care
It is not time-limited, allowing individuals who are ‘upstream’ of a 6-month or less terminal prognosis to receive services aligned with palliative care principles. Additionally, individuals who qualify for hospice service, and who are not emotionally ready to elect hospice care could benefit from these services.
Hospice
Hospice care focuses on the pain, symptoms, and stress of serious illness during the terminal phase. The terminal phase is defined by Medicare as an individual with a life expectancy of 6-months or less if the disease runs its natural course.
This care is provided by an interdisciplinary team who provides care encompassing the individual patient and their family’s holistic needs.
Who can receive this type of care?
Palliative Care
Any individual with a serious illness, regardless of life expectancy or prognosis.
Hospice
Any individual with a serious illness measured in months not years.
Hospice enrollment requires the individual has a terminal prognosis.
Can my patient continue to receive curative treatments?
Palliative Care
Yes, individuals receiving palliative care are often still pursuing curative treatment modalities.
Palliative care is not limited to the hospice benefit. However, there may be limitations based on their insurance provider.
Hospice
The goal of hospice is to provide comfort through pain and symptom management, psychosocial and spiritual support because curative treatment modalities are no longer beneficial.
Hospice should be considered at the point when the burden of any given curative treatment modalities outweighs the benefit coupled with prognosis. Other factors to consider and discuss, based on individual patient situations, are treatment modalities that no longer provide benefit due to a loss of efficacy.
What services are provided?
Palliative Care
Pain and symptom management, in-person and telephonic visits, help navigating treatment options, advance care planning and referrals to community resources.
Hospice
Pain and symptom management, 24-hour on-call service, in-person visits, medical equipment, related medications, inpatient care, continuous care in the home, respite care, volunteer services, spiritual care, bereavement and counseling services.
There are four levels of care that can be provided to patients per CMS regulations (routine, inpatient, continuous, and respite care).
Where are services provided?
Palliative Care
Palliative care may be provided in any care setting.
- Home
- Hospice facility
- Skilled Nursing Facility
- Long-term Care Facility
- Long-term Acute Care Facility
- Assisted Living Facility
- Hospital
- Group Home
- Clinics
Hospice
Hospice care can be provided in most care settings.
- Home
- Hospice facility
- Skilled Nursing Facility
- Long-term Care Facility
- Assisted Living Facility
- Hospital (inpatient levels of care only)
- Group Home
Who provides these services?
Palliative Care
Palliative care may be provided by an interdisciplinary team. However, most palliative services are provided by a physician, nurse practitioner or nurse with consultative support from social worker and chaplaincy services.
These services are performed in collaboration with the primary care physician and specialists through consultative services or co-management of the patient’s disease process.
Hospice
Hospice care is provided by an interdisciplinary team that is led by a physician and includes nurses, social workers, chaplains, volunteers, hospice aides, therapy disciplines and others.
These services are performed in collaboration with the attending physician.
What types of health care organizations may provide these services?
Palliative Care
Palliative care is not dependent on care setting or type of medical practice. Services are performed in collaboration with the patient’s primary care physician, other specialists, and health care settings they may be receiving services from.
- Palliative Care Practices
- Licensed Home Health Agencies
- Licensed Hospice Agencies
- Nursing Facilities
- Healthcare Clinics
- Hospitals
Hospice
Hospice organizations
- State licensed and/or Medicare-certified Hospice providers
- Non-Medicare certified Hospice providers
- Veteran Affairs Hospice
How long can an individual receive services?
Palliative Care
Palliative care is not time-limited. How long an individual can receive care will depend upon their care needs, and the coverage they have through Medicare, Medicaid, or private insurance.
Most individuals receive palliative care on an intermittent basis that increased over time as their disease progresses.
Hospice
As long as the individual patient meets Medicare, Medicaid, or their private insurer’s criteria for hospice care. Again, this is measured in months, not years.
Payment
Does Medicare pay?
Palliative Care
Palliative care is covered through Medicare Part B. Some treatments and medications may not be covered.
May be subject to a co-pay according to the plan.
Hospice
The Medicare Hospice Benefit pays all related costs associated with the care that is related to the terminal prognosis as directed by CMS.
There may be some medications, services, and/or equipment that are not included in the Medicare Hospice Benefit.
Does Medicaid pay?
Palliative Care
Palliative care is covered through Medicaid. Some treatments and medications may not be covered.
May be subject to a co-pay according to the plan.
Hospice
In most states Medicaid pays all related costs associated with the care related to the terminal prognosis as directed by CMS.
There may be some medications, services and/or equipment that are not included in the Medicaid Hospice Benefit.
Does private insurance pay?
Palliative Care
Most private insurers include palliative care as a covered service. Each payer is different, and their palliative services will be outlined through the insurer’s member benefits.
Some treatments and medications may not be covered. May be subject to a co-pay according to the plan.
Hospice
Most private insurers have a hospice benefit that pays all related costs associated with the care related to the terminal prognosis.
There may be some medications, services and/or equipment that are not included in the individual’s policy. May be subject to a co-pay according to the plan.
When should I refer?
Palliative Care
Patients with advanced chronic illness that have received maximum medical therapy and are at risk of using the hospital for decompensation.
Source: National Hospice and Palliative Care Organization
Hospice
If you would not be surprised if this patient died within the next 12 months, they are likely appropriate for hospice. Patients that have received maximum therapy and focus has shifted to symptom management and comfort care.
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