Hospice Benefits
Palliative care Benefits
There is still some confusion distinguishing between hospice vs. palliative care. To add to the confusion, hospice care includes palliative care within it. However, the two can be separated as different services. Some have referred to palliative care for the seriously ill as nonhospice palliative care to differentiate palliative care from palliative care for terminally ill patients (Beasley et al., 2019).
Hospice Benefits |
Palliative care Benefits |
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| Hospice Medicare Benefit, Medicaid hospice, and some insurance services, Hospice care typically provides more services for terminally ill patients than any other care service, including management of symptoms. However, patients must stop any curative care for the terminal illness and must be within six months of dying. | |
Palliative care is offered under Medicare B, Medicaid, and private insurance services. Patients can receive curative treatment for their serious illness without any requirement regarding a terminal diagnosis. |
Some states are trying to bridge the types of services offered under palliative care. In 2014, the California legislature approved a palliative care Medi-Cal program (Medi-Cal is C.A.'s Medicaid program) to receive the types of services available through the Medi-Cal hospice benefit certain other services. http://www.leginfo.ca.gov/pub/13-14/bill/sen/sb_1001-1050/sb_1004_bill_20140925_chaptered.htm
All of us need to know what is specifically available in our state. It is also essential to understand that neither traditional Medicare nor the Medicare Hospice Benefit program pays for the patient's room and board. Medicaid does pay for room and board in institutions such as nursing homes.
Patients and caregivers are sometimes choosing between palliative care, which does provide management of symptoms, and hospice care, which includes management of symptoms and more health services but disallows curative care. It is a difficult choice, especially for families who could use the hospice program's extra homecare services. Another aspect of this choice is the side effects and risks of some of the curative treatments.
Patients often feel better when they stop treatments, giving them more quality time with loved ones. Connor et al. (2007) studied survival periods of 4493 terminally ill patients with and without hospice care. For those with hospice care, the mean survival was 29 days longer.
The question patients ask themselves is should I keep getting treatments hoping I may live longer or possibly be cured or in remission, or should I stop treatments and focus on being with my family? It is a hard choice for most patients, but it always is their choice.
In some homecare organizations, the same nurses who take care of hospice patients also care for palliative care patients. Once a patient establishes a relationship with a palliative care nurse, it is usually more comfortable for the patient to switch to hospice care with the same nurse.
Differences between curative/palliative care and hospice benefits
|
Curative/palliative care |
Medicare Hospice Benefit |
Curative treatment |
yes |
no |
Symptom management |
yes |
yes |
Payment |
Traditional Medicare/private insurance and Medicaid |
Medicare Hospice Benefit or hospice care under private insurance and Medicaid |
Eligibility |
Severe illness with symptoms needing management for quality of life. Treatment of disease eligible for cure or slowing progression |
65 or older or otherwise eligible for Medicare Terminal illness Six months left to live Stop curative care |
Cost of services |
Regular Medicare payments and private insurance combined or separate. |
All services related to terminal illness paid for by the MHB except for a copayment of up to $5 for each outpatient drug prescription and a possible 5% cost of the Medicare-approved inpatient respite care cost.
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Services offered |
Pain and symptom management Curative services Homecare and rehab nursing home and nursing and aide services are typically limited to after hospitalizations and significant illness changes. Regular Medicare does not pay for respite care. Other services vary depending on the type of Medicare program and private insurance, and Medicaid program. |
Pain and symptom management No curative services allowed Doctors' services Nursing and medical services Durable medical equipment for pain relief and symptom management Medical supplies, like bandages or catheters Drugs for pain management Aide and homemaker services Physical therapy services Occupational therapy services Speech-language pathology services Social services Dietary counseling Spiritual and grief counseling for you and your family Short-term inpatient care for pain and symptom management. Inpatient Respite care, care in a Medicare-approved facility so the usual caregiver can rest. Any other services Medicare covers to manage your pain and other symptoms related to your terminal illness and related conditions, as your hospice team recommends.
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https://www.crossroadshospice.com/palliative-care/palliative-vs-hospice/
https://www.medicare.gov/what-medicare-covers
Instant Feedback:
Palliative care is included in hospice care.
Reference
Beasley, A.M., Bakitas, M.A., Ivankova, N. & Shirey, M, R. (2019). Evolution and Conceptual Foundations of Nonhospice Palliative Care. Western Journal of Nursing Research. 41(10), 1347-1369.
Connor, S. R., Pyenson, B., Fitch, K., Spence, C., & Iwasaki, K. (2007). Comparing hospice and nonhospice patient survival among patients who die within a three-year window. Journal of pain and symptom management. 33(20),238-246.
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