Understanding Hospice & Palliative Care
Hospice Care and Palliative Care are Both Supportive Care
They both support the best quality of life for people living with serious illness and their families
- Hospice care in the US is usually defined by what Medicare covers: team-based symptom management for people with a 6-month prognosis who have decided against, or no longer qualify, for further curative treatment. Our services are covered by all Medicare Advantage programs and most private insurers.
- Palliative care can be provided along with potentially curative treatments for ~12 months. Currently, only a few private insurers cover palliative care, and it is not yet covered by Medicare or Medicaid. We have been providing palliative care services since 2008.
What does a “six-month prognosis” mean? Medicare has criteria that describe late-stage disease for many diagnoses, but determining prognosis is an inexact process. People can remain on hospice for more than six months if their condition warrants. On average, 15% of people are discharged from hospice because their condition improves. Anyone on hospice can also decide to disenroll at any time to resume curative treatment.
Unlike all other forms of healthcare, hospice and palliative care are reimbursed by a flat daily payment (about $175/day for hospice care in the Portland area). This means that giving extra care costs the hospice more, and is a key reason why non-profits may be willing to provide more care than for-profits.
| Resource | Palliative Care | Hospice Care | Medical Director |
|---|---|---|
| Nurse (RN) | ||
| Aide (CNA) | ||
| Social Worker | ||
| Spiritual Care Counselor | May be included | |
| Volunteer | Not included | |
| Medical Equipment & Supplies | Covered by insurer | |
| Medications | Covered by insurer | |
| Timeframe | 12 months+ | 6 months+ |
For both hospice and palliative services, care is not continuous, although visits can be made at any time of the day or night. Visit frequency is more limited under palliative care coverage. Hospice visits are increased as needs change – a nurse, an aide and a spiritual counselor may all visit in the same day.
Home Care vs. Hospice
Hospice care and home care are often used together to supplement family caregiver time
| Care Type & Cost | Home Visits | Day/Night Medical Support | Meal Prep | Personal Care | House-Keeping & Company | Spiritual Support | Social Services | Arts | Transport |
|---|---|---|---|---|---|---|---|---|---|
| Non-Medical Home Care Cost: $25-$30/hr | Available | Not Available | Available | Available | Available | Not Available | Available by referral | Not Available | Available |
| Hospice Care Cost: Covered by Medicare, Medicaid & most private insurers | Multiple visits may be provided each day by team members | Nurses answer calls and make visits at any hour and a Medical Director is on call 24/7 | Available by referral (Meals on Wheels) | Aides are Certified Nursing Assistants who are part of medical team | Volunteers come to home for 2-4 hrs/wk to help with light housework and provide companionship | Spiritual Care Counselor assigned to each household | Medical Social Worker assigned to each household | Certified Music and Art therapists support specific needs | Only medical transport is included |
Hospice Myths & Facts
- Several studies in people with cancer have shown that those on hospice lived longer than those receiving active treatment
- About 15% of people on hospice are discharged due to a stabilization or improvement in their health
- People on hospice can revoke service at any time and for any reason
- Medications that effectively treat symptoms can continue to be provided
- Each hospice has their own list of medications that they cover
- Prescription medications unrelated to the hospice condition may be paid for by other insurance benefits including Medicare Part D
- The selection of their attending physician is up to the individual; Care Partners is committed to honoring their freedom of choice
A Do-Not-Resuscitate order is not needed to be on hospice. We encourage people to fill out POLST forms and Advance Healthcare Directives to clarify their wishes, but no specific choices are required.
Whenever possible we use non-drug therapies and techniques. With medications, we strive to use the lowest doses necessary to meet patient needs/goals. We want to maximize quality of life, which includes the capacity to interact with family and friends. A number of people even travel with our assistance.
The hospice benefit includes 4 levels of care, one of which is general inpatient care (GIP) for symptoms that cannot be adequately managed in the home setting. Hospice patients may also be hospitalized for conditions unrelated to their terminal illness, if required.
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