Palliative Care and Hospice

Palliative care is a new trend in medicine to provide comfort for the symptoms of the disease while not directly treating the disease itself. It is being used more and more in hospitals, nursing homes and by home health agencies to support the disease process. It is primarily used for people with severe illnesses and suffering from chronic pain, anxiety, or discomfort.

Hospice is a form of palliative care for patients who are terminally ill. A commonly used definition for terminally ill patients is, "patients who have a progressive, incurable illness that will end in death despite good treatment, and who are sick enough that you would not be surprised if they died within six months." Whereas hospice comes into play when a patient is diagnosed as terminal, palliative care can be used at any stage in the treatment of a severe illness, from diagnosis on.

Because it is new, palliative care may or may not be covered by insurance plans such as Medicare. Or only certain protocols or medications might be covered. As it evolves so will the definitions, procedures and treatment plans. The concept involves a team approach using doctors, nurses, social workers and chaplains, similar to the hospice team. If a loved one is experiencing a great deal of discomfort or pain in the treatment process for a serious illness, the family should inquire whether the institution or care provider has a palliative care plan. Use of this care will help alleviate the suffering.

Hospice Care

Hospice care has been around for 30 years and is a much better defined subcategory of palliative care. Hospice involves a team approach using the following providers.

• Family caregivers;
• The patient' s personal physician;
• Hospice physician (or medical director);
• Nurses;
• Home health aides;
• Social workers;
• Clergy or other counselors;
• Trained volunteers; and
• Speech, physical, and occupational therapists, if needed.

The purpose of hospice is the following:

• Manages the patient's pain and symptoms;
• Assists the patient with the emotional and psychosocial and spiritual aspects of dying;
• Provides needed medications, medical supplies, and equipment;
• Coaches the family on how to care for the patient;
• Delivers special services like speech and physical therapy when needed;
• Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time; and
• Provides bereavement care and counseling to surviving family and friends.

Medicare Hospice

A person can receive hospice from Medicare if he or she is eligible for Medicare Part A (Hospital Insurance), and the doctor and

• the hospice medical director certify that the person is terminally ill and probably has less than six months to live, and
• the person or a family member signs a statement choosing hospice care instead of routine Medicare covered benefits for the terminal illness, and
• care is received from a Medicare-approved hospice program.

A person may continue to receive regular Medicare benefits from his or her customary doctors for conditions not related to the hospice condition.

Although hospice is a valuable service, Medicare does not pay enough or provide enough care for many patients. For those who have long term care insurance, they may be able to get more hospice coverage from the insurance than from Medicare.