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Understanding the Distinctions Between Palliative Care and Hospice Services
- 1. Understanding Hospice & Palliative Care as Distinct Medical Services Founded 1978 Founded 2008
- 3. Definitions: Palliative Care Hospice Care Palliative Care is specialized medical treatment focused on providing relief from the symptoms and stressors associated with serious illness. Services are provided at the same time as curative care and are integrated at all points in the disease trajectory regardless of prognosis. Hospice Care is a type of Palliative care provided to those with incurable medical conditions indicating a probable life expectancy of less than six months. The patient is no longer a candidate for curative treatment or feels the burden is greater than the benefit. Both • All care is guided by the organization’s mission to honor the importance of choice, allowing patients to define for themselves the most dignified manner in which to live. • Care is provided by an interdisciplinary team. • The team meets with each patient and their loved ones to develop an individual care plan unique to the patient’s needs and requests. • The goal is to improve quality of life for both the patient and the family.
- 4. Evolution of Palliative Care: Curative Treatment Prior 1973 DX Curative Treatment DX Hospice Introduction 1973 Hospice 6 months Diagnosis Therapies to relieve suffering and improve quality of life 6 months Hospice Death New Paradigm Bereavement Curative Treatment Palliative Care
- 5. Where are services provided? Palliative Care Hospice Care • Inpatient Hospital Palliative Provider Consultations • Home Palliative Program • Outpatient Palliative Provider Consultations • Inpatient Palliative Unit • Inpatient Hospice Unit • Home Hospice Program (private residence, facilities, etc.) Home Palliative Care Outpatient Palliative Clinic Inpatient Palliative Care Inpatient Hospital Consults Hospice Inpatient Unit . . Home Hospice Program
- 6. Who is eligible for services? Palliative Care Hospice Care Patients receiving treatment for the following advanced illnesses are likely candidates for Palliative Care: Pulmonary Disease Cardiac Disease Cancer End Stage Renal Disease Other Advanced Illnesses as appropriate Patients with incurable medical conditions indicating a probable life expectancy of less than six months. The patient is no longer a candidate for curative treatment or feels the burden is greater than the benefit.
- 7. Who pays for these services? Palliative Care Hospice Care • Insurances reimburse for Palliative Provider Consultations • Home Palliative Program services are covered by Elaine Wynn Palliative Grant • Patients are not billed for Palliative services • If the patients need services such as Home Health or DME, the palliative team coordinates with the insured provider. • Insurance reimburses at various levels for all hospice care, DME and medications relevant to the hospice diagnosis.
- 8. Palliative Care Hospice Care The following triggers indicate a need for Palliative support: • Advanced illness • Ex. Cardiac, Pulmonary, Renal, Cancer • Uncontrolled symptoms: Pain, nausea, vomiting, anxiety, etc. • Admission from long-term care facility • Hospital readmission < 30 days • Age 75+ with non-traumatic admission • ICU admission > 3 days • Multi-organ failure • Goals of Care disagreements amongst family impairing surrogate decision making The following triggers indicate a need for Hospice support: • Reasonable prognosis of less than 6 months • Decision to stop dialysis, blood transfusion or vent support • Refusal of surgery • Metastatic cancer • End Stage Cardiac Disease with diminished response to medical interventions • End Stage Pulmonary Disease with multiple infections and recurrent respiratory failure • Inoperable life threatening physical condition When should you request a consult?
- 9. Palliative Care Hospice Care • Advance directives • Further workup • Rehab potential • Code status • Tracheostomy/PEG placement • Hydration • Continuation/discontinuation of medications/treatments • Disposition • Final arrangements • Advance directives • Further workup • Rehab potential • Code status • Tracheostomy/PEG placement • Hydration • Continuation/discontinuation of medications/treatments • Disposition • Final arrangements Common concerns in geriatric patients
Editor's Notes
- Catrisha Cabanilla-Del Mundo Medical director at NAH Program director for fellowship Overview on hospice and pc
- Palliative care is patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information and choice. Hospice care – either medical team says no more treatment or patient/family says no more treatment
- 2007: Research published in the Journal of Pain and Symptom Management reports that hospice patients live an average 29 days longer than similar patient that did not have hospice care. 2007: Findings of a major study out of Duke University published in the Journal of Pain and Symptom Management shows that hospice services save money for Medicare and bring quality care to patients and families. 2009: Research published in the Archives of Internal Medicine suggests benefits of advance care planning discussions with physicians include lower costs and reduced utilization of aggressive care at the end of life. 2010: A provision in The Patient Protection and Affordable Care Act will require state Medicaid programs to allow children with a life-limiting illness to receive both hospice care and curative treatment. 2010: Research publishedin New England Journal of Medicine finds that patients with non-small-cell lung cancer may live longer with hospice and palliative care.
- Final thoughts: if you haven’t already been fairly exposed to hospice and palliative care, hopefully after hearing this presentation, you can leave with the idea that a palliative care plan can be tailored for patients with chronic and/or advance illnesses. It can be used as additional support (symptom management, psychosocial support, counseling, advance care planning, etc.) or perhaps even as a bridge to hospice if that realistically is where it’s heading.