The COVID-19 pandemic has prompted a renewed push to provide Palliative Care services to patients that are seriously ill and experiencing life-limiting conditions. Currently, conversations between CMS  (Centers for Medicare and Medicaid Services) and NHPCO (National Hospice and Palliative Care Organization) include the creation of a Palliative Care demonstration project. Demonstration projects allow  CMS to test and measure the likely effects of potential program changes, including new methods of service delivery, coverage for new types of services, and new payment approaches. Such a project could possibly lead to Palliative Care being a permanent benefit in Medicare and Medicaid.  

In Hospice News (September 20, 2020), NHPCO President Edo Banach states: “A community-based  Palliative Care demonstration is especially critical now because it can safeguard the health of vulnerable patients and families against possible transmission of COVID-19 by providing care where the patient lives. These community-based services provide better outcomes for patients and can reduce the costs of care. We believe the time is right to start this demonstration project and continue to innovate  how we deliver health care in this country.” Recognizing the rekindled interest and conversation about Palliative Care, this article seeks to define and consider the benefits of Palliative Care and Hospice Care,  clarifying the Hospice definition and Palliative definition.1 

What is Palliative Care? “Beneficial at any stage of a serious illness, Palliative Care is an interdisciplinary care delivery system designed to anticipate, prevent, and manage physical, psychological, social, and spiritual suffering to optimize quality of life for patients, their families, and caregivers. Palliative Care can be delivered in any care setting through the collaboration of many types of care providers. Through early integration into the care plan of seriously ill people, Palliative Care improves the quality of life for both the patient and the family.”2 This definition is recognized by NHPCO as an excellent way to understand  Palliative Care and the type of care that patients receive when enrolled in Palliative Care programs. To further expand on the definition above, NHPCO adds “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.”3 

In some ways, the definition of Palliative Care reminds us of Hospice Care. So, what are the differences between Palliative Care and Hospice Care? To begin, Palliative Care is not Hospice Care.  Palliative Care services can be accessed when the patient is undergoing treatment with the expectation that their life-limiting illness or symptoms will be cured. In other words, Palliative services are available with curative or life-prolonging care, with a focus on pain and symptom control. Just like Palliative Care, Hospice Care focuses on the pain, symptoms, and stress of serious illness. However, Hospice Care supports patients during the ”terminal phase” – defined by Medicare (CMS) as a “life expectancy of 6- months or less if the disease runs its natural course”. When enrolled in Hospice Care, the patient is no longer receiving curative treatment. 

1 https://hospicenews.com 

2 https://nationalcoalitionhpc.org 

3 https://nhpco.org

Who can receive Palliative Care? Palliative Care is available for any individual with a serious, life-limiting illness, regardless of life expectancy, prognosis, or age. A person is eligible for Hospice Care when he or she has an estimated life expectancy of six months or less. 

Can an individual receive Palliative Care while pursuing curative treatment? Yes, as previously stated,  Palliative Care services are available concurrently with or independent of curative or life-prolonging care. The goal of Hospice Care is to provide comfort through pain and symptom management and psychosocial and spiritual support when curative treatment is no longer beneficial. Hospice Care is considered when the burden of curative treatment outweighs the benefit coupled with prognosis.  When discussing such matters, it is important to consider whether the current modes of treatment are still beneficial or effective. If so, Palliative Care may be the extra support that is needed. If current modes of treatment are not useful, leading to increased hospital visits, patient worry, and concern,  Hospice Care may be a helpful option. 

Palliative Care is provided by a Palliative Care team, in consultation and collaboration with the individual’s primary care physician. Hospice Care is provided by an interdisciplinary team that is led by a  physician and includes Hospice Nurses, social workers, chaplains, volunteers, hospice aides, therapy disciplines, and others. Because of the close relationship that primary care physicians have with their patients, they are in a unique position to provide care for life-limiting illnesses, which includes recognizing the need for and recommending Palliative Care or Hospice Care when appropriate. In many cases, the patient’s physician may remain in charge of the patient’s care, medication management, communication, and written orders, enhancing the care of the patient.  

Who pays? Palliative Care provider/primary care physician visits are loosely covered through Medicare  Part B. However, most treatments and medications are not covered. Who pays for Hospice care? 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 if they are unrelated to the terminal diagnosis. Most generally, Medicare covers Hospice services. 

In the final analysis, who benefits from Palliative Care? Palliative care helps persons who are diagnosed with having a serious illness and are receiving treatment, persons who require or are likely to require special care or services, or persons living with a chronic, debilitating, or life-limiting illness. When is  Hospice recommended? The Medicare Hospice Benefit, considered “the model for quality care for persons nearing the end of life” expressly tailors medical care, pain management, and emotional and spiritual support to the patient’s needs and wishes when a patient prognosis is six months or less and the patient is no longer benefiting from curative treatment. 

Certainly, the concepts of Hospice Care and Palliative Care overlap, but they are not the same, even though the terms are used interchangeably. For more detailed information and frequently asked questions, check out NHPCO at https://NHPCO.org.

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The word "hospice" was once used to describe a place of refuge for people on a difficult journey. Our excellent care and deep compassion for patients and families offer a place of comfort on the end-of-life journey. Recognizing that in hospice care the main guardians are the family caregiver and the hospice team, care is most often provided in the home setting or community setting, rather than in hospitals and hospice care facilities. The Serenity Hospice Care team will support the patient and family wherever they are to call home.

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