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Hospice or Palliative Care? : Choosing a Care Plan for Seniors

Chris Cooper - October 19, 2011 10:40 AM

In the United States, hospice and palliative care represent two different aspects of care with a similar philosophy but different payment systems and location of services. Palliative care services are most often provided in acute care hospitals organized around an interdisciplinary consultation service with or without an acute inpatient palliative care ward. Palliative care may also be provided in the dying person's home as a "bridge" program between traditional U.S. home care services and hospice care, or in long-term care facilities. In contrast, over 80% of hospice care in the United States is provided in a patient's home with the remainder provided to patients residing in long-term care facilities or in free-standing hospice residential facilities.

Palliative care is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than striving to halt, delay, or reverse progression of the disease itself or provide a cure. The goal is to prevent and relieve suffering and to improve quality of life for people facing serious, complex illness. Non-hospice palliative care is not dependent on prognosis and is offered in conjunction with curative and all other appropriate forms of medical treatment.

Hospice in the United States has grown from a volunteer-led movement to improve care for people dying alone, isolated, or in hospitals to a significant part of the healthcare system, from both non-profit and for-profit providers. In 2008, 1.45 million individuals and their families received hospice care. Hospice is the only Medicare benefit that includes pharmaceuticals, medical equipment, 24-hour/seven-day-a-week access to care, and support for loved ones following a death. Hospice care is also covered by Medicaid and most private insurance plans. People in home-like hospice residences, nursing homes, assisted living facilities, veterans' facilities, hospitals, and prisons may also receive hospice care.

There is often confusion between the terms hospice and palliative care.

In the United States, hospice services and palliative care programs share similar goals of providing symptom relief and pain management. Non-hospice palliative care is appropriate for anyone with a serious, complex illness, whether they are expected to recover fully, to live with chronic illness for an extended time, or to experience disease progression. In contrast, although hospice care is also palliative, the term hospice applies to care administered towards the end of life.

Palliative care:
• Provides relief from pain and other distressing symptoms
• Affirms life and regards dying as a normal process
• Intends neither to hasten or postpone death
• Integrates the psychological and spiritual aspects of patient care
• Offers a support system to help patients live as actively as possible
• Offers a support system to help the family cope
• Supports the needs of patients and their families
• Will enhance quality of life
• Is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy.

Under the Medicare Hospice Benefit (MHB), a patient signs off their Medicare Part A (hospital payment) and enrolls in the MHB with direct care provided by a Medicare-certified hospice agency. Under terms of the MHB, the hospice agency is responsible for the Plan of Care and may not bill the patient for services. The hospice agency, together with the patient's primary physician, is responsible for determining the Plan of Care.

Medicare does not pay for custodial care, and thus the room and board costs of an inpatient hospice are similar to the cost of a nursing home. Patients may elect to withdraw from the MHB and return to Medicare Part A and later re-enroll in hospice.

Hospice care is available in the later stages of Alzheimer’s disease and other dementias. Medicare may pay for hospice care when a person with a dementia:

1.) Reaches stage 7 of the disease process on the Functional Assessment Staging Scale (FAST Scale). This is when the person with dementia speaks 6 words or less.
2.) Is unable to ambulate (walk) without assistance
3.) Is unable to dress without assistance
4.) Is unable to bathe without assistance
5.) Is unable to maintain continence or bowel or bladder control

There are other signs and symptoms to be considered, such as aspiration pneumonia, urinary tract infections, and weight loss of 10% of more in the last six months.

Families who have questions and would like to know if there family member is eligible for hospice should call a local hospice organization and arrange for an assessment.

To read Chris Cooper’s article, Helping Elders Articulate their Long-Term Wishes, click here.

Chris Cooper, CFP®, is the owner of ElderCare Advocates, Inc. a geriatric care management and long-term-care consulting firm. He is also the owner and founder of Chris Cooper & Company, Inc., a fee-only financial planning firm that works with small business owner, persons preparing to retire, and the very elderly. Chris is a regular contributor to and was recently interviewed by eCareDiary’s co-founder, Susan Baida, regarding Empowering Family Caregivers. Chris has also on has appeared on CBS's Early Show, NBC's Today Show, and is a regularly featured guest on CNBC's Power Lunch. He is frequently quoted in The Wall Street Journal, USA Today, The New York Times, Kiplinger's Personal Finance, Money, and SmartMoney.

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