Palliative care improves the quality of life of patients and their families by relieving the pain, symptoms and stress of a serious or debilitating illness. Designed to help patients feel better, palliative care can help to relieve symptoms such as loss of appetite, pain, nausea and sleeplessness, as well as provide help with health care decision making, managing health care and supporting family members. Palliative care services are available in many hospitals and community programs, and may be offered to patients who are undergoing curative care for their illness.
Considered to be the model for quality, compassionate care for people facing a life-limiting illness or injury, hospice care involves a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient's needs and wishes. Support is provided to the patient's loved ones as well. Hospice is available for those patients who will no longer benefit from curative care.
At the center of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so.
CHOOSING A HOSPICE
In many communities there are several competing hospices from which to choose. The following questions will help you decide what is right for you:
- From the very first phone call, is staff helpful, concerned? Do they answer your questions?
- If you are uncertain about whether hospice is right for you, do they offer an initial consultation so you have an opportunity to ask questions and determine what you want?
- Are you within their geographic service area?
- How quickly will the hospice services begin?
- What is expected from the family caregiver? Will they help you find additional help if needed?
- What will their responsibilities be? What members of the hospice team will you see and how often?
- Do they have a relationship with your personal physician?
- Ask them to explain their 24/7 availability in a situation when you need immediate help.
- How do they define "palliative" or comfort care? Are certain treatments automatically excluded? If you require expensive therapies or devices to manage pain and other symptoms, will they be available?
- What out-of-pocket expenses should you expect?
- Do they provide services for residents in different settings? A nursing home? An assisted living facility?
Services are provided by a coordinated team that draws upon many different kinds of professionals who provide medical care and support services.
The team also ensures that services and resources are available and provided when needed, without the family having to locate and arrange for them. When staying at home, family and friends are encouraged to participate in the patient's care as much as possible. When someone doesn't have family who can serve as caregivers, the team may be able to help identify friends and people in the community who volunteer to help. The hospice team remains available for help and support to the patient and family.
Specific services include:
- Home Health Aide
- Hospice Aides
- Physician (Your personal physician is a welcome part of the hospice team and may continue to bill for professional services.)
- Social Workers
- Trained Volunteers
- Bereavement counseling and support is provided to the family for up to 13 months or longer, if needed, after the death of their loved one.
- All medications related to the terminal diagnosis.
- Medical supplies and appliances related to the terminal illness.
- Patient and family education (i.e. the team teaches the family caregivers how to provide care.)
- Short-term inpatient care, including respite care.
- Other services as required, including: physical, occupational, dietary and speech-language therapy.
What's not included:
Hospice insurers, including Medicare, don't pay for round-the-clock home nursing. In addition, experimental treatments, clinical trials or other medical services aimed at curing the disease are not covered. Funeral services are also not covered by hospice.
ELIGIBILITY & PAYMENT
Hospice is covered by Medicare, Medi-Cal and most commercial insurance.
Insurance pays for a wide range of support services that are aimed at keeping the patient as comfortable as possible. While each hospice has its own policies concerning payment for care, it is a principle of hospice to offer services based upon need rather than the ability to pay. While hospice care is a covered benefit under many insurance plans, many hospices also rely heavily, if not entirely, upon community support for donations to provide care to those who cannot otherwise afford it.
With many diagnoses, it can be very difficult to predict exactly how long someone may have to live. Too often, because of this uncertainty, people are not referred to hospice care early enough and receive just weeks or even days of care. In reality, there is no penalty for under estimating survival time in hospice care. Initially a physician certifies that the patient has a life expectancy of six months or less, if the disease follows its normal course. The first two certifications are for 90 days. Thereafter the physician must re-certify eligibility every 60 days. As long as the patient is re-certified, he/she remains eligible for hospice, even when it exceeds the six months time period.
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