Hospice Care Versus Palliative Care
Confusion abounds concerning hospice care and palliative care. Although very similar in philosophy and goals, these two specialty areas are not necessarily synonymous. To help clear up the confusion, this article highlights the similarities and differences.Hospice care is defined as support and care for terminally ill persons to help them achieve maximum comfort and the greatest satisfaction possible with remaining life. Its services are designed to optimize the care experience at end-of-life. The focus is on the quality of remaining life rather than life extension or the hope for a cure. Hospice neither speeds up nor slows down the dying process, as this philosophy of care accepts the fact that dying is a normal part of life.
With hospice, there are valid concerns of underutilization and ineffective use. Even though almost 42 percent of eligible terminally ill patients receive hospice services at some point before they die, the median duration of hospice services is only 19.7 days. This means that half the patients are enrolled in hospice care for just under 3 weeks. This median length of service is a decrease from 26 days in 2005. Such short stays in hospice do not give health care professionals enough time to develop and implement a patient centered plan or adequately prepare families to take care of their loved ones at home. Many physicians are slow to refer people to hospice, waiting to acknowledge with certainty that the patient is terminal. This may be due to the fact that most physicians traditionally concentrate on trying to cure patients. The concept of treating symptoms without curing the underlying disease is often foreign to them. As a result, the majority of patients enroll in hospice in the very end-stages of their diseases, often at a point when death is imminent, much too late to optimize the benefits of hospice services.
Palliative care had its inception in the hospice movement but is now widely used outside of hospice locations. Palliation is a broad term that focuses on the relief and prevention of suffering in patients whose diseases or conditions are no longer responsive to curative treatment, due to life-limiting illness. The goal of palliative care is to prevent, manage, and relieve unpleasant symptoms and to promote the best possible quality of life for patients as they near lifeís end. The point at which palliative management eclipses curative treatment is not an exact science, but must be decided on a case by case basis with considerations of the unique circumstances of each individual patient.
Although similar, palliative care and hospice are not necessarily synonymous. Both healthcare specialty areas use an interdisciplinary approach to treat patients with life-limiting diseases, chronic illness, or progressive neurological conditions who are nearing the end of life. Both focus on providing these patients with the best quality of life possible by maximizing functional capacity and by relieving distressing symptoms such as pain, shortness of breath, fatigue, nausea, anorexia, and constipation. Palliative care is most often provided in the hospital, whereas hospice most often takes place within a patientís home. With palliative care, therapies intended to prolong life may still be provided, since palliative care does not require the patient to give up the fight for a cure. Unlike hospice, palliative care does not always indicate end-of-life, as it may be provided at any stage during serious illness, from diagnosis through death. And, it can be used in conjunction with curative treatments. In sharp contrast, patients receiving hospice care must give up any treatments that are deemed curative or life sustaining, if they wish to receive coverage. Costs and reimbursement venues differ also. Hospice care is paid in full by the Medicare benefit and/or Medicaid. However, in order to qualify for Medicare or Medicaid hospice benefits, patients must be determined to be within the last 6 months of life. Palliative care, instead of being reimbursed in full, is often underfunded. As a result, hospice programs far outnumber palliative care programs, with palliative care being difficult to access in some areas.
Hospice and Palliative Care
NHPCO facts and figures: Hospice care in America (2011 ed.)Last edit by Joe V on Jul 20, '12
VickyRN is a certified nurse educator (NLN) and certified gerontology nurse (ANCC). Her research interests include: the special health and social needs of the vulnerable older adult population; registered nurse staffing and resident outcomes in intermediate care nursing facilities; and, innovations in avoiding institutionalization of frail elderly clients by providing long-term care services and supports in the community. She is faculty in a large baccalaureate nursing program in North Carolina.
VickyRN has '16' year(s) of experience and specializes in 'Gerontological, cardiac, med-surg, peds'. From 'Under the shadow of His wings...'; Joined Mar '01; Posts: 12,044; Likes: 6,439.4Jul 21, '12 by billyboblewisI have one problem with both of these types of care and the way the agencies providing them do it. They rent out space in LTAC's and other facilities and the patients are cared for as part of the regular population. They do not recieve the attention they should because staff feels they have just been left there to die. They may get pain meds on occasion but often becuase of their debilitiation and inability to request help or complain they are just ignored for most of the day. I much prefer when these companies maintain their own facilities and hope I am never left in the position to rot away and die in a rented bed.....1Jul 21, '12 by cherryames1949Thanks for the heads up billybob. Years ago a loved one of mine was in a nursing home being managed by hospice. I was UNimpressed. My friend was in agony when I arrived. I got the on call hospice nurse on the phone and got the situation worked out. I had to wonder what happened after I left. She mercifully passed away within the week. We can and must do a better job With end of life issues.4Jul 21, '12 by VickyRN Senior ModeratorQuote from billyboblewisI agree. Same with skilled nursing/ rehab or "swing-bed" patients. These patients will receive a much higher quality of care in a hospital-based program or stand-alone inpatient hospice or palliative care facility than they ever will in a LTC or LTAC facility. There is a big difference in a ratio of 6 patients per nurse as opposed to 25 residents to nurse in the typical LTC or LTAC facility. One can't possibly give quality attentive care with these horrendous ratios.I have one problem with both of these types of care and the way the agencies providing them do it. They rent out space in LTAC's and other facilities and the patients are cared for as part of the regular population. They do not recieve the attention they should because staff feels they have just been left there to die. They may get pain meds on occasion but often becuase of their debilitiation and inability to request help or complain they are just ignored for most of the day. I much prefer when these companies maintain their own facilities and hope I am never left in the position to rot away and die in a rented bed.....5Jul 21, '12 by MaremmaIndeed it is very distressing to me to have hospice patients mixed in with my LTC and rehab patients. They absolutely do not get the attention they need, at least not on second shift. I have several down my hall right now making it even more complicated and nerve racking.
It certainly creates a lot more work for me with no additional help from anyone. They seem to all only come on day shift. If something changes in one of these patients I have to first call hospice to tell them and get their recommendations. wait for their return call. Wait again for them to call me back the second time to tell me what their RN super says to do. THEN I may call he Dr and ask him for whatever it is that they decided should be done or changed etc. Sometimes the Dr does not agree and I have to call them back again and go through the whole ordeal again. Mind you all the while still trying to get my med pass done and deal with all my other problems etc. Of course this is taking even more of my precious little time away from the patients.
God forbid they admit someone to hospice on day shift, don't have the hospice sticker on the chart yet and haven't warned the poor nurse coming in on the second shift. It is the end of the world if you follow the orders still in place and call the Dr when x y or z happens, wind up with a new order for a med hospice won't pay for. Amazingly the hospice nurse will suddenly appear on second shift the next day to rip you a new one for not calling them first and getting their permission to call the Dr!
Often the families seem to be misled or simply cannot understand when they agree to put family members on hospice too.They become very upset and some get outright nasty when their family member no longer can have things they were allowed to have before (there are almost always multiple med changes as soon as the patient goes hospice) They don't understand that their family member can no longer receive certain treatments they were before going hospice etc. Of course I am the nurse right in front of them so I get the backlash for this too.
They become ugly because their family member is not receiving all the "extra" care they were "promised" by the hospice nurse. I take the backlash for that too. We simply do not have the time and staffing to provide extra care for some patients over the others and the hospice nurses and aids only get a few hours a week so they are rarely the ones there when family is. it is beyond frustrating to deal with the backlash when I was not even present for the intake. I have no clue what they are told or who was present etc for these meetings. I had a family member screaming at me because she walked into her mothers room and no one was sitting there to keep her mother company till she got off work and could come in?! She was convinced we were required to do this?
Frustrating indeed. To many cooks in the kitchen only makes things worse for the actual patient.