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. Specialties Hospice Article
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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. It's 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 life's 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 patient's 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.