Definition of Palliative and Hospice Care
Palliative care is defined as a specialized, interdisciplinary medical care for people with serious illnesses, their families, and caregivers.1-4 The goal of palliative care is to improve both the patient’s and the family’s quality of life by providing relief from the symptoms, pain, and stress of a serious illness through the assessment, prevention, and management of physical, psychological, social, and spiritual problems. According to the National Coalition for Hospice and Palliative Care, hospice care is defined as a specific type of palliative care that serves a more restricted patient population.1 Similar to palliative care, the goals of hospice care are to provide symptom and pain relief as well as emotional and spiritual support to patients and family members in order to improve their quality of life. While the benefits and services of palliative care is varied across institutions, that of hospice care are clearly defined.5 Hospice care is a compassionate care provided to those with life-limiting illness or injury and focuses on caring, not curing, by supporting symptom relief and dignity at the end of life.
Palliative and Hospice Care Patients
Palliative care1-4 can be provided regardless of the diagnosis or the age of the patient and at any stage in a serious illness.1-3 It may be provided with curative treatment and may begin early in the course of a serious illness. A 2015 Institute of Medicine (IOM) consensus recommends early integration of palliative care after the diagnosis of a serious illness, which can be provided simultaneously with curative or disease-modifying treatments.2 Unlike palliative care, hospice care is provided to patients of all ages with a time-limited prognosis in which their life expectancies are measured in months, not years.1 In order for an adult patient to be eligible to receive hospice care under the Medicare or Medicaid hospice benefit, the patient must have a prognosis of six months or less which is certified by two physicians. In addition, the patient must forego insurance coverage for curative treatment efforts.
Care Provided by Palliative and Hospice Care
Both hospice and palliative care aim to provide patients with advanced illness and their family members with relief in physical, emotional, and spiritual pain, with the goal of providing the best quality of life for both patients and family members.1 Hospice care, unlike palliative care, requires patients to forgo all curative treatments and will not provide for prescription drugs, unless intended for pain or symptom relief.6 Inpatient, outpatient, or ambulatory hospital care services are also not provided under hospice care.
According to the Social Security Act,7 Title 18, Section 1861 (dd), hospice care includes the following types of care:
- Nursing care
- Physical or occupational therapy, or speech-language pathology services
- Medical social services
- Services of home health aide and homemaker services
- Medical supplies and the use of medical appliances
- Physicians’ services
- Short-term inpatient care on an intermittent, non-routine, occasional basis; cannot be provided for over five consecutive days
- Any other services specified in the plan
Location of Palliative and Hospice Care Services
The IOM notes that palliative care should be available across not only the continuum of an illness but also across health care settings, from nursing homes and acute care hospitals to outpatient clinics and home.2 Palliative care is most commonly provided in hospitals, but is also provided in hospital clinics, group practices, cancer centers, nursing homes, and less often through home care programs.8 Hospice care is most commonly provided at home.8 It can also be provided in assisted-living, residential hospice, or nursing home facilities, as well as in inpatient hospice units.
Payment for Palliative and Hospice Care Services
Palliative care is covered by most private insurances and by Medicare and Medicaid.9 Although coverage may differ, most of these insurance plans cover palliative and hospice care in hospital settings and in nursing home facilities. Under Medicare and Medicaid, hospice care services typically include physical care, counseling, medications, and equipment and supplies related to the terminal illness.8,9
Hospice care is covered under Medicare hospice benefit and under Medicaid, although coverage depends on state residence.8 Most private and commercial insurance plans follow the Medicare model. Hospice care can be provided to patients with Medicare Part A if the following criteria are met:
- Certification by a hospice care physician and the regular physician in charge of patient care of the terminal nature of illness
- Acceptance of only comfort care and forgoing all curative treatment
- Signing a statement choosing hospice care and forgoing all other Medicare-covered treatments
- National Consensus Project for Quality Palliative Care. Clinical practice guidelines for quality palliative care, 4th edition. Richmond, VA: National Coalition for Hospice and Palliative Care; 2018. https://www.nationalcoalitionhpc.org/ncp.
- IOM (Institute of Medicine). 2014. Dying in America: Improving quality and honoring individual preferences near the end of life. Washington, DC: The National Academies Press.
- Elizabeth, H, McInturff, B. 2011 Public opinion research on palliative care. Center to Advance Palliative Care (CAPC) with support from the American Cancer Society (ACS) and the American Cancer Society Cancer Action Network (ACS CAN). 2011. https://media.capc.org/filer_public/18/ab/18ab708c-f835-4380-921d-fbf729702e36/2011-public-opinion-research-on-palliative-care.pdf. Accessed Dec 26, 2018. .
- World Health Organization. 2018. WHO definition of palliative care. https://www.who.int/cancer/palliative/definition/en/. Accessed Dec 26, 2018.
- Lester PE, Stefanacci RG, Feuerman M. Prevalence and description of palliative care in US nursing homes: a descriptive study. Am J Hosp Palliat Care. 2016;33(2):171-177.
- Medicare Hospice Benefit . Center for Medicare and Medicaid Services. Feb 2019. Web site. https://www.medicare.gov/pubs/pdf/02154-medicare-hospice-benefits.pdf. Accessed April 16, 2019.
- Hospice. Centers for Medicare and Medicaid Services. Mar 2019. Web site. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/index.html. Accessed April 16, 2019.
- Kelley AS, Morrison RS. Palliative care for the seriously ill. N Engl J Med. 2015;373(8):747-755.
- Center to Advance Palliative Care. Palliative care is covered under both public and private insurance plans. August 13, 2015. Website. https://getpalliativecare.org/palliative-care-is-covered-under-both-public-and-private-insurance-plans/. Accessed Apr 16, 2019.