Defintion of Hospice and Palliative Medicine

Hospice focuses on the comprehensive care of patients with terminal illnesses.  Hospice is not a place, rather it is a host of services that offer support, resources, and assistance to terminally ill patients and their families. The main goal of hospice is to provide peaceful, symptom-free, and dignified transition to death for patients with incurable and advanced diseases. The hope for a cure shifts to hope for a life free of suffering. The focus becomes quality of life rather than its quantity. Hospice care is centered around the patient as a whole. Through a series of valuable services, every aspect of the patient’s care is addressed and managed. This is often achieved by considering each individual’s goals, values, beliefs and rituals.

Hospice is offered to patients with terminal illness with presumed life expectancy of 6 months or less based on certain clinical criteria.  Although this limited life expectancy is one of the basic criteria for referral to hospice care, practically any patient who has a terminal illness and no longer seeks aggressive or curative therapy may benefit from hospice care.  Medicare guidelines require re-certification of terminal illness by a hospice physician if a patient on hospice outlives the expected 6 months. After this initial period, re-certification is required every 60 days. Clinical tools based on evidence of clinical and functional decline are available as guideline in determining eligibility for re-certification. So long as there is evidence of decline, an individual may continue to be appropriate for hospice every 60 days.

Palliative medicine focuses of managing patient's symptoms who are still considering aggressive and curative treatment for the terminal illness. Same hospice principles of improving quality of life and reducing patient suffering are honored under palliative care. The eligibility criteria are much more loosely termed in palliative medicine compared with hospice medicine. As a general guideline, patients may be referred to palliative care with life expectancy for 2 years or less. Because physical and emotional symptoms are a part of most advanced diseases, efforts to manage these symptoms should be undertaken as early as possible. Palliative medicine can provide an avenue for a comprehensive symptom management for patient with chronic diseases such as, cancers, chronic lung disease, congestive heart failure, only to name a few. But from practical point of view, many patients are offered these services much later in the course of their disease and eventually transition into hospice soon after enrolling in palliative care. Any patient with a terminal illness which is not terminal or deemed end-stage can be considered for referral to palliative care for more optimal management of their symptoms while they continue to seek aggressive disease-directed therapy.  

Hospice care is covered under Medicare hospice benefits. Most private insurances also have coverage for hospice benefits. Conversely, palliative care is not a separate coverage under Medicare and only a number private insurances cover these benefits for their members. Some hospice agencies opt to enroll patients to their palliative care programs with eventual transition to hospice as the disease progresses and the burden of aggressive medical treatment becomes overwhelming for the patient.  In instances where insurance does not cover palliative services, hospice agencies tend to either cover the cost of patient care while under their palliative care service or charge the patient a reasonable fee for their patient visits and services.
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