During major healthcare treatments it is common to ask for the difference between palliative care vs hospice. Palliative care and hospice are two types of healthcare that people sometimes refer to as the same kind of treatment. However, palliative care and hospice are different. Each type of treatment is available to different patients, has different coverage options, and is a different type of care.
In this article, we explore the following:
Fighting a long illness can cause serious harm to one’s mental health. Unfortunately, many patients suffer emotional or mental trauma from a long illness. This trauma can go untreated while healthcare professionals are treating the primary illness. It is crucial to care for the patient’s emotional wealth while still treating the primary illness.
Palliative care is often referred to as “comfort care” because it is a holistic healthcare approach to make sure the patient is as comfortable as possible. Unfortunately, the reality is that aggressive treatment of an illness can cause mental trauma to the patient. Palliative care is an effort to treat a patient’s trauma while treating the primary illness. In addition, palliative care teams can consist of specialized doctors, nurses, social workers, nutritionists, and even chaplains.
Palliative care protects the patient’s emotional and mental health from the beginning of treatment. In contrast, traditional healthcare models focus on treating the primary illness and later attempt to repair any emotional trauma. Palliative care can begin during the initial diagnosis. Healthcare professionals can also provide palliative care wherever patients require treatment. Some patients prefer to receive palliative care in the hospital, while others prefer to receive treatment in outpatient clinics or at home.
The good news is palliative care is highly flexible. Patients can receive palliative care regardless of their illness, and at any point in their treatment. Healthcare professionals can administer palliative care during other treatments, and it can be provided by multiple healthcare members.
In addition to helping relieve pain, palliative care also helps create a dialogue between patients, families and caregivers. Palliative treatments help create a deeper understanding of illnesses and different types of treatments employed during the end-of-life stages. Discussing treatments openly also helps patients and families work through complex emotions, as well as determine what treatments are best for them.
Honest, open conversations at the palliative care stage can be extremely helpful if a transition to hospice becomes necessary. Families and patients already familiar with palliative care are more prepared to assess whether quality of life care is more crucial than daily care.
To help promote the best patient care and the most options, Parentis Health offers both palliative care and hospice. Our unique continuum of care model makes it easy to access palliative care services with Home Health, Home Care and transportation. Fortunately, Parentis Health facilitates a smooth transition to hospice.
Hospice is similar to palliative care insofar as the goal is to enhance a patient’s quality of life. However, hospice has stricter eligibility criteria than palliative care. In addition, hospice is usually reserved for patients in their final days.
Hospice treats many of the same issues as palliative care. These issues include pain, nausea, sleep issues, and emotional wellness. However, hospice is not offered alongside treatment efforts, like palliative care is. And while the hospice and palliative care teams can be similar, patient eligibility for hospice is more restrictive. In general, hospice is available only to patients who doctors have determined are in the end-stages of life.
According to Medicare guidelines, “end-stages” are typically defined as less than six months left to live. However, this does not mean that patients in hospice can only receive hospice care for six months. It is very common for patients to live under hospice care for longer than six months. In addition, patients can recover to the point that hospice is no longer necessary. Or, patients can pursue other treatments and opt out of hospice care entirely.
The good news is patients can pay for palliative care and hospice with Medicare and their private insurance. For patients reliant on Medicare, the available coverage depends entirely upon the plan the patient is enrolled in.
Patients can use private insurance or Medicare for both palliative care and hospice. Anyone enrolled in Medicare Part A or Medicare Part B (“original Medicare”) is eligible for either palliative care or hospice. In addition, patients enrolled in Medicare Part C (“Medicare Advantage”) are automatically covered for both palliative care and hospice.
Hospice care, in most cases, has 100% Medicare coverage. Fortunately, the Medicare coverage includes a wide range of services. These services include both long-term and short-term care, medications, home health and home care, as well as in-patient respite care.
Anyone enrolled in Medicare Part A (“hospital insurance”) and/or Medicare Part B (“medical insurance”) can receive hospice care coverage, provided they meet the necessary requirements.
Under Medicare, hospice care requires several major components:
In general, palliative care is paid for by private insurance and out-of-pocket costs. However, select Medicare plans may help offset costs.
Determining coverage for hospice is very straightforward if you are covered by Medicare. If you meet the Medicare requirements, you have full coverage. However, palliative care may require more out-of-pocket costs. Fortunately, patients can use a combination of Medicare options in order to offset costs considerably.
2https://www.medicare.gov/coverage/hospice-care, accessed 12/10/21.
3https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice, accessed 12/15/21.
Medicare Part A provides coverage for inpatient and skilled care that are central to palliative care. This coverage includes hospital stays, short-term stays at skilled nursing facilities, as well as home health care.
Medicare Part B also covers multiple aspects of palliative care. Included in the coverage is doctor appointments, medical equipment, outpatient rehabilitation therapy and mental health counseling.
Medicare Part C (also known as Medicare Advantage) provides enhanced palliative care coverage. The enhanced coverage includes prescription drugs and long-term care. Medicare Advantage also offers Special Needs Plans (SNPs). SNPs unite Medicare Parts A-D (“prescription drugs”) coverage under one plan, facilitating care coordination while streamlining coverage and co-payments.
There are several SNPs available under Medicare Advantage that can further extend palliative care coverage. These include Chronic Condition Special Needs Plans (C-SNPs) and Institutional Special Needs Plans (I-SNPs).
C-SNPs cover a wide variety of chronic health conditions, such as autoimmune disorders, Type 2 diabetes, dementia, substance abuse and mental health conditions. I-SNPs help ensure that patients who need to live in some kind of medical institution–including long-term care facilities and skilled nursing homes–can rely on Medicare to cover their healthcare costs associated with palliative care efforts.
To learn how much palliative care coverage is available we recommend you contact your insurance company directly. The reason is that your individual plan may offer additional benefits beyond what’s available under Medicare, including Medicare Advantage.
Here at Parentis Health we are always happy to explain all of the available insurance and coverage options. We view ourselves as a resource to help ensure that families and loved ones get the best care possible. Please feel free to contact us for any additional information.