Palliative Care, Hospice, and Advanced Directives: A Comprehensive Guide
Palliative Care
Definition: Palliative care is generally described as a symptom management program. Its exact services and structure can differ depending on the hospital or agency providing it, unlike hospice which is federally guided.
Who Qualifies: Typically, individuals with a life-limiting disease or a chronic illness who are seeing multiple doctors for their condition. They are not necessarily terminal.
Focus: Primarily on symptom management, but also addresses physical, emotional, and planning needs. It views and treats the person as a whole.
Location: Can be provided at home (home palliative care), in a hospital, or in an inpatient setting.
Benefits: Helps manage and organize complex medical situations, including symptoms from the disease itself or its treatments. There are no downsides; it only helps.
Referral: Patients must be referred and meet specific criteria.
Treatment Concurrently: Patients can receive palliative care while still undergoing curative treatments (e.g., chemotherapy, radiation, antibiotics, procedures) for their life-limiting illness.
Funding/Coverage: Can be covered by self-pay insurance. Medicaid or Medicare might cover palliative care services, but this is individualized and depends on the specific hospital, facility, or palliative care company.
Limitations on Resources: Some palliative care companies might provide medications (though not always delivered to home) or order equipment like a walker, but often cannot provide more extensive equipment like a hospital bed or general supplies.
Does not mean you are dying: Having palliative care does not mean a person is dying; it means they have a disease limiting their life or function, and they can still receive curative treatments.
Hospice Care
Definition: True end-of-life care.
Who Qualifies: Individuals with a terminal illness, with a doctor's prognosis that they have months to live. This is a technical criterion; patients may live longer or shorter than this timeframe.
Funding: Federally funded through Medicare, meaning all hospice companies should follow the same rules, criteria, and offer similar services, leading to more standardization than palliative care.
Treatment Limitations: Patients cannot be receiving curative treatments (e.g., chemotherapy, radiation, invasive procedures) while on hospice. If a patient opts for curative treatment, they are taken off hospice.
Symptom Management: Despite the lack of curative treatments, symptom management (e.g., pain management, diabetic management, oxygen for comfort) is still provided. The focus shifts entirely to comfort.
Resources Provided: Hospice typically provides more extensive resources, including medications delivered to the home, medical equipment (e.g., hospital bed, walker), supplies, and in-home visits.
Location: Can be provided at home (with -hour nursing available, often requiring family obligation for care), in a hospice facility, or sometimes in the hospital.
Patient Choice: Patients can opt into or out of hospice. If a patient on home hospice calls and is admitted to a hospital, their hospice benefits end.
Extension/Graduation: Hospice can be extended if a patient lives longer than the initial months. Patients can also