Barbara Rutkowski, EdD, MSN, CCM - Vice President, Clinical Operations, Advanced Plan for Health.
This is an important topic our clients are seeking information on, so we wanted to share more details here. Health systems can save money and human misery when they better understand end-of life care options.
Palliative care and hospice are different. The National Institutes of Health (NIH) – National Institute on Aging (NIA) shares some valuable clarification and information. While both include a multidisciplinary approach to relieving symptoms and providing comfort, palliative care may also include curative treatment, whereas hospice does not. Palliative care can be a good segue to hospice. To qualify for hospice care, providers must believe that, assuming a normal course of illness, an individual has six months or less to live. However, estimating remaining life is difficult, and improvements in care through hospice may extend life, while definitely enhancing access to necessary healthcare and comfort measures.
Unfortunately, many Plan members, who are at the end of life and have no hope of a cure, do not take full advantage of hospice. Others are placed into hospice as they are actively dying. Waiting until this late phase means that they miss the support, ready caregivers 24/7 and the many supportive patient and family services that minimize long emergency department waits, delays in getting needed services, and more rapid symptom relief during the last phase of their lives. The reason behind this is that there is a misunderstanding about hospice, which for many individuals means imminent death and “giving up”. That is why many providers wait to recommend hospice – and families do not access hospice – until their loved ones are actively dying. It is important to note that if someone elects hospice and then decides to receive curative treatment, they can opt out of hospice and get back into it when they forego curative, aggressive care. Individuals may specify what comfort measures they want when they are losing their mortal lives, so that they need not suffer excessively.
The overriding goal of hospice is to provide comfort care in the last stage of life, as well as a peaceful death.
According to the National Hospice and Palliative Care Organization (NHPO) In 2016, only 48% of all Medicare decedents received one or more days of Hospice care at the time of death. Caucasians, females and the oldest elderly individuals were most likely to be in hospice, whereas less than 10% of other ethnicities, particularly Asian and American Indians were least likely to utilize hospice services. Understanding cultural beliefs is essential in helping individuals optimize end of life choices. Hospice is open to all ages and all individuals. The most common diagnostic categories in 2016 responsible for death were cancer followed cardiac/circulatory conditions.
A close look at our workforce population shows an ever-rising age, and that means some of the terminal illnesses that once were common in senior years are increasingly apparent in the workforce and spouses. This is why employers and health plans need to educate themselves on treatment options and benefits at the end of life, when expensive, aggressive curative treatment is no longer effective or a prudent use of Plan resources.
Hospice History and Current Day
In Western society, the definition of hospice has been evolving in Europe since the 11th century. For centuries, hospices were places of refuge for the sick, wounded, or dying, as well as for travelers and pilgrims, according to Wikipedia. Today, hospice is more commonly known as an end of life holistic program and the NHPO states that Hospice Care is “considered to be the model for quality, compassionate care for people facing a life-limiting illness or injury, hospice care involves a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient's needs and wishes. Support is provided to the patient's loved ones as well. At the center of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so.”
Insurance Coverage for Hospice
Hospice is covered by Medicare and other governmental programs, unless the individual has private insurance, because Medicare and Medicaid are the “payors of last resort,” private insurers typically pay first.
When an individual has a terminal diagnosis with months to live, a hospice application may be encouraged so that services may be started when the patient and family are ready – day or night.
Hospice is a Concept, Not a Place
Hospice is a concept, not a place, so individuals may be living in a facility if their care overwhelms their caregivers, or they may be living at home. Regardless of their location, the interdisciplinary hospice team comes to them regularly and provides a plethora of services, pain control, medical equipment, home care, provider visits, medications, and emotional, spiritual and psychosocial support for both the patient and family.
The goal is compassionate care, not cure. Often hospice patients live beyond their expected life, and may even be discharged alive from the program because their health has improved so much. Some may require hospitalization for symptom and pain management that cannot be managed in a less acute setting or they may need to be admitted into a hospice facility to provide respite care for their caregivers.
Selecting a Hospice Provider
In selecting a Hospice provider, it is important to be sure that they are accredited and listed as a Medicare provider. Ask providers, extended care facilities, hospital social workers and individuals using their services to be sure that you have selected the best hospice in your area.
The major advantage is that reputable hospice nurses, nurse practitioners, social workers and other hospice team members usually have exceptional critical care backgrounds and compassion. The hospice certification process is comprehensive, which is why most professionals are well aware of national and community resources and have the requisite skills for this special calling. They also have standing orders which means that the oxygen, hydration, pain medication, and other services can be delivered so much faster than going through the traditional medical system (with its inherent deficiencies) to squeeze in last minute appointments for office visits, or service individuals with pressing healthcare needs on weekends, holidays and after hours.