How are Hospice and Palliative Care provided?

All hospice is palliative, but not all palliative is hospice.

Both programs are designed to provide you comfort and target quality of life.

The programs do this task in different ways, because of when and how the programs are accessed.

Hospice is a Medicare-designed program that is implemented when an individual is no longer pursuing curative treatments and has a prognosis of less than 6 months of life if the disease process were to run its course. Hospice provides equipment, medications, and a team of support – nursing, chaplain, social worker, and an aide. Additional services can be added such as massage therapy, physical therapy, occupational therapy, and speech therapy.

Palliative is not defined by Medicare and will vary based on the provider. Most palliative programs support interventions to aid in quality of life while pursuing curative treatments. The goal for palliative is to focus on the patient and their health goals during treatment. The patient is financially responsible for all care and equipment needs. The palliative team is comprised of a practitioner (for Elite, this is a nurse practitioner), a nurse, a medical assistant, a chaplain, and a social worker.

Elite provides both hospice and palliative care services to the communities of the Lewis-Clark valley, Moscow area, and Orofino area. We may request to schedule a meeting with you, called a Goals of Care, to support your goals and needs. This conversation also helps to identify the right program for you based on what you are currently pursuing with your doctor.

If you would like additional information, please email us at info@EliteHHH.com. We would be happy to address any questions you may have about our programs, these services, and your healthcare goals.

Understanding Hospice

Last week, we gave a 24-question quiz to test your knowledge of hospice. What we have found is that there are many misconceptions of hospice, what it is, what it is designed to do, and when to pursue it. So, let’s dig into the questions together. As always, feel free to send follow-up questions to info@elitehhh.com

Hospice is a 24/7 service.

Hospice is provided on a 24/7 basis. That means patients and families on hospice can call at any time of day to speak with a nurse or have the nurse come out to the home to do a visit. Our goal is comfort. These issues do not always occur during a regular business day. That is why these are services designed to meet your needs…whenever that may happen.

Hospice is only for 6 months even if you continue to live beyond that time frame.

Hospice is a service designed to be initiated during the last 6 months of life. BUT, this is not an exact science, and patients are not beholden to the 6 months. Medicare guidelines dictate that hospice services are only to be stopped if the patient’s condition improves beyond a brief or temporary period that the life expectancy is now beyond 6 months. Hospice benefits do not expire, and patients can access these benefits if conditions change again, and they now qualify for hospice again.

Hospice is only for cancer patients.

Hospice is not contingent on a particular disease process, like cancer. In fact, many hospice patients have conditions related to heart and lung disease, dementia, kidney failure, neurological disease, and many other conditions. Hospice is not a cancer-specific service.

Hospice services are paid for by health insurance.

Hospice is covered by nearly all insurance plans. Medicare and Medicaid cover these services in nearly all 50 states. Coverage may vary state by state. Some things are not covered based on state benefits such as nutritional supplements and disposable supplies. Room and board at a nursing home and over the counter medications are typically not covered and are often paid out of pocket by the family or through a long-term care insurance plan.

Hospice services include comfort and grief support for families after the patient dies.

Hospice includes bereavement services. These services are provided for 13 months after the passing of a loved one. This may be one-on-one counseling, group sessions, or periodic phone calls. Bereavement is often extended to members of the public who interacted with the individual who passed as well.

Hospice can be provided in nursing homes.

Hospice can be provided in a residential setting. That means traditional homes/apartments/condominiums, nursing homes, and assisted living communities – including memory care facilities may all serve as locations for hospice.

Hospice is only appropriate if the person only has a few days to live.

Hospice is designed to be a gradual progression of increased care and support as symptoms change and the body changes. Most people find hospice is beneficial when the full range of skilled medical, emotional, and spiritual support services for provided for at least a month or longer.

Patients on hospice cannot receive care from spouses, partners, children or other loved ones.

Hospice supports the family and caregivers of the patient through education and partnership. Support for stress and identifying resources are often key elements of the hospice care plan. In most cases, family members provide the day-to-day patient care.

Hospice helps by speeding up the dying process.

Hospice does not speed up the dying process. At this point of the illness, no medical intervention can prolong or cure the terminal illness. Hospice is designed to support the quality of life by addressing symptoms and discomfort. Some studies suggest patients actually live longer on hospice than without the service.

Hospice cannot be provided in the home.

Over 66% of all hospice is provided in the home setting!

Only persons older than 65 can receive hospice.

Hospice is not constrained to age. Any person with a terminal diagnosis and expected to pass in 6 months is eligible for hospice, regardless of age.

Anyone can make a referral to hospice.

Anyone can initiate the process for a hospice review. Often, patients, family members, or caregivers reach out to hospice and ask if the service is appropriate. This usually starts a conversation with the patient’s provider (doctor, nurse practitioner, or physician assistant) to better understand the patient’s prognosis and goals. If hospice makes sense, the provider writes an order, and the hospice assessment occurs.

Lots of great information here. If there are questions, let us know. We are happy to answer any questions you may have. Email us at info@elitehhh.com

Hospice and Palliative Care Month

November is the month where we get the privilege to highlight the unique realm of healthcare that is focused strictly on quality of life.

The Hospice Foundation of America provides resources to assist in selecting the best hospice provider for you.

Here are some key ideas to consider when selecting a hospice provider

https://hospicefoundation.org/Videos/video-player?id=85

What does a day on hospice look like? According to the Hospice Foundation of America, hospice is…

  • Medical care for people with an anticipated life expectancy of 6 months or less, when cure isn’t an option, and the focus shifts to symptom management and quality of life. 
  • An interdisciplinary team of professionals trained to address physical, psychosocial, and spiritual needs of the person; the team also supports family members and other intimate unpaid caregivers.  
  • Specialty care that is person-centered, stressing coordination of care, clarification of goals of care, and communication.
  • Provided primarily where a person lives, whether that is a private residence, nursing home, or community living arrangement, allowing the patient to be with important objects, memories, and family.
  • Care that includes periodic visits to the patient and family caregivers by hospice team members. Hospice providers are available 24 hours a day, 7 days a week to respond if patient or caregiver concerns arise.
  • The only medical care that includes bereavement care, which is available during the illness and for more than a year after the death for the family/intimate network.

For more information, check out Hospice Foundation Of America – What is Hospice?

This is an unbiased website about what to look for and consider when selecting a hospice provider.

As a local provider, we hope you will choose us to support you and your loved ones in this critical decision. We know every story is different and every experience is unique. Our goal is to tailor your experience to you and your wishes. If you have questions, you can always call or email us.

November is Hospice and Palliative Care Month – Let’s talk Palliative

Palliative care is a medical specialty, similar to cardiology or urology. This type of specialized medical care is for people living with a serious illness. Palliative care may be utilized to support symptom management and coincide with curative treatments, such as chemotherapy, radiation, surgery, therapy, and/or medications. Palliative care is meant to enhance a person’s current care by focusing on quality of life for them and their family.

Palliative services are supportive for many chronic illnesses, such as heart disease, pulmonary diseases (e.g., COPD), cancer, dementia, and neurological diseases (e.g., Parkinson’s). The goal of palliative care is to reduce discomfort and the limitations associated with disability. Palliative also supports through medical, social and emotional supports. It is a team approach and aids patients in preparing for invasive treatments, understanding their disease processes, and supporting recovery and return to everyday life.

June is Cancer Survivor Awareness!

In June, we have the opportunity to celebrate with cancer survivors. Recognizing the journey these individuals have taken and supporting them through phases of diagnosis, recovery, rehabilitation, and a return to “normal” is often our focus as healthcare providers. However, moves in medical literature are beginning to address the need for a healthcare framework that addresses survivorship. What does this look like? Where is our role as healthcare providers in meeting these survivors on the different phases of their journey? How do we change our approach?

At the core, cancer survivorship must address the likelihood of recurrence and new cancers, the physical effects on the individual, the psychosocial effects on the patient and family, management of general health, and maintaining a plan for other chronic conditions (Nekhlyudov et al., 2019).  There is a concern that the burden of a comprehensive approach is allocated to a specific provider, be it the primary care or even the oncologist. However, the approach, to be effective, should surpass the practitioner’s specific area of expertise. In understanding a health history, the consideration of survivorship is critical in building a care plan. This fact means that all healthcare professionals need to build a survivorship plan. For these care plans to demonstrate effective outcomes, the role of counseling cannot be minimized. Adherence to comprehensive survivorship plans is directly related to the supports in following the plan while addressing the likelihood of recurrence or complications from other health conditions (Jacobsen et al, 2018). Measurements of quality of life are integral in measuring the effectiveness of the plan and play a role in the patient’s adherence. Assuring critical issues, such as neuropathy and joint pain, which are often concerns voiced in accessing activities that are meaningful generate from conversations that identify what is of value to the patient and their family (van Leeuwen et al., 2018). Building these directly expressed concerns from quality of life measures into the care plan supports the shift for patients that are survivors and challenges practitioners to create comprehensive treatments that meet this unique need.

For more information, check out these articles:

https://academic.oup.com/jnci/article/111/11/1120/5490202?login=true

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6036622/

https://hqlo.biomedcentral.com/articles/10.1186/s12955-018-0920-0