Q. I recently read about hospice and palliative care and now I’m thoroughly confused. They sound like exactly the same thing, but offered at different times. Why is hospice covered by Medicare and Medicaid, when palliative care is typically not? Thanks for your help!
A. People often confuse palliative care with hospice care, and the confusion is completely understandable. Both types of care ease the suffering severe illness can bring, while improving the quality of life for people with serious or life altering illnesses. Both palliative care and hospice care are about improving overall wellness, including physical, emotional, spiritual, and social well-being.
As you mentioned, the only real difference between palliative care and hospice care is in their timing. You can begin palliative care at any time, while hospice care is offered when you are not expected to live beyond six months because medical treatments no longer help you. In reality, people can remain in hospice care for years though. In fact, contrary to what many believe, hospice care doesn’t always signal the end of life. It’s possible to receive hospice care and then resume curative or life-prolonging treatments.
Both hospice and palliative care aim to improve the patient’s quality of life and will provide caregivers with emotional and practical support. Both provide essentially what is known as “comfort care.”
What is Comfort Care?
Comfort care is often used interchangeably with palliative care or hospice. Hospice, palliative, and comfort care all offer relief from the pain and symptoms of a serious illness. They also address the emotional, social, and spiritual needs of patients and their families. They all can be provided in hospitals, nursing homes, assisted living facilities, specialized clinics, or at home.
All three terms refer to care to improve quality of life by relieving suffering and providing practical, emotional, and spiritual support. Comfort care is a broader and more holistic approach to caring for patients and their families.
Some of the most common medical conditions for comfort care patients include cancer, heart failure, chronic obstructive pulmonary disease (COPD), stroke, and Alzheimer’s disease. For those with chronic illnesses, comfort care prevents or relieves suffering as much as possible to improve quality of life. Generally speaking, those suffering from chronic illnesses need care in four areas—physical comfort, mental and emotional needs, spiritual issues, and practical tasks. Their families need support as well.
Effective comfort care starts with clear conversations about goals and priorities. For example, people experience pain differently. Doctors and family must listen and continue to ask questions to find the right level of pain relief.
Most comfort care includes support for families. Caring for a sick family member can be stressful and confusing. Comfort care includes caregiver education and practical support, such as home health aides.
Why is Hospice Care Covered While Palliative Care is Not?
Palliative care and hospice care are both comfort care, but may be provided at different times, which may be why hospice care is covered, while palliative care is not (although as mentioned, they are essentially the same thing).
Hospice care is covered by Medicare, VA benefits, Medicare Advantage, Medicaid and most private insurance plans. Services related to the life-limiting illness, such as medication, equipment and supplies, are all covered with few or no out-of-pocket expenses.
Both Medicare and Medicaid may cover some palliative services. However, since neither Medicare nor Medicaid use or recognize the term “palliative care,” the treatment received under the label of palliative care has to be covered by your standard insurance benefits.
- Palliative care consultations are covered by Medicare and most private insurance companies. Co-pays may apply.
- Medicare Part A benefits may cover palliative care, much like getting care from a specialist. To get palliative care at home, you’ll have to request a referral for home-based palliative care which is covered by Medicare under some circumstances, but often not.
- Medicare Part B may cover some of the services and supplies to treat your disease.
- If you qualify for Medicaid benefits, they may also cover some palliative care treatments and medications, but again, not all.
- Some private insurance plans also cover palliative care as part of their chronic care, long-term care, or hospice benefits.
- If you have private insurance, you might have some coverage for palliative services. A long-term care insurance policy is another option to cover palliative services. We often suggest that our clients consider hybrid policies and are happy to chat more about your options.
But, per your question, besides when the care is received, why is hospice care always covered while palliative care is not?
Palliative Care is Often Not Fully Understood
According to CMS, because of Medicare requirements, hospice is typically for patients with a life expectancy of six months or less. A patient’s doctor and a hospice medical director work together to determine life expectancy. Palliative care is for people at any stage of illness. The illness is not required to be life-limiting.
Palliative care has been shown to increase patients’ satisfaction with the care they receive and to save on medical expenses by reducing the need for hospitalizations and trips to the emergency room. Despite dramatic growth in the number of hospitals providing such care over the last decade, full palliative care services remain unavailable to many patients.
Besides it not being covered, several other factors may explain why palliative care is not more widely available, as follows:
- Palliative care is a relative newcomer in the field of medicine, and it only became a board-certified medical specialty in 2006. Several studies have found that the number of specialists doesn’t meet the need.
- There is also some confusion about exactly what palliative care is. “The field itself hasn’t yet defined who should get it, what it is, and who provides it,” said Judy Thomas, the CEO of the Coalition for Compassionate Care of California, which advocates for palliative care and hospice services.
- Many patients and even doctors shy away from turning to palliative care because they associate it with terminal disease and the abandonment of hope for recovery. Another complicating factor is that the same services are often referred to as “palliative care” or “hospice care,” depending on who is receiving them.
A few years ago, the federal government began demonstration projects that extend palliative care to desperately ill patients who would have been considered eligible for hospice care, but were not willing to give up on curative treatment. The bills in Congress would expand that eligibility even further, to patients with advanced illnesses but for whom death is not considered so imminent. One such bill is the Enhance Palliative and Hospice Education and Training Act S.2080/H.R. 647, which passed the house. Hope this bill continues and palliative care is better understood, available to more people, and covered by Medicare and Medicaid, similar to hospice, in the future.
Need Comfort Care? — Nursing Home Comfort Care may be a Better Option than Home Care
Do you have a loved one who may need comfort care? If comfort care is right for your loved one, it can be rendered in a nursing home setting, and this might be the preferred place. For more details as to why nursing homes are a better option for comfort care, please read more in my article, “The Ugly Side of Hospice.”
Unlike comfort care provided at home, nursing homes are staffed with nurses and doctors 24/7, making them (in many cases) a better choice for a loved one’s long-term care needs and end-of-life needs, and hospice care can just as easily be provided in the nursing home as it can at home. Many nursing homes have a contract with one specific hospice provider, so if you have a loved one in a nursing home, you might not have a choice in picking a comfort care provider. Receiving comfort care at a dedicated hospice facility can also be a very good choice; the problem is that there are very few dedicated comfort care facilities around the country.
Protect your family’s hard-earned money and assets from the catastrophic costs of nursing home care
The best time to create your long-term care strategy is before you actually need long-term care. If you’re over 65, we recommend that you begin your asset protection planning now. Even if you are currently receiving long-term care services for yourself or a loved one, it’s still not too late to plan and protect assets and improve dignity and quality of life; please call us to make an appointment for an initial consultation:
About Evan H Farr, CELA, CAP
