Palliative care is the treatment of pain and symptoms and it is an important part of hospice care. Some people who do not have a limited life expectancy or are still seeking curative treatments may choose to receive palliative care services only. These services help people manage pain and symptoms such as nausea, insomnia, anxiety or other unpleasant side effects from their illness or treatment. If hospice is needed at a later date, they may transition without having to go to another provider. Note than care from Kansas City Palliative Home Care is only available to patients in their home or in assisted living who have skilled nursing needs. They need not have a terminal diagnosis. Hospice is available to all patients with a life expectancy of six months or less. For the criteria on palliative care vs. hospice CLICK HERE
There is not a specific time limit. At the time of referral to hospice, a physician and the hospice medical director must certify a patient as being terminally ill and having a prognosis of 6 months or less if the disease runs its normal course. After 90 days, the patient’s condition is assessed and recertified. After the end of the first two 90-day periods, patients are recertified every 60 days. Recertification is based on the patient’s current condition, not the date they first entered hospice. If the patient’s condition improves, the patient is discharged from hospice and may return at any time their condition worsens and a terminal diagnosis can be certified.
Medical research is improving our understanding of pain and enabling us to effectively control it. Over 90 percent of people find relief in medicines taken by mouth. Patients who cannot swallow or don’t respond to oral medicine may find relief with a skin patch, suppository, subcutaneous lines or IV. Other medical treatments and non-drug therapies can be helpful and we will work to find a combination of treatments that make patients comfortable. Types of medications available include aspirin, acetaminophen, NSAIDs, opioids, adjuvants, antidepressants, anticonvulsants and steroids.
There is not a specific time limit. General Inpatient Level of Care (GIP) is intended by Medicare for short-term symptom management. Patients are admitted when they meet the criteria set by Medicare and they may stay as long as they continue to meet criteria. When a patient stabilizes and no longer meets criteria, the patient may be discharged to return home or transfer to a long-term care facility. If the patient chooses to remain at the Hospice House, there is a room and board fee, currently $290 per day, dependent on the availability of a residential bed at the time.
When dealing with any serious illness, the ability to discuss options and help families plan ahead is crucial. The worst time to make decisions is during a crisis, when emotions are running high and decisions must be made quickly. Your ability to make recommendations and feel confident that you are doing your best to respect a patient’s wishes is dependent upon understanding their values and what is most important to them. Early in your treatment plan, schedule a time to talk about advance planning and learn from them what they do and don’t want to happen. Instead of talking about death, talk about how they want to live. If they talk about quality of life being very important, you can explain the philosophy of hospice and what steps might lead up to making a decision to enter a hospice program. We can help. Our online guide Assistance with Difficult Conversations may help and our expert nurse liaisons are available to help you initiate conversations and help answer questions.
Many patients who begin with palliative home care transition to hospice care. If one of our physicians followed your patient and then referred to hospice, it would be considered a self-referral and would not be ethical. Our physicians are always available to consult with you while your patient is on palliative home care, but you will direct the plan of care. Your patient will have an RN case manager who handles all the details and coordinate with your office. Each patient has an interdisciplinary team, just like in hospice, providing nurses, home health aides, social worker, chaplains, music/art therapists and other medical professionals as needed to give comfort and support right in their own home.
Medicare limits the coverage of medications for hospice patients to those that are related to the hospice diagnosis, helping manage symptoms and providing comfort. A medication designed to cure the disease is generally not covered. Our staff will work closely with you to help understand coverage and make recommendations as needed to adjust medications and therapies.
Both the demand for hospice services and available insurance coverage for those services have expanded. The number of hospice providers in our area continues to grow. Differences include business model (not-for-profit or for profit), longevity in the community, based locally or part of a chain, scores on patient surveys, breadth of services offered, qualifications of medical director(s), availability of palliative home care, having an inpatient facility, number of trained volunteers, coverage area, availability of pediatric/perinatal care and ability to serve the underinsured.
