In this article, Dr. Janet Bull, medical director at Four Seasons Compassion for Life in Henderson County, explains the difference between palliative care and hospice as part of a series presented by the Western Carolina Medical Society.
This is a frequent question that people often ask us at Four Seasons Compassion for Life. First of all, let me discuss the similarities. Both hospice and palliative care help people with serious illnesses by talking to them to understand their personal values and goals, and their hopes for medical treatment. We help individuals by educating them on their illness and discuss the benefits and burdens of treatment options. Both services focus on improving a patients’ quality of life by aggressively managing symptoms, like pain and shortness of breath. Patients who qualify receive care from a team of people, which includes doctors, nurse practitioners, physician assistants, social workers, and chaplains. Frequently it is issues like medication errors, inability to afford drugs, depression and spiritual concerns, which cause patients to be readmitted to the hospital after being discharged. Coordination of care among doctors, as well as helping patients/families navigate a complex health system are important aspects of both services.
Now let me discuss the differences. Hospice provides care for those patients who have six months or less to live and choose not to seek curative treatment but instead focus on comfort care. Palliative Care however, is not limited by life expectancy, and is provided at the same time as curative treatment. Another difference is how it is covered financially. Medicare offers a Hospice Benefit for patients 65 years or older, while palliative care is a fee for service program.
Let’s use a common example to demonstrate what each service provides. Jenny is a 70 year old with advanced breast cancer who is having a significant amount of symptoms including pain and fatigue. A palliative care clinician and social worker evaluate Jenny at the clinic and perform a thorough symptom and needs assessment. She is started on two medications; one to help with pain, the other fatigue. The social worker gets her signed up for Meals on Wheels and gives her other strategies to help deal with her pain. A long discussion is held with Jenny to find out what’s important to her and to help her understand what is likely to occur with her cancer, including the risks and benefits of the treatments. The clinician calls her cancer doctor to discuss Jenny’s goals and to get input on her treatment. Jenny feels much better, but after a 6-month timeframe her cancer has progressed and the treatments are no longer effective. She is referred to hospice and the team meets with her to reassess her needs and goals due to her worsening illness. Jenny is having trouble getting out of bed and bathing herself. The team sets up a hospital bed and schedules a nurse’s aide to bathe her four times a week. The chaplain and social worker are offered to help with social and spiritual needs of both Jenny and her family. Hospice is able to provide end of life services based on Jenny’s goals throughout the remainder of her life and provide bereavement support to her family.
Janet Bull, MD FAAHPM is the Chief Medical Officer at Four Seasons Compassion and holds a consultant assistant professorship at Duke University Medical Center. She is a member of the Western Carolina Medical Society, Fellow of the AAHPM, board certified in hospice and palliative medicine and holds a hospice medical director certification. She directs the Research Department at Four Seasons and is the 2014 recipient of a Center for Medicare and Medicaid Innovations Grant.