Can You Go on and Off Hospice Care
Many Americans die in facilities such as hospitals or nursing homes receiving care that is not consistent with their wishes. It's important for older adults to plan ahead and let their caregivers, doctors, or family members know your end-of-life preferences in advance. For example, if an older person wants to die at home, receiving end-of-life care for pain and other symptoms, and makes this known to health care providers and family, it is less likely he or she will die in a hospital receiving unwanted treatments.
If the person is no longer able to make health care decisions for themselves, a caregiver or family member may have to make those decisions. Caregivers have several factors to consider when choosing end-of-life care, including the older person's desire to pursue life-extending treatments, how long he or she has left to live, and the preferred setting for care.
What is palliative care?
Palliative care is specialized medical care for people living with a serious illness, such as cancer or heart failure. Patients in palliative care may receive medical care for their symptoms, or palliative care, along with treatment intended to cure their serious illness. Palliative care is meant to enhance a person's current care by focusing on quality of life for them and their family.
Who can benefit from palliative care?
Palliative care is a resource for anyone living with a serious illness, such as heart failure, chronic obstructive pulmonary disease, cancer, dementia, Parkinson's disease, and many others. Palliative care can be helpful at any stage of illness and is best provided soon after a person is diagnosed.
In addition to improving quality of life and helping with symptoms, palliative care can help patients understand their choices for medical treatment. The organized services available through palliative care may be helpful to any older person having a lot of general discomfort and disability very late in life.
Who makes up the palliative care team?
A palliative care team is made up of multiple different professionals that work with the patient, family, and the patient's other doctors to provide medical, social, emotional, and practical support. The team is comprised of palliative care specialist doctors and nurses, and includes others such as social workers, nutritionists, and chaplains. A person's team may vary based on their needs and level of care. To begin palliative care, a person's health care provider may refer him or her to a palliative care specialist. If he or she doesn't suggest it, the person can ask a health care provider for a referral.
Where is palliative care provided?
Palliative care can be provided in hospitals, nursing homes, outpatient palliative care clinics and certain other specialized clinics, or at home. Medicare, Medicaid, and insurance policies may cover palliative care. Veterans may be eligible for palliative care through the Department of Veterans Affairs. Private health insurance might pay for some services. Health insurance providers can answer questions about what they will cover.
Visit the National Hospice and Palliative Care Organization website to find palliative care near you.
In palliative care, a person does not have to give up treatment that might cure a serious illness. Palliative care can be provided along with curative treatment and may begin at the time of diagnosis. Over time, if the doctor or the palliative care team believes ongoing treatment is no longer helping, there are two possibilities. Palliative care could transition to hospice care if the doctor believes the person is likely to die within six months (see What does the hospice six-month requirement mean?). Or, the palliative care team could continue to help with increasing emphasis on comfort care.
For more information, check out NIA's article on Frequently Asked Questions About Palliative Care.
What is hospice care?
Increasingly, people are choosing hospice care at the end of life. Hospice care focuses on the care, comfort, and quality of life of a person with a serious illness who is approaching the end of life.
At some point, it may not be possible to cure a serious illness, or a patient may choose not to undergo certain treatments. Hospice is designed for this situation. The patient beginning hospice care understands that his or her illness is not responding to medical attempts to cure it or to slow the disease's progress.
Like palliative care, hospice provides comprehensive comfort care as well as support for the family, but, in hospice, attempts to cure the person's illness are stopped. Hospice is provided for a person with a terminal illness whose doctor believes he or she has six months or less to live if the illness runs its natural course.
It's important for a patient to discuss hospice care options with their doctor. Sometimes, people don't begin hospice care soon enough to take full advantage of the help it offers. Perhaps they wait too long to begin hospice and they are too close to death. Or, some people are not eligible for hospice care soon enough to receive its full benefit. Starting hospice early may be able to provide months of meaningful care and quality time with loved ones.
Where is hospice care provided and who provides it?
Hospice is an approach to care, so it is not tied to a specific place. It can be offered in two types of settings — at home or in a facility such as a nursing home, hospital, or even in a separate hospice center.
Read more about where end-of-life care can be provided.
Hospice care brings together a team of people with special skills — among them nurses, doctors, social workers, spiritual advisors, and trained volunteers. Everyone works together with the person who is dying, the caregiver, and/or the family to provide the medical, emotional, and spiritual support needed.
A member of the hospice team visits regularly, and someone is usually always available by phone — 24 hours a day, seven days a week. Hospice may be covered by Medicare and other insurance companies. Check to see if insurance will cover the person's particular situation.
It is important to remember that stopping treatment aimed at curing an illness does not mean discontinuing all treatment. A good example is an older person with cancer. If the doctor determines that the cancer is not responding to chemotherapy and the patient chooses to enter into hospice care, then the chemotherapy will stop. Other medical care may continue as long as it is helpful. For example, if the person has high blood pressure, he or she will still get medicine for that.
| Question | Palliative Care | Hospice |
|---|---|---|
| Who can be treated? | Anyone with a serious illness | Anyone with a serious illness who doctors think has only a short time to live, often less than 6 months |
| Will my symptoms be relieved? | Yes, as much as possible | Yes, as much as possible |
| Can I continue to receive treatments to cure my illness? | Yes, if you wish | No, only symptom relief will be provided |
| Will Medicare pay? | It depends on your benefits and treatment plan | Yes, it pays for some hospice charges |
| Does private insurance pay? | It depends on the plan | It depends on the plan |
| How long will I be cared for? | This depends on what care you need and your insurance plan | As long as you meet the hospice's criteria of an illness with a life expectancy of months, not years |
| Where will I receive this care? |
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Although hospice provides a lot of support, the day-to-day care of a person dying at home is provided by family and friends. The hospice team coaches family members on how to care for the dying person and even provides respite care when caregivers need a break. Respite care can be for as short as a few hours or for as long as several weeks.
What are the benefits of hospice care?
Families of people who received care through a hospice program are more satisfied with end-of-life care than those who did not have hospice services. Also, hospice recipients are more likely to have their pain controlled and less likely to undergo tests or be given medicines they don't need, compared with people who don't use hospice care.
For more information, check out NIA's article on Frequently Asked Questions About Hospice Care.
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For more information about hospice and palliative care
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Content reviewed: May 14, 2021
Can You Go on and Off Hospice Care
Source: https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care
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