When people are facing the end of life, whether it is themselves or a loved one, it can be very difficult to decide between all the care options that are available. There are many factors to consider, which may complicate the picture for caregivers who are often faced with arranging proper end-of-life care in a timely manner.
Individuals at the end of life can receive care in a variety of settings. Their selection is largely dependent upon the intensity of the care that they require, resources that are available, and their individual wishes.
It can be very challenging for family members to assist with these life-altering decisions or make them on behalf of a loved one. Advance care planning is critical to ensuring that caregivers know what their loved ones’ wishes are. Proper planning also helps medical professionals accurately interpret and execute these wishes as well.
The following provides a summary of end-of-life care options, where they are provided, the benefits they offer, and how these services are paid for—with an approximation of current costs as available.
Who is it for?
- Individuals who have been diagnosed with a terminal illness and are medically certified as having a life expectancy of six months or less can receive this type of care. In order for hospice care to be covered, a patient must decline curative treatments and elect care for symptom management and comfort instead.
- This type of care is not limited to one specific setting. Patients may receive care in a variety of settings, including at home, in the hospital, a long-term care facility, such as a skilled nursing facility or an assisted living facility, or a free-standing hospice facility.
- The focus is to provide comfort care for those at end of life.
- This care includes support from an interdisciplinary team that addresses physical, psychosocial, and spiritual needs.
- Caregivers are able to benefit from short-term respite care as well as grief and loss counseling with Chaplains and/or Social Workers.
- If a patient outlives their original life expectancy, their care can continue as long as they remain eligible for services.
- Hospice care can be discontinued at any time if a patient changes their mind or their prognosis changes. So long as the patient is eligible, they may resume hospice care at any time.
Payment sources and costs:
- For those eligible and receiving care from a provider that is certified by the Centers for Medicare and Medicaid Services (CMS), all care related to the admitting diagnosis is covered under the Medicare and Medicaid Hospice Benefit. Care and medications for other unrelated conditions will be covered in the same way they were prior to the patient’s admission to hospice.
- Private insurance may cover some costs depending upon the policy.
- If there is a cost to patients or their families, it is typically based on a sliding scale fee structure.
- If a patient requires short-term inpatient services in a long-term care facility or hospital, emergency room care, or ambulance transportation, it must be arranged through a hospice provider in order to be covered or unrelated to the patient’s terminal illness.
Who is it for?
- Palliative care and hospice are often confused. Individuals with a severe illness who require pain and symptom management, but are found to have a life expectancy of longer than six months are able to receive palliative care. Conditions commonly associated with this care include heart failure, chronic obstructive pulmonary disease (COPD), Parkinson’s disease, cancer, kidney failure, and many others. Palliative care focuses on providing patients with relief from the symptoms, pain, physical stress, and mental stress of a serious illness—whatever the diagnosis.
- Palliative care programs provide comfort care but also offer the option for patients to continue curative care, if they so choose.
- Some symptoms related to a chronic diagnosis that are commonly addressed by this type of care include pain, nausea, depression, sleep issues and shortness of breath. The ultimate goal is to improve the patient’s quality of life throughout the course of the illness.
- Services can be received in any setting with support provided by an interdisciplinary team of health care professionals who are palliative care experts and skilled in discussing end-of-life care goals.
- Both palliative care and hospice care provide comfort. But palliative care can begin at diagnosis, and at the same time as treatment. Hospice care begins after treatment of the disease is stopped and when it is clear that the patient is not going to survive the illness.
Payment sources and costs:
- Palliative care is covered in the same way that any other medical services are covered.
- Most insurance plans, including Medicare and Medicaid, cover all or part of palliative care costs.
- Additional services, such as home health aide or professional caregiver services, are not included.
- Studies show that when patients are receiving services from a palliative care program or team, their hospital expenses are significantly decreased.
- This is largely dependent upon the patient’s goals for care, the patient’s condition, and the amount and quality of caregiving support available. Consulting with the patient’s primary care physician and support team (usually family and/or friends) will usually indicate whether or not home-based care is an appropriate option. It is important for family caregivers to establish a significant care team in order to prevent burnout while providing care at home.
- Patients can remain at home instead of receiving care in an unfamiliar and potentially uncomfortable setting like a hospital or long tern nursing care facility.
- This type of care provides more autonomy and control over one’s care, daily activities, visitors and the environment.
- Patients are less likely to experience confusion or delirium and more likely to get better rest at home compared to an inpatient setting.
Payment sources and costs:
- Costs are highly dependent upon the type, intensity, and frequency of care that the patient requires.
- Care may be received from hospice, community-based palliative care programs, home health agencies, non-medical home care agencies, private, professional caregivers and the patient’s personal support team, such as family members and friends.
- Payment sources are dependent upon care needs and eligibility and include Medicare, Medicaid, private insurance, long-term care insurance, the Veterans Administration (VA), and private patient/family resources.
- Unlike hospice and palliative care, non-medical home care is not covered by the Medicare benefit. While some long term care insurance policies do cover non-medical home care, patients and families often cover the costs of these services which can include homemaker/companion services. Non-medical home care is approximately $20-$25 per hour, depending upon location, needs, and time frame of services. For some patients, these costs may be well worth the added comfort of remaining at home and may even be less costly than care in a hospital or long-term care facility.