Since there is no Medicare regulation that specifies what treatments are deemed palliative, it is up to the individual hospice agency to determine whether or not they can financially and philosophically provide the interventions listed below. These interventions range from low cost-low tech (hydration via clysis) to high cost-high tech (multi-agent chemotherapy). With the exception of very large hospice agencies that have a substantial financial base, most agencies will not provide high-cost interventions; patients may elect to be discharged from hospice care if they wish to pursue these options.
It is important to realize that hospice is a program that delivers palliative care and that palliative care can be provided outside hospice. As such, hospice care is not a medical intervention. The goals of hospice intervention is to provide support for the patient and family and to enable “the good death”. This is an inherently vague goal and one that cannot be proved in clinical trials.
Keeping this in mind, conventional madical interventions are potentially indicated in patients with a) good functional status (up, out of bed > 50% of the time; KPS >50; ECOG 0-2) and/or b) a clear goal to be met (e.g. wedding anniversary in two weeks). These interventions are not indicated solely to assist patients or families psychologically cope with impending death – to give the impression that something is being done. In other words, the goal of hospice is to co-ordinate care, provide psychological support, bereavement counselling and spiritual support to patient and family but not to continue care that is futile. Hospice serices by defintion require a prolonged period of time and hospice is generally ineffective if it comes in at the point that the dying process has already began.
According to the World Health Organization (WHO), palliative care is defined as the active total care of patients whose disease is not responsive to curative treatment. The term palliative care often incorrectly is used interchangeably with hospice care, and its goal is to ensure that the patient and family achieve the best possible quality of life. The essential components of palliative care are effective control of symptoms and effective communication with patients, their families, and others involved in their care. This can be done on a hospice or outside it.
Inpatient hospices can be used for hospitalization until death or as short -term placement until a home hospice can be arranged. Hospice can also be provided in SNF settings.
Rehabilitation, with the aim of maximising independence, is also essential to good care. As a disease progresses, continuity of care becomes increasingly important—coordination between services is required, and information must be transferred promptly and efficiently between professionals in the community, in hospitals, and in hospices.
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Hospice Eligibility and Election: Does Policy Prepare Us to Meet the Need? Journal of Aging & Social Polic 27, Issue 4, 2015
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