Palliative care and family medicine

Hospice

Hospice is a philosophy that addresses the physical, psychological, social, and spiritual aspects of death and dying
- Patients elect to pursue palliative rather than curative treatment

Hospice care can be provided in any setting- patient's home, hospice home, nursing home, or hospital

Patient's are eligible for hospice care if they have a any terminal illness with an estimated prognosis of less than six months
- This includes non-cancer diagnoses, such as congestive heart failure, chronic obstructive pulmonary disease, failure to thrive, and dementia

Hospice benefits cover all expenses related to the patient's terminal diagnosis that are deemed "reasonable and necessary for palliation"
- This includes medications, skilled nursing, nursing aides, and hospital equipment, such as a hospital bed for the patient's desired location
- Medicare pays hospice on a per diem basis that covers all medical care; this payment method often requires the attending physician to consider the cost of individual medications and treatments when multiple methods are available to treat the same symptom

Hospice benefits provide the patient's family with bereavement support for up to one year following the death of the patient

Patients appear to benefit most when hospice care is initiated at least two months prior to death

Medicare covers hospice care for if the following four criteria are met:
- The patient is eligible for Medicare Part A
- The patient enrolls in a Medicare-approved hospice
- The patient has given written consent for hospice care
- The patient's physician and the hospice medical director certify that the patient has a terminal illness with an estimated prognosis of less than six months

As long as a disease is running its "normal course," there is no penalty and the patient will not automatically be discharged from hospice if they survive longer than six months
- Hospice care is initiated with two 90 day periods followed by unlimited extensions in 60 day intervals

The patient's primary care physician can and often does serve as a member of the patient's hospice care team
- The attending physician is often the patient's primary care physician
- The attending physician is required to write admission orders, be available by telephone, and handle the routine day-to-day medical needs of the patient

Most private insurers offer a benefit that is modeled after the Medicare Hospice Benefit

Patients may leave and reenter hospice care if there are unforeseen fluctuations in their disease course

Anyone, including friend's and family members, can refer a patient to hospice; the referral does not have to come from a physician or other medical professional

Medical problems and hospital admissions that are unrelated to the patient's terminal diagnosis generally are still covered by the patient's insurance plan while a patient pursues hospice care