Palliative care vs. hospice: The start of patient empowerment
Receiving a diagnosis of a serious or terminal illness, such as cancer or heart failure, can trigger worry and distress in patients and their loved ones. This life-changing news can leave people feeling helpless or hopeless. Yet, as they look to their doctor for guidance, one discussion may get overlooked or avoided — talking about palliative care.
The hesitation is understandable. Many people still don't understand the difference between palliative care versus hospice. They may think palliative care means end-of-life care or that their doctor has given up on them. In reality, the opposite is often true: Palliative care is the start of patient empowerment.
Palliative care vs. hospice: What's the difference?
It's easy to confuse palliative care and hospice. Both provide highly specialized patient care. In 2006, hospice and palliative medicine became a board-certified subspecialty for doctors in family medicine and internal medicine, along with seven other medical specialties. These doctors go through an additional year of fellowship training beyond their primary residency training.
Hospice care is palliative care focused specifically on the end of life. But while 100% of hospice care is palliative care, all palliative care is not hospice care. "Palliative care is a medical specialty focused on the relief of suffering. We can provide that relief regardless of the patient's prognosis," says Dr. William Logan, Staff Vice President and National Medical Director at Carelon Health.
Palliative care relieves suffering by:
- Coordinating fragmented care.
- Helping people understand the complexities of their illness.
- Managing symptoms related to their illness.
- Providing opportunities for patients and caregivers to plan their current and future involvement with the healthcare system.
Hospice care: Palliative care focused on end of life describes two specific things:
- A healthcare approach and philosophy that prioritizes comfort over cure. Under hospice care, patients with terminal illnesses agree to no longer pursue curative treatment, such as chemotherapy. The focus then is on providing comfort care during the patient’s remaining time.
- A specific Medicare payment program. To qualify for hospice care under Medicare, doctors must certify that patients have six months or less to live. Hospice patients may live longer than six months, but that's the threshold for the Medicare to pay for hospice services.
At Carelon Health, Palliative Care has evolved from focusing on caring for older, end-of-life patients to caring for patients of all ages under all types of insurance coverage, including commercial, Medicare, and Medicaid.
Taking a whole-health approach
Palliative Care from Carelon Health is a holistic approach that goes beyond comfort care to educate and empower patients on their healthcare journey. When appropriate, it can provide a seamless transition for patients to hospice.
"By definition, Palliative Care is whole-person care," says Dr. Logan. "Suffering occurs across many different domains — physical, spiritual, social, and financial. Carelon Health assesses all of these domains and coordinates care and planning for predictable episodes of disease progression. By caring for the whole person, patient satisfaction and quality of life dramatically improve."
Patients diagnosed with a serious illness can begin Palliative Care at any point in their healthcare journey — from the moment of diagnosis. But the sooner they start, the more help they can receive from a specialized team laser focused on relieving suffering caused by both their disease and their medical treatments.
"When people are more empowered in making decisions about their health, they feel more control and less uncertainty," says Dr. Logan.
Encouraging patient-driven care
Palliative Care from Carelon Health is also patient driven. From the first Palliative Care team meeting, patients, family members, and caregivers are encouraged to identify their healthcare goals. Often, this will be the first opportunity that patients and caregivers have had to voice those goals of care.
People who receive Palliative Care gain better control over their care. Patients and caregivers don't have to worry about coordinating care and treatments with numerous doctors. They may feel less alone on their healthcare journey. They have a specialized team of doctors, nurses, social workers, therapists, and counselors coordinating their care. When they have an issue, such as lingering pain or a new side effect, they can call a Palliative Care nurse specialist, 24/7.
Carelon Health's Palliative Care model has evolved, as well. It's moved from focusing on only the sickest patients at end-of-life care to even care for younger, healthier patients who have received a serious illness diagnosis. Typical diagnoses may include but are not limited to cancer, lung disease, and degenerative neurological diseases, such as multiple sclerosis or ALS (Lou Gehrig's disease). The benefits to these patients are astonishing, says Dr. Logan.
"Patient comfort, the relief of suffering, actually is considered at the same time as that fight or cure for their disease. Patients have a vastly better experience when Palliative Care is integrated into that longitudinal care," he says.
Facilitating advance directives
Throughout every patient interaction, the Carelon Health Palliative Care team discusses advance care planning. This may include executing advance directives. These are legally binding documents that map out how that person wants to encounter the healthcare system. Advance directives might include:
- A living will. This document outlines future healthcare decisions you want made in the event you can't communicate your wishes.
- Durable power of attorney for healthcare. This document names a person — called a healthcare proxy — to make medical decisions on your behalf if you, for some reason, become unable to speak for yourself.
The Palliative Care team includes social workers who can help patients and their families consider their choices and how they line up with their values and wishes. "These discussions and documents take the guesswork out of the decision making as things evolve," says Dr. Logan. "Thoughtful, proactive decisions are often far wiser than those made under duress." Palliative Care social workers can even help patients and families connect with appropriate spiritual counsel, if needed.
While patients do well on treatment, Palliative Care adds a layer of coordinated and specialized care they wouldn't receive under the usual healthcare journey. Engaging with Palliative Care also has benefits when treatment fails to stop disease progression, and the patient no longer has treatment options to cure their disease.
Our Palliative Care doctors, nurse practitioners, and other care team members are experts at identifying when patients are eligible for hospice care. Identifying these patients early helps avoid unnecessary interventions that can increase suffering without increasing quality of life, Dr. Logan notes.
Carelon Health exceeds national benchmarks for two key end-of-life care areas:
- Hospice-to-death ratio — which is over 68%.1 "The name of this metric sounds morbid, but it actually describes the percentage of people with terminal serious illness who die while in hospice care compared to those who don’t have hospice," Dr. Logan explains. "The national benchmark is between 30% to 50%.1 We do a really good job of recognizing folks who are eligible for hospice care and helping them receive it earlier — when they can receive the most benefit."
- Median hospice length of stay — which is about 39 days. The national average is about 18 days.2 "It's incredibly common for people to wait until the last moment prior to death to enroll in hospice," says Dr. Logan. "We help to identify the right people for hospice, and we help them to transition to hospice care earlier. Hospice care is amazing. It's a huge wraparound comfort bubble for patients and for their families. It includes bereavement therapy when that person passes away. We're really helping patients and families to receive the most benefit from this amazing care resource."
Palliative Care is empowerment
A devastating healthcare diagnosis or chronic illness doesn't have to leave patients and their loved ones fearing the future. Palliative Care from Carelon Health empowers patients to take charge of their healthcare journey both right away and for what may lie ahead. Better patient care can begin today with an open conversation about the benefits of Palliative Care.
1 Internal Report – Carelon Health Palliative Care Outcome KPI Dashboard, 2023 Jan.-Dec.
2 National Hospice and Palliative Care Organization (NHPCO).
