| ATTRIBUTES | PALLIATIVE CARE | HOSPICE CARE/EOL |
|---|---|---|
| Primary Objective |
To effectively manage symptomatic advanced conditions by reducing disease exacerbation, hospitalization and maintain physical functioning Goal Engage in Life |
To provide comfort of pain and symptoms associated with a terminal condition and provide support until death Goal Comfortable Death |
| Prognosis |
Initiate palliative care with a diagnosis of a non-reversable condition (e.g., heart failure, chronic obstructive pulmonary disease, chronic kidney disease etc.)
Debilitated not Terminal/Dying |
Admission into hospice requires provider referral with a 6 month or less prognosis Terminally Ill and Dying |
| Origin |
Palliative care originated by medicine with a focus on the clinical aspects of disease and symptom management – research based Medical |
Hospice care originated by social work and nursing with a focus on pain relief and comfort until death Social Work/Nursing |
| Reimbursement |
Routine reimbursement from third party payers, Medicare, Medicaid on underlying conditions and associated symptoms. Fee for service Bill Routine CPT/ ICD-10 Codes |
Hospice care Benefit from third party payers, Medicare, and Medicaid. Capitated daily reimbursement based on geographical cost of living Capitated Daily Fee |
| Care Limitations |
No restrictions or limitations on the clinical management of patient needs. Appropriate referrals, diagnostics, and pharmacological and nonpharmacological interventions based on patients’ underlying etiology No Limitations or Restrictions |
Discontinuation of routine medications not covered by hospice benefit. Limited access and utilization of clinic or hospital. Patient receives medication box of opioid, benzodiazepines, anticholinergics etc. Medication/Care Access Limited |
| Disease Trajectory |
Palliative care initiation at onset of an advanced chronic or malignant condition. No prognostication. Focus on symptom management. Palliative interventions intensify as the patient approaches death and appropriate referral to hospice team Earlier Access > 6 Months |
Hospice care initiation occurs at the end-of-life. Average length of stay in US hospice care is 77 days Limited Care < 6 Months |
| Multidisciplinary |
Palliative care recognizes the complex care of the patient and family and utilizes an interdisciplinary team to address these needs: Utilization of Healthcare Team |
Hospice care team is employed at the onset of patient admission into services. Full Hospice Care Team |
| Clinical Practice Guidelines |
Majority of guidelines are for cancer and come from different countries (UK, Canada etc.).
Medical societies and associations offer guidelines on symptom management. CDC 2016 pain management guidelines are currently under revision |
2018 Clinical Practice Guidelines for Quality Palliative Care 4th edition- National Coalition for Hospice and Palliative Care. No clinical management on symptoms. Provides the nurse with comfort and communication guidance Guidelines Do Not Include Clinical Symptom Management |