End-of-Life Care Options

Posted on | March 9, 2016 | 1 Comment

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Sophia Bernazzani

When your loved one is given months or even weeks to live, it can result in a tidal wave of emotions for you and the rest of the family. Questions such as “Where will he stay?” or “How will we keep her comfortable?” immediately spring to mind. End-of-life care refers to the various types of services available to someone who is approaching death. Nursing@Simmons has created a guide that explains the five primary options for receiving end-of-life care. Below we explore the basics of each

1.Home

People who choose to live out their final days at home typically have family support and good financial resources combined with a desire for independence. The amount of external support required depends on the person’s condition and whether or not a nearby family member is available and willing to help out. Types of services needed by a homebound patient may range from help with daily activities and medical needs to transportation. In addition to a close family member, he or she may enlist the help of:

Home health agencies
Professional caregivers
Community-based hospice or palliative care programs

Payment sources: Medicare/Medicaid, private and/or long-term care insurance, Veterans Administration (VA), and patient/family resources

2. Hospice

Hospice is generally an option for those with a life expectancy of six months or less. Hospice care focuses on keeping a person comfortable rather than on finding a cure. It can be administered at home, in a hospital, in a long-term care facility, or at a freestanding hospice house. Hospice facilities cannot refuse care based on a patient’s inability to pay.

Payment sources: Medicare/Medicaid hospice benefit, private insurance, and patient/family resources

3. Hospital Inpatient Care/General Inpatient Hospice (GIP)

These options are usually for very ill individuals who require constant medical monitoring. They may be cared for on a general nursing floor of a hospital or in an intensive care unit (ICU). In these settings, a patient often has access to a palliative care team, which involves providers working together to tend to his or her physical, emotional, and spiritual needs.

Payment sources: Hospital inpatient costs to Medicare/Medicaid have increased significantly over the past five years, but out-of-pocket costs to patients/families remain minimal and unchanged.

4. Long-Term Care Facility

Long-term care settings include assisted living facilities, which cater to semi-independent people who need assistance with some daily living and nursing tasks, as well as skilled nursing facilities, which provide comprehensive care for more complex needs.

Payment sources: Long-term care insurance and Medicaid (covers room and board if eligible)

5. Palliative Care

This type of end-of-life care is for seriously ill people who require ongoing pain and symptom management. Palliative care can be provided in any setting and can maximize quality of life for patients and families during the final days. Palliative care experts are qualified to assist with a variety of end-of-life issues, including goals for care and advance directives. Models of care include:

Hospital-based consult teams
Inpatient palliative care units
Community-based palliative care programs

Palliative care has been shown to reduce costs for both patients and health care organizations. People who receive this type of care earlier in their hospitalization are less likely to be in the ICU. Plus, studies actually show lower inpatient costs with palliative care.

Easing a Difficult Decision

Choosing the location for end-of-life care is a tough decision that must be made with input from the patient, family, and primary care provider. Carefully evaluating the full range of options available — as well as their associated costs — can help you ensure affordable care, greater comfort for your loved one, and peace of mind all around.