How and Where Is Palliative Care Provided and How Is It Paid For?
Palliative care is most often offered and started by the cancer care team who is giving your treatment. The doctors and nurses you see during your treatment visits may provide some palliative care themselves, such as helping to manage symptoms and side effects like nausea or pain. And, they will continue to help control those problems while you are getting treatment. But they will often refer patients to a team of palliative care specialists.
This palliative care "team" typically includes a palliative care doctor (who may be board-certified in Hospice and Palliative Medicine), a palliative care nurse, social worker, dietitian, patient navigator, and maybe a person with a spiritual role such as a pastoral counselor or chaplain.
Many hospitals and oncology clinics have these teams as part of the services they provide. With many types of professionals, the palliative care team can better help with symptoms and problems that are harder to manage, like severe pain, family distress, insurance issues, or complex medical problems.
Where palliative care is given
Palliative care is most often given to the patient in the home as an outpatient, or during a short-term hospital admission. Even though the palliative care team is often based in a hospital or clinic, it’s becoming more common for it to be based in the outpatient setting.
The palliative care team also can see patients, family, and caregivers in intensive care units, emergency rooms, treatment centers, or hospital units.
Most actual palliative care happens at home. At home, you may take medicines and use other methods prescribed by the team, or your family members and loved ones might need support as they help care for your needs . The team provides support to the patient as well as to the home caregivers.
You can read more about caregiving in What a Cancer Caregiver Does.
How palliative care is paid for
Palliative care can be covered by both government and private insurance plans, but it may be part of chronic care or long-term care coverage. Sometimes it's included in the hospice care part of coverage depending on how the health plan describes what palliative care is.
It's important to check and see if your insurance coverage has certain limits on palliative care, such as a list of what types of serious illnesses are covered, or other situations that may or may not be eligible for palliative care services.
There can also be limits on where palliative care is provided. Coverage may differ if you are getting palliative care in the hospital, rehab, or a skilled nursing or hospice facility instead of getting it at home. Sometimes nursing visits, social work, and spiritual care are covered, in addition to the care and medicines that help control symptoms. It's best to check with your health insurance company for details about what is covered and what is not.
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The American Cancer Society medical and editorial content team
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Along with the American Cancer Society, other sources of information on palliative care include:
GetPalliativeCare.org
Website: www.getpalliativecare.org
Has information on palliative care for patients and home caregivers, including where to find palliative care programs in your state
City of Hope Pain/Palliative Care Resource Center
Website: http://prc.coh.org
Web-based clearinghouse of information and resources to help patients and families to improve the quality of pain management and palliative care
Center for Medicare and Medicaid Services (CMS). Medicare hospice benefits.Accessed at https://www.medicare.gov/pubs/pdf/02154-medicare-hospice-benefits.pdf on April 2, 2019.
Dunn GP, Pruskowski J, Simonian LK. Palliative care for cancer and treatment-related changes for inpatients. In Hopewood P, Milroy MJ, eds. Quality Cancer Care: Survivorship Before, During, and After Treatment. New York, NY: Springer Publishing Company; 2018:199-216.
Ferrell BR, Temel JS, Temin S, Smith TJ. Integration of palliative care into standard oncology care: ASCO clinical practice guideline update summary. Journal of Oncology Practice. 2017; 13(2):119-121.
Gomes B, Calanzani N, Curiale V, McCrone P, Higginson IJ. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database of Systematic Reviews. 2013; 6(6):CD007760.
Krouse RS, Kamal AH. Interdisciplinary care for patients with advanced cancer. In DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2019:2242-2247.
National Hospice and Palliative Care Organization (NHPCO). History of hospice care. Accessed at https://www.nhpco.org/history-hospice-care on April 2, 2019.
National Hospice and Palliative Care Organization (NHPCO). Facts and figures: Hospice care in America. Updated April 2018. Accessed at https://www.nhpco.org/sites/default/files/public/Statistics_Research/2017_Facts_Figures.pdf on April 2, 2019.
Parikh RB, Wright AA. The affordable care act and end-of-life care for patients with cancer. Cancer J. 2017; 23(3):190-193.
Last Revised: May 10, 2019
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