Palliative care services are available and increasingly utilized within nursing home and skilled nursing facility settings. This specialized medical approach provides an additional layer of support for residents living with a serious illness. The primary goal of this care is to enhance a person’s quality of life through expert symptom management and comprehensive comfort measures. Accessing these services requires understanding the specific logistics of team coordination and the mechanisms for funding the care.
Palliative Care Defined and Distinguished From Hospice
Palliative care is a specialized field of medicine focused on providing relief from the symptoms and stress of a serious illness. This type of care is appropriate for anyone with a serious long-term condition, regardless of their life expectancy. It functions as an extra layer of support that works in parallel with any existing treatments intended to cure or slow the progression of the disease. The patient can continue receiving curative treatments, like chemotherapy or rehabilitation, while benefiting from the palliative team’s expertise in managing complex symptoms like pain, nausea, and shortness of breath.
Hospice is a specific type of palliative care, but it is reserved for individuals who have a terminal prognosis of six months or less, certified by two physicians. When a resident enrolls in hospice, the focus officially shifts away from curative treatments and entirely toward comfort and quality of life. Palliative care, by contrast, is not limited by prognosis and actively works alongside life-prolonging therapies.
How Palliative Care Teams Coordinate in a Nursing Home
Delivering palliative care in a nursing home involves the careful integration of an interdisciplinary team (IDT) with the facility’s existing staff. The IDT is typically comprised of a palliative care physician or nurse practitioner, registered nurses, social workers, and often chaplains. This external or visiting team brings specialized expertise in complex symptom management and psychosocial support. They coordinate care with the resident’s primary care physician and the facility’s medical director to ensure a unified approach to treatment.
The palliative care specialists do not replace the nursing home staff but instead serve as consultants and collaborators. They provide pain management consultations, adjust medications for symptoms like anxiety or insomnia, and help facilitate complex conversations about care goals. The social worker on the team helps the resident and family navigate the healthcare system and provides emotional support. Regular care planning meetings and family conferences are held to align the facility’s day-to-day care with the patient’s personal wishes and values.
Effective communication between the palliative team and the nursing home’s nurses and aides is important to ensure continuity of care around the clock. For instance, a palliative nurse may recommend a specific pain regimen, which the facility staff must then carry out and monitor reliably between visits. This coordinated approach helps to minimize discomfort and stabilize symptoms, which may ultimately help the resident avoid unnecessary trips to the emergency room or hospital.
Steps for Starting and Paying for Palliative Services
The first step for a resident or family seeking palliative care is to discuss the need with the primary care physician or the facility’s medical director. These medical professionals will determine if a resident is appropriate for the service and can then place a referral for a palliative care consultation. Many palliative care programs operate on a consultation basis, functioning similarly to other medical specialists who visit the facility.
The financial coverage for palliative care services differs significantly from the bundled benefit structure of hospice care. Palliative care is generally covered by standard insurance plans, including Medicare Part B and Medicaid, and is billed like any other specialized medical service. For example, a consultation with a palliative care physician or nurse practitioner is billed under Medicare Part B, subject to typical deductibles and co-payments.
This fee-for-service model means that the resident may still have out-of-pocket costs, unlike the comprehensive coverage provided by the Medicare Hospice Benefit. Families should confirm coverage details with the specific palliative care provider and their insurance plan to understand any potential costs. Accessing palliative care early can provide immediate relief and support without requiring a shift away from all curative treatments.