The question of whether hospice care falls under the umbrella of Post-Acute Care (PAC) is a source of frequent confusion within the healthcare system. Both types of care are provided to patients after they have been stabilized in a traditional hospital setting, leading many to group them together. However, the intent, philosophy, and regulatory structures governing each are fundamentally different. Defining what each service offers and its ultimate purpose clarifies the relationship.
Defining Post Acute Care
Post-Acute Care (PAC) is a range of services a patient receives after a hospital stay for an acute condition, illness, or injury. The patient is not yet prepared to return home independently. The goal of PAC is to help the patient transition from acute medical intervention back to their prior level of functional independence or the lowest possible level of care. These services focus on rehabilitation, recovery, and regaining strength.
PAC services are delivered across specialized settings. These include:
- Skilled Nursing Facilities (SNFs) for short-term rehabilitation and medical treatment.
- Inpatient Rehabilitation Facilities (IRFs), which offer intensive, multidisciplinary therapy.
- Long-Term Acute Care Hospitals (LTACs) for patients with complex, hospital-level needs.
- Home Health Agencies (HHAs), providing skilled nursing and therapy intermittently in the patient’s home.
The duration of PAC is short-term, lasting from days to months. The objective is preventing hospital readmission by ensuring the patient can manage their condition. Treatment plans involve physical, occupational, and speech therapy, along with skilled nursing care for managing complex medical needs. The process centers on measurable progress toward functional recovery and a return to community living.
Understanding Hospice Care
Hospice care provides comfort and support for individuals with a terminal illness. Eligibility requires two physicians to certify the patient has a prognosis of six months or less to live. The patient must elect to forgo curative treatments related to the terminal diagnosis in favor of palliative care.
The goal is not recovery or rehabilitation, but maximizing the quality of life remaining by managing pain and other symptoms. Hospice care is delivered by an interdisciplinary team. This team includes nurses, physicians, social workers, spiritual counselors, and trained volunteers. They provide holistic support, addressing the physical, emotional, social, and spiritual needs of the patient and their family.
While most hospice care is provided in the patient’s home, it can also be delivered in residential facilities, nursing homes, or hospitals. Medicare-certified hospices must offer four levels of care. These levels range from routine home care to continuous home care for symptom crises and general inpatient care for short-term symptom management. The focus remains on comfort and dignity throughout the end-of-life journey.
Classifying Hospice Within Healthcare
Hospice is not classified as traditional Post-Acute Care due to the fundamental difference in outcome and treatment intent. While both services may begin after an acute hospital stay, PAC aims for functional recovery. Hospice, conversely, focuses on comfort-focused end-of-life support. This contrast creates a regulatory separation within the healthcare finance system.
The Centers for Medicare & Medicaid Services (CMS) regulates hospice as a separate benefit under the Medicare program. This benefit is governed by different rules and payment models than those covering PAC services like Skilled Nursing Facilities or Inpatient Rehabilitation Facilities. PAC settings operate under payment systems designed to incentivize rehabilitation and discharge, which conflicts with the philosophy of hospice.
Some PAC settings, such as a Skilled Nursing Facility, may provide routine hospice services to a patient. However, the hospice care itself is paid for under the separate hospice benefit. PAC is defined by its rehabilitative intent, whereas hospice is defined by its palliative, non-curative intent. The differing goals mean they occupy separate, non-interchangeable categories within the continuum of care.