[Skip to Navigation]
Invited Commentary
October 2018

Hospice Use and Palliative Care for Patients With Heart Failure: Never Say Never in Medicine, but It Is Never Too Early to Start the Conversation

Author Affiliations
  • 1Department of Medicine, Adult Palliative Care Services, Columbia University Medical Center, New York, New York
  • 2Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
JAMA Cardiol. 2018;3(10):926-928. doi:10.1001/jamacardio.2018.2750

Hospice is both a benefit and a philosophy of care to maximize the quality of life for patients whose prognosis seems less than 6 months. An interdisciplinary team, including physicians, nurses, social workers, and spiritual/bereavement counselors, provides expert medical care, symptom management, and emotional and spiritual support expressly tailored to the patient’s needs and wishes. Support is provided to the patient’s family as well.1 One of its goals is to move the end-of-life care from acute care hospitals to the home. In the United States, the Medicare Hospice Benefit pays for approximately 80% of all hospice care. Medicare Hospice Benefit pays for covered services using a per diem capitated arrangement in 1 of 4 levels of care, Routine Home Care, Respite Care, General Inpatient Care, and Continuous Home Care. Routine Home Care is the most common level of hospice care (98%) and this is provided at “home,” which includes private residence or nursing facility. When care at home is difficult owing to acute symptom management or impending death, acute inpatient care can be provided as General Inpatient Care level (1.5%) in a Medicare-contracted hospital or hospice inpatient facility.1

Add or change institution