Question

Why do long-term health care and palliative care private insurance lack popularity among elderly individuals in the United States?

Answer 1

Ans. Medicare, Medicaid and most private health insurers provide a full array of palliative care services for patients who are hospitalized or in hospice care, including pain management, care coordination, 24-hour help lines, advanced care planning, and social and spiritual services. Their families are also usually eligible for caregiver support services.

The same is not true for patients with serious, debilitating conditions who are not hospitalized or in hospice, which is generally for people who are expected to live six months or less.

Many insurance plans cover some palliative care services, such as pain management. But they tend not to cover services delivered by registered nurses, social workers and chaplains. Many Medicare, Medicaid and private insurance plans offer scant or no coverage of home visits, coordination of care, wound care, social and spiritual counseling, 24-hour hotlines, advanced care planning and family support.

This is particularly true when the insurance plan is a “fee for service” plan, which means providers are paid for each treatment or procedure. Managed care plans, under which providers are paid a lump sum each month to cover the care of each patient, are more likely to cover palliative services.

As an example, A doctor making a palliative care visit to a 103-year-old patient at her home in Santa Clarita, California. Insurance coverage for community-based palliative care is limited, but some state and federal steps may increase access.Jeannee Parker Martin’s mother will be 99 this year, and she still lives alone in the house in the Midwest where she raised her children. At 92, she was diagnosed with a slow-moving breast cancer to go along with her vascular disease.

Despite those serious conditions, doctors did not think Martin’s mother was near death, which meant her Medicare plan, like many health plans, did not cover what’s known as palliative care — treatments intended to provide relief from the symptoms and stress of serious chronic disease, such as pain, nausea, dizziness, anxiety and depression, as opposed to the disease itself.

A visiting palliative care nurse likely would have detected and tended to the sores that periodically developed on her legs because of her vascular illness. At least three times over the last four years, Martin said, they became open wounds that required intensive rounds of treatment at an outpatient hospital clinic.

Palliative care has been shown to increase patients’ satisfaction with the care they receive and to save on medical expenses by reducing the need for hospitalizations and trips to the emergency room.

Despite dramatic growth in the number of hospitals providing such care over the last decade, full palliative care services remain unavailable to many patients. But those who work in the field say they are encouraged by several developments over the last five years.