It’s a tough situation: you have a fatal condition. You require care beyond what family members can provide at home. But with a prognosis of more than six months to live, you are not ready for hospice care.

And an intensive care unit is too, well, intense, to say nothing of expensive.

So what do you do? Now there’s another option. Some hospitals are offering so-called palliative care units.

Palliative care focuses on treating your symptoms — like severe pain, or difficulty breathing — to make you more comfortable, and on offering emotional support to you and your family. It’s not designed to cure an underlying condition.

It has long been associated with hospice care — that is, given at the very end of life and often, but not always, at your home. But it is becoming increasingly clear that palliative care can help patients who suffer from serious chronic conditions but who are not necessarily expected to die imminently, and who may still benefit from some forms of high-tech treatment.

“Lots of older people with advanced chronic illnesses are not ready for hospice,” said Marlene McHugh, assistant professor of nursing at Columbia University School of Nursing and a co-author of a recent study focused on the acute palliative care unit at Montefiore Medical Center in New York. “We’re going to see more and more of this as patients age.”

Nearly 90 percent of large American hospitals — those with at least 300 beds — already have palliative care consultation services, according to the Center to Advance Palliative Care, located at Icahn School of Medicine at Mount Sinai in New York. The services are made up of teams of specially trained doctors, nurses and social workers who consult with your primary physician.

Designated palliative care units in hospitals are less common (fewer than 10 percent of hospitals have them). They’re beginning to catch on, though, as hospitals seek to give patients appropriate care while holding down costs.

Treating patients in a palliative care unit can free up costly beds in intensive care units for other patients. The Montefiore study, published in The American Journal of Hospice and Palliative Medicine, found that the palliative care unit provides “cost-effective acute care” for patients with advanced chronic illnesses, as well as those who are near death. Other studies involving more hospitals have shown similar findings.

Who might be treated in a palliative care unit? Perhaps an end-stage cancer patient needing treatment for an infection and high doses of pain medication; or an elderly patient with dementia, who needs a ventilator to help with breathing, or medicine to help with shortness of breath if the machine is removed.

“The goal is to make patients more comfortable,” said Dr. Serife Eti Karakas, a clinical assistant professor at Albert Einstein College of Medicine and the lead author of the Montefiore study.

Hospitals with a dedicated unit generally have private rooms for patients, accommodations for family members who want to stay overnight and meeting rooms for family consultations and private phone calls.

The units allow some flexibility for patients who don’t meet the relatively narrow criteria for hospice care or who aren’t emotionally ready to seek it. Generally, “a patient in a palliative care unit can get more aggressive therapy,” said Donald Schumacher, chief executive of the National Hospice and Palliative Care Organization.

While some patients ultimately die in the palliative care unit, many others are stabilized so they can be discharged — to a nursing home or, depending on their situation, to their own home, or to hospice care. “It’s the best of both worlds,” said Dr. Diane Meier, director of the Center to Advance Palliative Care.

Here are some questions to consider if you are advised to receive treatment in a palliative care unit:

1. Who should help make the decision about treatment?

Your doctor will consult the hospital’s palliative care team, and they’ll discuss your options with you and family members who may be involved in your care. Palliative care specialists are trained to help patients and families make such decisions.

2. Does my insurance cover all the costs?

Medicare and private insurance plans generally cover care in an in-hospital palliative care unit, just as with other hospital admissions. Your share of the cost depends on your plan’s benefits. With traditional Medicare, for instance, you’ll probably have a deductible for your overall hospital stay. And you’ll also have a separate payment — typically, 20 percent of the cost — for services provided by a palliative care doctor or nurse practitioner, just as you would for a consultation with a cardiologist or other specialist.

3. How should I decide when to enroll in hospice care?

That’s a decision that also should be made after talking to your doctor, as well as your palliative care team and family. Once a patient enrolls in hospice, which is covered as a special Medicare benefit, he or she generally pays nothing, although there may be some co-payments required, like those for medications. Patients in hospice, however, agree to forgo treatment aimed at curing their illness. They can always choose to stop hospice care, though, if their condition improves or if they simply change their mind, Mr. Schumacher said.

E-mail: ann.carrns@gmail.com

Article source: http://www.nytimes.com/2013/09/04/your-money/deciding-when-to-enter-a-palliative-care-unit.html?partner=rss&emc=rss