TriCentral PC Toolkit : Chapter 2: Understanding Palliative Care and the TriCentral PC Program : How the TCPC program is similar to and different from hospice care

The TCPC Program is modeled after Kaiser Permanente's hospice program in that it targets seriously ill patients near the end of life and offers them superb pain management and other symptom control in the comfort of their home. Both programs emphasize "high touch" over "high tech" as they work to customize end-of-life care to match the patient's and family's preferences and values. Both treat the whole patient, taking into consideration the person's physical needs as well as his or her social, emotional, and spiritual needs.

For all their similarities, the TCPC and hospice programs have important differences. Part of the difference is regulatory: Kaiser Permanente's hospice program is designed to meet the federal regulatory guidelines for Medicare-approved hospice programs, while the TCPC Program is governed by Medicare regulations for home health services.

From a patient standpoint, however, the most significant differences are in the admission criteria and the treatments available, with the TCPC Program offering more treatment options to a larger patient population than the hospice program. These enhancements, described below, are intended to prompt timely referrals to the TCPC Program.

In the TCPC Program, physicians are not required to give a six-month prognosis, as they must for any hospice admission. Recognizing that it is often difficult to estimate life expectancy, referral guidelines are relaxed. Primary physicians are asked to refer any patient if they "would not be surprised if this patient died in the next year." Thus, as a general rule, palliative care patients are accepted into the program with a prognosis of 12 months or less to live.
While the TCPC Program emphasizes much improved pain control and other symptom management, patients do not have to forego curative care, as they do in the hospice program.
Patients are assigned a palliative care physician who coordinates care from a variety of healthcare providers, including specialists and the patients' primary care physician, thus preventing the service fragmentation that often occurs in healthcare systems.

The chart on the following page gives you a side-by-side comparison of the hospice program and the TCPC Program.

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For more information about the TriCentral Palliative Care Toolkit visit www.growthhouse.org/palliative/. All content is Copyright © 2002, 2003 by Richard D. Brumley, M.D. All rights reserved. No part of this toolkit may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publishers. This guide to developing home-based outpatient palliative care services was developed through a grant to the Kaiser Permanente TriCentral Service Area from The Project on Death In America. The Kaiser Permanente TriCentral Palliative Care Program is a Sustaining Member of the Inter-Institutional Collaborating Network On End-of-life Care (IICN) which links major organizations internationally.