Scenario: When Martha, a 72-year-old grandmother, was diagnosed with end stage kidney disease, she faced a difficult decision. Her doctors informed her that the disease was not curable, and the conversation turned to hospice care. Hospice seemed like a compassionate choice, focusing on comfort and quality of life rather than aggressive treatment like frequent dialysis. 

But Martha hesitated—she fought to receive access to healthcare throughout her life. Was choosing hospice giving up? Could she trust what the doctors said? She wasn’t quite ready to stop certain treatments that might still improve her day-to-day life, like all of her kidney disease medications or her frequent, though very difficult, dialysis.

A solution for this challenge exists–concurrent care.

Concurrent care allows patients to receive both hospice services and treatments aimed at their disease for a limited period of time. Concurrent care means that a patient does not have to immediately and abruptly forgo treatment in order to receive supportive hospice services. Concurrent care is currently only available for some veterans and pediatric patients.

Typically, choosing hospice means giving up treatments to cure a disease. However, concurrent care changes the narrative. It recognizes that patients at the end of life deserve comfort without having to forgo all curative treatments for a transitional period of time while they get used to the reality that they are at the end of their lives.

Some patients benefit greatly from a longer period of transition to recognize the limitations of curative or disease-directed treatment. Model programs have allowed patients to engage in repeated conversations about comfort-only care while receiving hospice supportive care and continuing some disease-directed treatments. 

In one model that tested concurrent care, hospice social workers went to patients’ homes to answer questions over time, to assess how patients were doing, and to offer pain and symptom management while the patient was still receiving disease-directed treatments. Caregivers could ask questions to understand the transition. Social workers and hospice nurses providing the transition care educated and helped encourage patients to recognize the limits of disease-directed care while managing symptoms, which avoided medical crises and emergency hospitalizations. To date, these models allow flexible decision-making for patients, demonstrating high patient satisfaction, improved symptom management and quality of life, fewer hospitalizations, and lower costs.

Martha’s Journey with Concurrent Care

Scenario Resolution: After discussing her options, Martha decided to enroll in hospice care while continuing some treatments through concurrent care. The hospice team provided her with a dedicated nurse, a social worker, and a chaplain who visited regularly to address her physical, emotional, and spiritual needs. At the same time, Martha continued receiving dialysis, though less frequently, while she grew more familiar with the supportive hospice care.

With the help of concurrent care, Martha’s days became less about “giving up” and more about embracing meaningful moments. Her daughter, who had worried about managing her mother’s care alone, felt supported by the hospice team. Martha eventually chose to enroll in hospice only and to stop the disease-directed treatments. 

Why Concurrent Care Matters

End-of-life care should honor a person’s values, goals, and wishes. Concurrent care makes patient-directed care achievable by providing a bridge that combines the compassionate focus of hospice with time to more slowly let go of disease-directed or curative treatments. 

Compassion & Choices is advocating for concurrent care through our federal advocacy to reform the Medicare hospice benefit. We believe that concurrent care is a viable option to help healthcare teams build trust with patients and a support that addresses inequities in access to end of life care.

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