As you or a loved one face serious health challenges, you may see the need for additional care. You have probably heard of hospice and palliative care, two different types of services available to individuals and families in need. We want to define, explain, and compare hospice and palliative care with the hope that this information may help with your health decisions.
What is palliative care?
Palliative care is symptom-focused care for a person with a serious illness, regardless of diagnosis or prognosis. It has an interdisciplinary approach and provides a layer of care in addition to primary care. By interdisciplinary, we mean that an entire team of people will meet to address the needs of the whole person, including physical, mental, emotional, and spiritual needs. This team may include doctors, nurses, physical therapists, pain management professionals, a chaplain, social workers, financial counselors, and administrative assistants.
People struggling with a life-threatening illness or severe diagnosis would qualify for palliative care. The goals of palliative care include relief from physical and psychological distress while providing an overall blanket of support to the patient and their family.
For example, a young woman diagnosed with breast cancer may live another 50 years. But at the time of her diagnosis, she is distressed for herself, her husband, and her young children. Palliative care might be an excellent temporary fit for this family. In contrast, for those in a more terminal situation, palliative care can be a graceful way to transition a patient and their family, eventually, to hospice care.
A primary care doctor refers patients to palliative care the same way he refers them to any specialist. Receiving palliative care does not mean you are about to die or that medical professionals are giving up on you. On the contrary, palliative care can improve the quality of life and help an individual live longer. Palliative care is usually temporary, yet, it is available for as long as the patient needs it.
What is hospice care?
Hospice care also treats symptoms and all physical and psychological needs. However, it is usually focused care that is provided for the last six months of a person’s life. Hospice is federally funded care; therefore, everyone should have equal opportunities. To receive hospice care, at least two doctors must agree that their patient has a reasonable life expectancy of six months.
A common myth is that hospice is a place to go and die. More commonly than not, hospice care takes place in the comfort of one’s own home and may last several months. A little-known fact is that hospice care can be provided for longer than six months, as long as the person fits the qualifications. Then recertification can take place every six months.
Most professionals agree that the earlier a person gets into hospice, the better they will be able to enjoy life. Yet, a person in hospice does not have to stay in hospice. They may be improving in health or may want to try an experimental treatment. You are not stuck once you start: people can go in and out of hospice at will.
Some people may feel panicked when they hear the word “hospice.” They may think, “It’s too soon for hospice – I’m not ready to die!” Hospice is not just for the last lingering days of life; it is about providing quality vs. quantity of life. And it is not only about pain management. Caregivers can provide antibiotics, any needed medications, counseling, and personalized symptom treatment. However, no chemotherapy or radiation treatments are allowed during hospice. Many people find that they feel better once they start hospice care.
Chronic terminal patients with diseases that wax and wane sometimes come on and off hospice. These diseases commonly include Alzheimer’s, congestive heart failure, COPD, and Parkinson’s. The trajectory is usually steeper for advanced cancer patients, who can experience a faster decline. Some people think they are giving up if they sign up for hospice; however, this does not have to be true. Hospice aims to help people enjoy their lives, eventually providing end-of-life care that allows them the opportunity to die with the respect, comfort, and dignity they deserve.
What are the differences?
Hospice has a shorter life expectancy, whereas palliative care is not limited to any particular amount of time. Palliative care is added to primary care, whereas when patients are under hospice care, hospice becomes the primary caregiver and takes over all medical services. Palliative care treats the symptoms but is also curative. Hospice primarily focuses on comfort care, reducing physical and mental stress, and complex symptom relief.
What are the similarities?
Both palliative and hospice care concentrate on symptom management. In addition, both have a team approach to care, in which they look at the whole person and not just the disease. Is there something else causing distress besides the illness, such as financial, emotional, and spiritual burdens, that can be addressed? Both hospice and palliative care teams provide doctors, nurses, chaplains, social workers, psychologists or counselors, and administrative assistance. Insurance, including Medicare, usually covers palliative and hospice expenses.
What role do family members play in palliative and hospice care?
The role of family members is similar in both palliative and hospice care. The hands-on, day-to-day care for the patient usually comes from the family, except when a patient moves to a hospice facility. Palliative and hospice care professionals provide support for family members who may be experiencing caregiver burnout and distress. Both hospice and palliative care want to meet with close family members alongside the patient to discuss treatment plans and offer support.
Family members often need to assist the patient in ensuring that they have advanced health care directives in place. Documenting desires for a power of attorney and life-support interventions will guide future care and communicate end-of-life wishes before that time comes.
We hope this information will help you make the best decisions for yourself or your loved one. This world is graced with wonderful palliative care and hospice care professionals who dedicate their lives to provide respectful, thoughtful, and personalized care for you and your family. Do not hesitate to contact your primary care physician to learn more about the health care options available for you now and in the future.
Julie McFadden, a hospice nurse. The Patient Story.
Dr. Kate Lally, Medical Director of Palliative Care New England (2015): Institute for Healthcare Improvement (IHI): The difference between palliative care and hospice care.
Amy Newton (2016): UT Tyler Health Science Center: Palliative Care vs. Hospice: How Are They Different? (MD) & Bonsall (MSN, RN, CRNP),
Lippincott Nursing Center, Wolters Klewer (2018): Palliative Care and Hospice Care.
Zeng, Y. S., Wang, C., Ward, K. E., & Hume, A. L. (2018). Complementary and alternative medicine in hospice and palliative care: a systematic review. Journal of pain and symptom management, 56(5), 781-794.