What's the Difference Between Palliative Care and Hospice?
You've likely heard of hospice - at least it has been the more common term used in my circle to describe the care given to a person as they neared the end of their life. Many people are less familiar with palliative care and the differences between it and hospice. Perhaps people are unfamiliar with both because it is uncomfortable to talk about a serious illness or tough medical decisions.
Hospice and palliative care can be complimentary to one another when someone is facing a serious illness or the effects of old age. It is important to have difficult conversations and proactively plan for the end of one's life while you are in a strong mental state.
If you are here, you must have some questions about hospice, palliative care, or both. So let's jump to it.
What is Hospice?
Hospice is the holistic and comprehensive care of patients and their families at the end of life. Hospice care is made up of a robust interdisciplinary team. The team can consist of physicians, nurses, social workers, religious advisors, home health aides, and others. Experts on the team cover the physical, psychosocial, spiritual, and cultural aspects of dying. Other professionals that may have a role in hospice, but are less common - nurse practitioner/physician assistant, music therapist, massage therapist, or a child life specialist.
How Does Hospice Work?
Hospice is paid for by private insurance, Medicare A, or Medicaid.
If you are starting hospice, then curing the illness is likely no longer the goal. To many, this seems like doctors and even the patient are "giving up." I prefer the way that Atul Gawande puts it in his book "Being Mortal". I'm summarizing here but he essentially says that often times moving to hospice ends up prolonging a persons life and the goal becomes to help the person live out the rest of their days as comfortable as possible. Let them enjoy the end of their life instead of experiencing a myriad of tests and appointments that may not serve them anyway. The takeaway for me as I read this book was that we live longer once we stop trying to live longer.
Go grab a copy of his book here. Or if you don't have time, give this Harvard Blog Post a read.
Your doctor/primary provider remains involved with planning and caring for you.
Hospice is not only for people dying. You might still lead a somewhat normal life while on hospice.
If the patient is under 21, hospice care can be provided at the same time as traditional medical care (they call this concurrent care).
How Does Someone Qualify for Hospice?
The general rule for hospice eligibility is that the person is expected to live less than six months. That said, many people end up on hospice for longer than six months. The goal and focus of hospice care is not to find a cure, but to provide comfort. It is a good chance to allow people to make decisions according to their desires while they are still able. Hospice is meant to provide comfort-focused care to support their medical, spiritual and mental well-being until they pass away.
Where Can I Receive Hospice Care?
Hospice is available 24/7, every day of the year. Depending on the situation, hospice may take place in home, at a hospital, in a nursing home or an in-patient hospice facility. The level of care required and your preferences will both be considerations. The most common form of hospice is called routine level of care and is most commonly provided in the person's home or living facility. Everything needed for hospice care is delivered to the location (medicine, equipment, etc.) A nurse is always available by phone and they have access to on-call hospice physicians/providers if more help is needed. Overnight and holiday visits are provided by a nurse or another appropriate team member if necessary.
The next level of hospice care is used if the care team can't manage your symptoms at home. This is called general in-patient care (GIP) you may qualify for general in-patient care (GIP).
While there are other levels of hospice care, these are the main ones.
What is Palliative Care?
Palliative care is focused on providing care regardless of your ultimate goal. This includes prioritizing the comfort, symptom management, and quality of life for seriously ill people. Goals can be any of the following: obtaining a cure, prolonging life, or being comfortable at the end of your life. Palliative care teams consist of an interdisciplinary team that may include a physician, nurse practitioner, nurse, social worker, and a religious advisor.
Alfred Tip: have a few extra minutes? Use the time to create an advanced directive, power of attorney, or will.
What Do Palliative Care Teams Do?
Palliative care teams manage symptoms, pain, and any resulting issues that affect patients and their families. The teams tend to the physical, emotional, and psychological needs of the patient. Caregivers facilitate ongoing advance care planning conversations to identify a trusted person to serve as your Health Care Proxy. It is important for the team to understand your wishes for end-of-life care and document those wishes within a Living Will, Physician Orders for Life-Sustaining Treatment (POLST), and/or Do Not Resuscitate/Do Not Intubate (DNR/DNI) form.
If you are in need of these forms, fill out this form to connect with a qualified attorney in your area. Fill out this five question form and we'll get you in touch with the best attorney in your area. If you are receiving palliative care, you may also be receiving other types of treatments such as nursing care, physical therapy, occupational therapy, chemotherapy, dialysis, etc. Care teams can also assist you during transition periods, like returning home after a hospitalization.
Who Qualifies for Palliative Care?
Adults and children in the following situations:
One or more serious illness
Frequent hospitalizations
Steadily declining health and/or progression of a disease or condition
Uncontrolled symptoms
In need of support and conversations related to advanced care planning
In need of additional psychosocial support
Where Do People Receive Palliative Care?
Palliative care is available almost anywhere you might think of. This includes hospitals, nursing homes, rehab facilities, doctors’ offices, dialysis units/centers, or at home.
Palliative Care vs. Hospice
If you still have questions, this table can quickly illustrate the differences.
| Palliative Care | Hospice |
Diagnosis | May still be seeking cure for illness | No longer seeking a cure |
Treatment | Serious, life threatening illness or declining health | Life threatening condition |
Prognosis | No limit | Life expectancy of 6 months or less |
Payment | Private insurance, Medicare B, Medicaid | Private insurance, Medicare A, Medicaid |
Duration | Varies | Until death or no longer meet criteria |
Team | Varies | Always includes nursing, home health, social worker, spiritual care |
Frequency | Out-patient: At least monthly, varies with needs. In-patient: Daily, varies with needs. | Nurses visit every two weeks, more as needed. Other team members vary. |
Other Services | No impact | May need to cancel other insurance covered treatments |
How to Get Palliative and Hospice Care
There are a number of ways. You can simply talk with your medical team or call a local hospice and palliative care agency. Anyone can start the palliative care and hospice process for you. If you're struggling to know what to say, here are a few simple questions for you to ask:
“Can I have a palliative care consult?”
“Can I ask you about what to expect from my disease and how to plan for the future?”
“I’m tired of going to the hospital. I want to spend the rest of my time in comfort, on my own terms. Can you help me achieve this?”
There are certain life insurance policies that can be used while you are still living to help cover medical bills. See if you qualify through Ethos Life Insurance.
Share Your Wishes for End-of-life Care
Alfred is meant to be a resource for you. If you are end-of-life planning for yourself or a loved one, use our simple, robust tool to organize all of your most important information.
If you would like to use the best available tool to plan ahead for FREE, fill out this simple four question form.