The Difference Between Hospice and Palliative Care: Under...

The Difference Between Hospice and Palliative Care: Understanding Your Options

When facing a serious illness, you may hear healthcare providers mention both "hospice care" and "palliative care." While these terms are sometimes used interchangeably, they represent distinct approaches to care with different eligibility criteria, services, and goals. Understanding the differences helps patients and families make informed decisions about the most appropriate care for their situation.

What is Palliative Care?

Palliative care is specialized medical care focused on providing relief from symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and their family, regardless of the diagnosis or stage of disease.

Key Characteristics of Palliative Care

Available at Any Stage: Palliative care can begin at diagnosis and continue throughout treatment. You don't need to have a terminal prognosis or stop curative treatment to receive palliative care.

Works Alongside Curative Treatment: Patients can receive palliative care while also pursuing treatments aimed at curing or controlling their disease. Palliative care complements—rather than replaces—other medical care.

Addresses Multiple Needs: Palliative care teams address physical symptoms like pain and nausea, as well as emotional, social, and spiritual concerns that accompany serious illness.

Interdisciplinary Approach: Palliative care teams typically include physicians, nurses, social workers, chaplains, and other specialists who work together to provide comprehensive support.

No Time Limit: Patients can receive palliative care for years if needed, as long as they have a serious illness that would benefit from symptom management and support.

Who Benefits from Palliative Care?

Palliative care is appropriate for anyone with a serious, chronic, or life-threatening illness, including:

Cancer at any stage
Heart disease
Lung disease (COPD, pulmonary fibrosis)
Kidney disease
Dementia or Alzheimer's disease
Neurological diseases (ALS, Parkinson's, multiple sclerosis)
HIV/AIDS
Liver disease
Stroke
Any condition causing significant symptoms or impacting quality of life

What is Hospice Care?

Hospice care is a specific type of palliative care designed for people who are nearing the end of life. Hospice focuses on comfort and quality of life when cure is no longer the goal.

Key Characteristics of Hospice Care

Terminal Prognosis Required: To qualify for hospice, a physician must certify that the patient has a terminal illness with a life expectancy of six months or less if the disease follows its expected course.

Curative Treatment Ends: When electing hospice benefits, patients agree to forego treatments aimed at curing their illness. However, they can revoke hospice benefits at any time to pursue curative treatment.

Comprehensive End-of-Life Support: Hospice provides all services and medications related to the terminal illness, along with extensive support for patients and families during the dying process and bereavement.

Specific Benefit Periods: Medicare hospice benefits are provided in defined periods (two 90-day periods followed by unlimited 60-day periods), with recertification required to continue care.

Bereavement Services: Hospice includes grief support for family members for up to 13 months after the patient's death.

Who Benefits from Hospice Care?

Hospice is appropriate when:

A physician has certified a terminal prognosis of six months or less
The focus of care has shifted from cure to comfort
Aggressive treatments are no longer desired or beneficial
The patient and family want comprehensive end-of-life support

Key Differences Between Palliative Care and Hospice

Understanding the distinctions helps clarify which type of care is most appropriate for your situation.

Timing and Prognosis

Palliative Care: Can begin at any point after diagnosis of a serious illness. No specific prognosis required. Can continue for years.

Hospice Care: Requires a terminal prognosis of six months or less. Typically provided in the final months, weeks, or days of life.

Curative Treatment

Palliative Care: Patients can continue receiving treatments aimed at curing or controlling their disease while also receiving palliative care.

Hospice Care: Patients agree to forego curative treatments for their terminal illness, though they can receive treatments for unrelated conditions and can revoke hospice to pursue cure at any time.

Goals of Care

Palliative Care: Focuses on symptom relief and quality of life while also supporting curative or life-prolonging treatments.

Hospice Care: Focuses exclusively on comfort, quality of life, and support during the dying process. The goal is peaceful, dignified end-of-life care.

Location of Care

Palliative Care: Typically provided in hospitals, outpatient clinics, or long-term care facilities. Some programs offer home-based palliative care.

Hospice Care: Can be provided at home, in assisted living facilities, nursing homes, hospitals, or dedicated hospice facilities, depending on patient needs and preferences.

Insurance Coverage

Palliative Care: Coverage varies by insurance plan. Some services may not be fully covered, and patients may have copays or deductibles.

Hospice Care: Fully covered by Medicare, Medicaid, and most private insurance with little to no out-of-pocket cost. Includes all services and medications related to the terminal illness.

Team Composition

Palliative Care: Interdisciplinary team that consults with and supports the patient's primary medical team.

Hospice Care: Interdisciplinary team that assumes primary responsibility for all care related to the terminal illness.

Similarities Between Palliative Care and Hospice

Despite their differences, palliative care and hospice share important commonalities:

Patient-Centered Philosophy: Both prioritize the patient's goals, values, and preferences in care planning.

Symptom Management: Both excel at managing pain and other distressing symptoms.

Holistic Approach: Both address physical, emotional, social, and spiritual needs.

Family Support: Both recognize that serious illness affects the entire family and provide support accordingly.

Interdisciplinary Teams: Both use teams of specialists working together to provide comprehensive care.

Quality of Life Focus: Both aim to maximize quality of life and comfort.

Transitioning from Palliative Care to Hospice

Many patients receive palliative care for months or years before transitioning to hospice care as their illness progresses. This transition can be smooth and natural when:

Signs It May Be Time to Consider Hospice

Treatments are no longer effective at controlling the disease
Side effects of treatment outweigh benefits
Frequent hospitalizations are occurring
Functional decline is progressing
The patient expresses a desire to focus on comfort rather than cure
The physician indicates that prognosis is now six months or less

Making the Transition

Transitioning from palliative care to hospice doesn't mean abandoning your care team. In fact, many palliative care providers work closely with hospice programs to ensure continuity of care. Your palliative care team can:

Help you understand when hospice might be appropriate
Provide referrals to hospice programs
Continue to consult on your care if needed
Support your family through the transition

Common Misconceptions

Several myths create confusion about palliative care and hospice.

Myth: Palliative Care is Only for People Who Are Dying

Reality: Palliative care is appropriate at any stage of serious illness, from diagnosis onward. Many people receive palliative care for years while also pursuing curative treatment.

Myth: Choosing Hospice Means Giving Up

Reality: Hospice represents a shift in goals from cure to comfort, not giving up. Many families find that hospice allows them to focus on what matters most—quality time together and meaningful experiences.

Myth: You Can't Change Your Mind About Hospice

Reality: Patients can revoke hospice benefits at any time to pursue curative treatment or for any other reason. They can re-elect hospice benefits later if desired.

Myth: Palliative Care and Hospice Are the Same Thing

Reality: While hospice is a type of palliative care, not all palliative care is hospice. The key differences relate to prognosis, curative treatment, and timing.

Myth: Hospice Hastens Death

Reality: Research shows that hospice does not hasten death. In fact, some studies suggest that hospice patients may live as long or longer than similar patients receiving aggressive treatment, likely due to better symptom management and reduced stress.

How to Access Palliative Care and Hospice

Getting Palliative Care

Ask Your Doctor: Request a referral to palliative care specialists. Many hospitals have palliative care teams.

Contact Programs Directly: Some palliative care programs accept self-referrals.

Check Your Hospital: Many hospitals offer palliative care consultations for admitted patients.

Explore Home-Based Options: Some organizations provide palliative care at home.

Getting Hospice Care

Physician Referral: Your doctor can refer you to hospice when appropriate.

Self-Referral: You or your family can contact hospice providers directly to discuss eligibility.

Hospital Social Workers: If hospitalized, social workers can help arrange hospice care.

Palliative Care Team: If you're receiving palliative care, your team can facilitate transition to hospice when appropriate.

Questions to Ask When Considering Palliative Care or Hospice

For Palliative Care:

What symptoms can palliative care help manage?
How will palliative care work with my current treatment plan?
Where will I receive palliative care services?
What will my insurance cover?
How often will I see the palliative care team?
Can I continue seeing my regular doctors?

For Hospice:

What services are included in hospice care?
Where can I receive hospice care?
What happens if I want to pursue curative treatment again?
How quickly can hospice services begin?
What support is available for my family?
What happens if I live longer than six months?

The Role of Advance Care Planning

Whether considering palliative care or hospice, advance care planning helps ensure your wishes are known and honored.

Important Documents

Advance Directive: Legal document specifying your healthcare wishes if you become unable to communicate.

Living Will: Specifies what medical treatments you do or don't want.

Healthcare Power of Attorney: Designates someone to make healthcare decisions on your behalf if you cannot.

POLST/MOLST Form: Physician orders for life-sustaining treatment that travel with you across care settings.

Having the Conversation

Discuss your values, goals, and preferences with:

Your healthcare providers
Your designated healthcare decision-maker
Family members who will be involved in your care
Your palliative care or hospice team

These conversations ensure that care aligns with what matters most to you.

Choosing the Right Care for Your Situation

The decision between palliative care and hospice depends on your specific circumstances, prognosis, goals, and preferences.

Consider Palliative Care If:

You have a serious illness but are still pursuing curative treatment
You want help managing symptoms while continuing disease-directed therapy
Your prognosis is uncertain or longer than six months
You want additional support but aren't ready to focus exclusively on comfort care

Consider Hospice If:

Your prognosis is six months or less
You want to focus on quality of life rather than cure
Managing symptoms at home is becoming difficult
You and your family need comprehensive end-of-life support
Frequent hospitalizations are impacting quality of life

You Can Have Both

Some patients receive palliative care for extended periods before transitioning to hospice as their illness progresses. This sequential approach provides appropriate support at each stage of the illness journey.

Conclusion: Accessing the Right Care at the Right Time

Understanding the difference between palliative care and hospice empowers you to make informed decisions about your care. Both approaches offer valuable support, symptom management, and improved quality of life—the key is accessing the right type of care at the right time for your situation.

You don't have to navigate these decisions alone. Healthcare providers, palliative care specialists, and hospice teams can help you understand your options and choose the path that best aligns with your goals and values.

At Preferred Hospice Care, we're committed to helping patients and families understand their care options. Whether you're exploring palliative care, considering hospice, or transitioning between the two, our compassionate team is here to provide guidance, support, and expert care.

Contact Preferred Hospice Care at (888) 264-4401 to discuss palliative care and hospice options for you or your loved one.