What is the Difference Between Palliative Care and Hospice?


When our loved ones are suffering through a serious or terminal illness, all we want is for them to be well taken care of and free from pain. Palliative care and hospice care are the two primary options to help make this happen. They both offer relief from the symptoms, pain, and anxiety of serious illness by addressing the needs of the patient and their family. And while all hospice care is palliative in nature, not all palliative care is hospice care.

So what is the difference between palliative care and hospice care? 

Hospice care provides a restful, comfortable experience for end-of-life patients who are no longer undergoing curative treatment, while palliative care combines symptom management and comfort measures with ongoing therapies. As such, our loved ones often spend much longer in palliative care than they would in hospice, with better outcomes. 

If you’re facing a decision between the two, read on to learn about the different eligibility standards, goals, coverage options, and ultimate reasons for choosing either palliative or hospice care.

Palliative Care: What You Need to Know

Palliative care is specialized medical care for people coping with a serious illness. The treatment seeks to relieve the symptoms of the illness and improve the quality of life for the patient and their family. 

Based on needs, not prognosis, palliative care takes an interdisciplinary approach to treating the patient and includes a team of doctors, nurses, and specialists. Not restricted to terminal diseases, palliative care is appropriate at any age and at any stage of illness. Palliative care is often concurrent with curative treatment, unlike hospice care.

Palliative Care Eligibility and Goal of Care

When should someone be offered palliative care? Any patient at any stage of a serious illness is eligible for palliative care. Patients with cancer, chronic lung disease, Alzheimer’s disease, amyotrophic lateral sclerosis, AIDS, heart disease, and others often choose palliative care to mitigate their symptoms while continuing treatment.

This is the exact goal of palliative care: to provide relief from the symptoms and stress of the illness. Some of the most common symptoms that interfere with a patient’s quality of life include:

  • Pain
  • Nausea and vomiting
  • Constipation
  • Diarrhea
  • Bowel or bladder dysfunction
  • Appetite loss
  • Chronic cough
  • Delirium or confusion
  • Physical weakness
  • Shortness of breath or difficulty breathing
  • Depression
  • Insomnia

Palliative care specialists and nurses seek to treat these symptoms through a combination of therapies, ranging from medication and physical assistance to emotional and spiritual support.

What Are the Types of Palliative Care?

Palliative treatments are tailored to the individual patient’s needs, but often include a combination of the following:1

  • Social – This type of care helps family members and caregivers cope with their loved one’s serious illness. Some of the interventions may include organizing family meetings, providing community support, and assisting with care duties to alleviate the burden on the patient’s loved ones.
  • Emotional – Terminal or life-limiting illnesses can be difficult to process, both for the patient and their inner circle. Counselors, psychologists, and other specialists offer support for patients and family members to cope with the situation.
  • Spiritual – This type of care helps patients and family members address spiritual questions, using faith-based communities to provide spiritual support. If a patient isn’t a practicing member of a specific religion, non-denominational chaplains can work with them to address spiritual concerns.
  • Mental – This type of care addresses mental health issues that arise from serious illnesses, such as insomnia, stress, depression, delirium, confusion, or anxiety. Interventions may include meditation, counseling, or medication.
  • Financial – Medical care can be expensive and may lead to additional stress on family and friends. Palliative financial care provides guidance for medical leave or disability applications, billing and insurance, and low-cost or free medication options.
  • Physical – Severe physical symptoms, such as fatigue, nausea, appetite loss, difficulty breathing, insomnia, and pain, can diminish a patient’s quality of life. Physical care addresses the range of symptoms with medication, physical therapy, or nutrition. For example, palliative care might be appropriate for someone learning how to recover from a stroke

Coverage for Palliative Care

Palliative care consultations and certain treatments are covered by Medicare and most private insurance companies. However, palliative care is not as widely or fully covered as hospice care, and depending on your insurance plan, you’re likely to still pay for some or all of:2

  • Your monthly premiums and annual deductible
  • Out-of-pocket co-pays for prescription medications
  • Some doctor and specialist visits
  • Coinsurance for inpatient care, in some cases
  • Coinsurance for expenses regarding prescription drugs

Is Palliative Care the Same as End-of-Life Care?

Palliative care focuses on improving the quality of life and managing the symptoms of a patient with a life-threatening or life-limiting illness but is available to patients at any stage of progression. While palliative care may include end-of-life care, planning, and support for late-stage patients, it’s not limited to terminal cases. 

Hospice care, on the other hand, is exclusively for end-of-life patients, usually with a prognosis of six months or less and limited available therapeutic options.

Hospice Care: Everything You Need to Know

Hospice care is specialized care that offers support, comfort, and preserved dignity at the end of life. When a patient forgoes curative treatment and is given a prognosis of six months or less, hospice care can address the physical, emotional, and spiritual quality of life through interdisciplinary care. 

A hospice patient is cared for by a hospice team, which may include a board-certified physician, nurse, nurse practitioner, social worker, spiritual support counselor, and home health aide. Care may take place in an inpatient hospice facility, assisted living facility, long-term care home, or patient home. 

Hospice Care Eligibility and Goal of Care

Due to Medicare requirements, hospice care is only available for patients with a life expectancy of six months or less.3 The physician and hospice coordinator work together to determine life expectancy and hospice care eligibility. 

The goal of hospice care is not to seek a cure for the illness but to manage pain and symptoms and improve the patient’s quality of life for however much time they have left. Some hospice patients have chosen to forgo painful or debilitating treatments that have no guarantee of improving or extending their life. When this happens, the focus of hospice is to manage pain, discomfort, and anxiety as patients approach the end of their life.

The Four Levels of Hospice Care

Hospice has four levels of care, as defined by Medicare.4 These include:

  • Routine home care – This is a basic level of hospice care provided in the patient’s home, assisted living facility, or long-term care home. At this level, hospice staff works with a patient’s physician to provide comfort measures for the end of life, including spiritual support, bereavement counseling, medical social services, medication, equipment, and adaptive equipment related to the diagnosis.
  • Continuous home care – At this stage, a nurse stays at the patient’s home for an extended period of time to handle medical crises or severe symptoms, such as pain or breathing difficulties. If the symptoms progress, a physician or nurse may decide to move the patient to an inpatient facility to better monitor and manage their care.
  • General inpatient care – Patients receive more advanced care in an inpatient hospice facility. The goal of inpatient hospice care is to control pain and symptoms with a short stay, allowing the patient to return to their home and continuous home care after treatment, if possible.
  • Respite care – Respite care is provided occasionally and involves short-term breaks to relieve family members. These breaks are planned in advance and allow caregivers to rest and recharge after assisting a loved one with a serious illness. Respite care is offered at Medicare-certified inpatient hospice facilities, skilled nursing facilities, and hospitals that can provide 24/7 nursing care as needed.

Coverage for Hospice Care

Hospice is typically covered by Medicare, Medicare Advantage, VA benefits, Medicaid, and private insurance plans.5 Most coverage offers low or no out-of-pocket expenses for life-limiting illness treatment, medication, supplies, and equipment. 

Does Hospice Care Mean You’re Dying?

Hospice care does not mean a patient is dying. However, hospice care is generally intended for patients with a life expectancy of six months or less. This prognosis doesn’t mean the patient will die during that time, just that the physician believes they could, and would benefit from hospice support.

How Long Can You Be In Hospice Care?

As long as a doctor certifies that a patient’s prognosis is six months or less, the patient is eligible for hospice care with Medicare and most private insurances. If the patient survives past the six-month period but the physician recertifies their terminal status, they can continue to receive the palliative care they need in hospice. 

Patients with terminal illnesses can enter periods of remission and therefore may enter and exit hospice care as their condition improves or declines. If a patient leaves hospice care during a remission period, insurance will typically discontinue coverage until such a point where the patient’s condition declines again and hospice care is once again deemed suitable.

Improve Quality of Life With Alliance’s In-Home Palliative Care

Despite the differences between palliative and hospice care, one fact remains: our loved ones deserve the best care and support, no matter what stage of illness they’re at. They deserve compassionate, expert in-home care from Alliance Homecare’s private duty nurses, home health aides, and care management advisors for a full team of advocates on your side.

Our dedicated team of medical professionals can support palliative or hospice care from the comfort of your home or a residence facility. Contact us to learn more about in home nurse care how we can help you or your loved one live the best version of their life.

Sources: 

  1. Cancer. Types of Palliative Care. https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/types-palliative-care 
  2. Healthline. Does Medicare Cover Palliative Care? https://www.healthline.com/health/medicare/does-medicare-cover-palliative-care#how-it-works 
  3. National Institute on Aging. What Are Palliative Care and Hospice Care?https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care 
  4. Centers for Medicare and Medicaid Services. Hospice. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice 
  5. Medicare. Hospice Care Coverage. https://www.medicare.gov/coverage/hospice-care 

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