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Many people, including some health care providers, are unclear about the benefits and differences between palliative care and hospice. This is partly due to the newness of the field of palliative medicine. But it’s also likely because many people aren’t comfortable talking about serious illness or making tough medical decisions.
Jump ahead to these sections:
- What is Palliative Care?
- What is Hospice?
- Palliative Care vs. Hospice
- How to Get Palliative Care and/or Hospice
- Sharing Your Wishes for End-of-Life Care
When we’re faced with a serious illness, it can be hard to envision anything other than a full recovery. The reality is that palliative care and hospice are not at odds with one another —in fact, the two can often be used in concert to better support people throughout the course of their illness.
As a hospice and palliative care nurse practitioner, I believe it’s important to have these difficult conversations and do some proactive end-of-life planning while you’re of sound mind and body. But this becomes critical near the end of life, or if a serious illness enters the picture.
What is Palliative Care?
Palliative care is a specialized type of health care that focuses on
Palliative care teams are made up of an interdisciplinary team that may include a physician, nurse practitioner, nurse, social worker, and a chaplain.
What Do Palliative Care Teams Do?
Palliative care teams tend to the physical, emotional, and psychological needs of the patient to manage symptoms, pain, and any resulting issues that affect them and their families.
They also facilitate ongoing advance care planning conversations to identify a trusted person to serve as your Health Care Proxy. As part of this process, they also aim 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.
Palliative care teams can supplement other healthcare services you may currently receive. You can still pursue other forms of care like:
- Nursing care from a home care service
- Physical or occupational therapy
- Chemotherapy
- Dialysis
- Tests, treatments, interventions that assess and treat your condition
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
- Steadily declining health and/or progression of a disease or condition
- Frequent hospitalizations and/or readmissions
- Uncontrolled symptoms
- In need of support and conversations related to advanced care planning
- In need of additional psychosocial support
Where Can I Receive Palliative Care?
Palliative care is available in many settings, including hospitals, nursing homes, rehab facilities, doctors’ offices, or dialysis units/centers, or at home.
What is Hospice?
Hospice is the holistic and comprehensive care of patients and their families at the end of life. Hospice care includes a vast interdisciplinary team who are experts in the physical, psychosocial, spiritual, and cultural aspects of dying.
Hospice is provided by an interdisciplinary team that is often made up of physicians, nurses, social workers, chaplains, home health aides, volunteers, and bereavement counselors. The following experts may also be part of a hospice team: nurse practitioner/physician assistant, music therapist, art therapist, massage therapist, pet therapy, or a child life specialist.
How Hospice Works
- Curative treatments are typically stopped when hospice starts. Examples of disease-directed interventions include chemotherapy, dialysis, or surgery to correct a problem. However, hospice care can be provided at the same time as traditional medical care for patients under the age of 21. This is called concurrent care.
- Your doctor/primary provider remains your doctor and is involved in designing and delivering your hospice care.
- You do not need to be actively dying to be appropriate for hospice; you may still work, care for yourself/your family, and even travel.
- Hospice does not hasten death. In fact, research suggests some people may actually live longer.
- Hospice is paid for by Medicare A, Medicaid, and many private insurers.
Who Qualifies for Hospice Care?
People who are expected to have less than six months to live qualify for hospice—although, some people stay on hospice for longer than six months.
During this time, there is a shift from hope for a cure to hope for comfort, an increased measure of control, and shared decision-making based on what is important to the patient and family. Patients are provided with comfort-focused care to support their medical, psychosocial, and spiritual wellbeing until the end of their lives.
Where Can I Receive Hospice Care?
Hospice provides 24/7, 365-
The most common form of hospice is called
If your care team cannot control your symptoms at home, you may qualify for general in-patient care (GIP). GIP hospice care is delivered in a hospital or hospice in-patient facility. There are other details and levels of hospice care that
Palliative Care vs. Hospice
Use this table to get a good overview of the differences between palliative care and hospice.
|
|
Palliative Care |
Hospice |
|
Treatment |
May/may not be getting curative treatment |
No longer seeking curative options |
|
Diagnosis |
Serious illness, life-threatening illness, or |
Life-threatening condition(s) |
|
Prognosis |
No limit on life expectancy |
Life expectancy of 6 months or less. |
|
Payment |
Covered partially or in full by Medicare B, Medicaid, and most private insurers |
Covered by Medicare A, Medicaid, and most private insurers |
|
Team Members |
Varies program to program |
|
|
Duration of Care |
Depends on needs and program design |
Until death or until Medicare criteria of eligibility are no longer met |
|
Frequency of Visits |
Out-patient setting: monthly but varies based on program and needs and program design In the hospital: Daily but varies based need and program design |
Nursing visits at least every 2 weeks with increased frequency as needed. Other team member visit frequency will vary. |
|
Other Home Services |
No impact on other services being received |
Home nursing care (VNA) and other services covered by insurance may need to be discontinued |
|
Bereavement Support |
Varies program to program |
At least 13 months of bereavement support is provided. |
Similarities Between Palliative Care and Hospice
For the purposes of this article, palliative care and hospice are different services or different levels of care, if you will. In the larger sense, however, hospice falls within the umbrella of Palliative Care Medicine. Thus, there are many similarities between palliative care and hospice.
Here are some of the concepts you can expect to experience with both palliative care and hospice:
- Care of the whole person (physically, socially, emotionally, spiritually, culturally)
- Early integration of palliative care and hospice
- An approach to looking at the risks and benefits of tests, medications, and other intervention that is focused on comfort and quality of life, as defined by you and your loved one
- Awareness and respect
of cultural, social, and religious preferences - Shared-decision making to ensure you are aware of your options and to help you choose what is most aligned with your goals and priorities
- Redefining and adjusting hopes and expectations
- Active listening: a skill that palliative care and hospice providers use to understand the meaning of what is being said, both verbally and nonverbally.
- Quiet/supportive presence: a palliative care or hospice provider will not always have a solution or fix, but they will be there to support you.
How to Get Palliative and Hospice Care
Speak to your medical team or call a local hospice and palliative care agency directly. Anyone can start the palliative care and hospice process for you.
Here are some questions you can use to start the conversation:
- “Can I see a palliative care specialist?”
- “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 want to focus on comfort and quality of life. How can I do this?”
- “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?”
Share Your Wishes for End-of-life Care
If you’re proactively planning ahead for the future or helping a loved one plan now, it’s important to document these wishes for end-of-life care. Make sure your family and care team know what you want.