Palliative Care vs Hospice

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Guest post by Hallie Kasper, MSN, PCP-BC, ACHPN, CPHON
Director of Palliative Care at Good Shepherd Community Care

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. 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.

This article explains how palliative care and hospice can support anyone facing a serious illness. As this article covers a lot, you may wish to click ahead to a main topic below:

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

What is Palliative Care?

Palliative care is a specialized type of health care that focuses on the comfort, symptom management, and quality of life for seriously ill people. It focuses on providing care regardless of your ultimate goal. Goals could include obtaining a cure, prolonging life, or being as comfortable as possible at the end of life.

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 a 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-day care across several settings, including at home, hospital, nursing home, and in-patient hospice facilities.  Your setting of care may be determined by the level of care you require.

The most common form of hospice is called routine level of care. This care is most often provided at your home or a facility you live in. Medications, specialized hospital equipment, and supplies are delivered to you. Beyond routine visits, a nurse is always available by phone. Nurses 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 when deemed necessary.

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 are beyond the scope of this article.

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 general decline in health

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

Interdisciplinary team always include nursing, social work, home health aides, spiritual care, and volunteers

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. Extent of this support varies.

 

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.

Cake is an end-of-life planning website (you’re reading the Cake blog now) that helps you document, store, and share all your important decisions with family. Beyond healthcare, Cake also helps you plan for financial, funeral, and legacy decisions. Create your free Cake account to start planning and make things easier on your family someday. 


Author Bio

Hallie Kasper.jpg.png

Hallie Kasper, MSN, PCP-BC, ACHPN, CPHON
Hallie is a nurse practitioner and Director of Palliative Care at Good Shepherd Community Care in Newton. She is certified in both hospice & palliative care and pediatric oncology.  Over the past 18 years, Hallie’s affinity for end-of-life care has driven her professional journey.  As a member of the Good Shepherd Community Care management team,  a Hospice and Palliative Care Nurse Mentor, a community board member, and now a professional blogger ( who knew?), she is thrilled to share and expand her knowledge and passion for early and comprehensive palliative care. Hallie lives in Needham with her husband and teenage daughter and son.