Palliative Care vs. Hospice: What’s The Difference?

Palliative care is medical care for people living with a serious illness. It focuses on providing comfort care delivered by a multidisciplinary team of doctors, nurse practitioners, nurses, social workers, pastoral care, chaplains and counselors.

Palliative medicine aims to mitigate symptoms—physical, emotional, psychological and spiritual—while also addressing your desires for care consistent with what matters most to you.

Palliative care can be provided alongside curative or long-term medical therapies. It can be put into place at any point in your illness and in any setting—home, hospital or nursing home. Palliative care consultations are available through virtual or telemedicine methods, as well as in-person meetings.

Common illnesses seen in the palliative care setting are those with pain and breathing difficulties as symptoms, including:

• Cardiovascular disease
• Cancer
• Chronic respiratory disease
• AIDS
• Diabetes
• Kidney failure
• Chronic liver disease
• Multiple sclerosis
• Parkinson’s disease
• Rheumatoid arthritis
• Neurological disorders
• Dementia
• Congenital anomalies
• Drug-resistant tuberculosis

Hospice care focuses on comfort and life quality for people with an end-of-life illness, according to the National Institute on Aging. A person in hospice has decided, along with their doctors, to stop treatment because it can no longer slow or cure the progression of their illness, and life expectancy is no more than six months.

A multidisciplinary team works with the patient and their caregiver to provide medical, emotional and spiritual support as needed. A member of the team visits regularly and is available 24 hours a day, seven days a week.
Some important facts about hospice:

• It assists people who are terminally ill to maintain the best quality of life possible.
• The focus is comfort, not a cure.
• Services typically include physical care, counseling, drugs, equipment and supplies for the terminal illness and related conditions.
• Care commonly occurs in the home.
• Family caregivers can get support, too.

Hospice is a subcategory of palliative care, making them similar. “Both palliative care and hospice care put the patient and family at the center and prioritize the patient’s wishes and values,” says Joe Shega, M.D., the chief medical officer of VITAS Healthcare, which provides end-of-life-care services nationwide.

“In both approaches, patients and healthcare professionals work together to develop an individualized care plan to thoroughly address all of a patient’s needs—physical, psychological, social and spiritual,” he says. “Pain and symptom management emphasizing patient comfort represents the number one goal for hospice and palliative care clinicians,” adds Dr. Shega.

While it can be tough to think about end-of-life care, planning ahead for the worst-case scenario and sharing your personal wishes with your loved ones can be immensely helpful for both you and them. Many preferences that are part of palliative care and hospice care belong in advanced care directives—legal documents that declare your predetermined medical decisions to avoid confusion when the time comes. From life-sustaining measures you would accept to DNR (do not resuscitate) orders you may want listed at the top of your medical chart, these directives can empower you to focus on living your remaining days to the fullest with love, dignity and grace.

“All hospice is palliative care, but not all palliative care is limited to hospice patients,” says Hank Willner, M.D., a medical consultant for Hospice Foundation of America. “Both address suffering, and hospice does so in a much more comprehensive manner.”

The goals of hospice and palliative care are to relieve suffering through pain and symptom management. But hospice care is palliative care for those with a projected life expectancy of no more than six months and focuses on quality of life and comfort rather than a cure.

Medicare covers all items and services needed for pain relief and symptom management. Your palliative or hospice care plan can include any or all of the following services:

• Doctor, nursing and medical services
• Durable medical equipment for pain relief and symptom management
• Medical supplies
• Pain medications
• Aide and homemaker services
• Physical therapy
• Occupational therapy
• Speech therapy
• Social services
• Dietary counseling
• Spiritual and grief counseling for you and your family
• Short-term inpatient care for pain and symptom management. (This care must be in a Medicare‑approved facility like a hospice facility, hospital or skilled nursing facility.)
• Inpatient respite care, so your primary caregiver can rest
• Medicare covers any other services to manage your pain and other symptoms related to your terminal illness and related conditions, as your hospice team recommends.

Medicare doesn’t cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).

Palliative Care

If you receive palliative care but not hospice care, you may be responsible for some out-of-pocket expenses, such as premiums, deductibles, copayments and coinsurance. Your insurance coverage determines your costs.

Hospice Care

Medicare Part A covers 100% of hospice if you meet the following criteria:

• Your hospice doctor and primary care physician certify that you’re terminally ill with a life expectancy of six months or less.
• You accept comfort care instead of care to cure disease.
• You declare your choice for hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

For more information about eligibility, coverage and costs, visit Medicare.gov or call 1-800-MEDICARE.

Hospice care shouldn’t be about dying, but rather about living a quality life with the time left.
Recognizing a decline in health status in people with a serious illness could make it possible to better anticipate medical needs and adjust the care plan accordingly for both the patient and their caregiver.

Here are questions to help determine whether it’s time for hospice care:

• In the last six months, has there been a rapid decline in health?
• Are you focusing more on quality of life than aggressive treatments?
• How frequent is hospitalization?
• Has appetite decreased, leading to a significant weight loss?
• Is pain well-controlled?
• Is shortness of breath, nausea or vomiting uncontrolled?
• Has sleeping or delirium increased?

If your answers indicate a clear and severe progression of your loved one’s condition, then it might be time to call your local palliative care and hospice group to discuss the most appropriate care options.