The Difference Between Hospice and Palliative Care

We often hear the two terms in the same sentence or title, “hospice and palliative care.” Yet even though they are complementary, they are two different things.

Palliative care, also called comfort care, is about providing relief. It is administered to people who have a debilitating disease, whether or not they are on their way to being cured, and no matter how long their lives will be lived.

By providing palliative care, a provider is considering the patient’s quality of life, making sure that the patient isn’t suffering difficult symptoms such as pain, nausea, fatigue, constipation, shortness of breath, insomnia, or even mental health challenges like depression for as long as he or she lives, no matter how long that might be.

Unlike hospice care (see below), palliative care has no time frame. It may be a short-term need, such as for patients who are undergoing cancer treatment, need comfort support and will eventually be cured, or at least their disease or condition will be managed. Or it may be a long-term need for patients who will cope with their diseases for the rest of their lives, perhaps for years. Palliative care may also be used in conjunction with hospice care (see below).

Palliative care benefits not just patients, but their loved ones as well who may also find comfort in knowing that their loved one’s suffering is being managed.

A patient’s doctor is the one who recognizes a patient needs palliative care and is also the one who prescribes it. Some doctors are becoming board certified in palliative care. There is also a nursing certification. If you are searching for a doctor to help with chronic suffering, whether or not it is an end-of-life situation, you may look to these boards to recommend their members. (Do a web search for “palliative care certification.”)

Palliative care is paid for by the patients’ insurer or payer (Medicare, Medicaid, and others) to the extent the patient’s insurance covers any other medical services.

If you feel as if more can be done to ease your physical or emotional suffering, ask your doctor to discuss palliative care options with you.

Hospice care is provided at the end of someone’s life, recognizing that patients suffer differently when they know the end of life is near.

Unlike palliative care, hospice care is triggered by a timeframe. A patient cannot be recommended for hospice care unless and until a doctor (and in some states, two doctors) certifies that the patient is within six months of the end of his or her life.

Hospice care may include some forms of palliative care. The difference is that hospice care provides no expectation or even suggestion of a cure. Hospice is intended only to manage symptoms, to keep the patient comfortable until he or she dies.

One misconception about hospice is that it’s a place – a facility where people go to die. While there are thousands of hospice care facilities across the United States and Canada, hospice may also be centered in a nursing home or a hospital. Hospice services may also be provided in the home.

Just as doctors may be board certified in palliative care, they may also be board certified in hospice care; often it is the same board certification.

Hospice organizations are run similarly to a doctors’ practice. They may have several locations, they have relationships with other providers, they must conform to HIPAA laws, sometimes they make house calls, and they accept some insurances and payers like Medicare or Medicaid.

Hospice organizations have their own medical/clinical staffs. One question patients and families may have is whether a patient must change doctors upon entering hospice services. The answer isn’t the same for all hospice organizations, so it’s best to ask if you are considering hospice for yourself or a loved one.

If the patient uses Medicare or Medicaid, the cost of hospice care is covered 100% for the hospice patient. If the patient relies on private insurance, the amount of coverage will vary. Be sure to confirm with your local hospice organization that payment will be covered.