While both hospice care and palliative care focus on a patient’s comfort and quality of life during a complex, serious illness, they are not the same. The main difference is this: Palliative care is given alongside a patient’s disease treatment plan, while hospice covers end-of-life care for a terminal disease. With hospice, curative medical interventions are no longer working or desired by the patient. 

Avoiding hospital stays and comfort are shared goals of palliative care and hospice. But to many, hospice feels too final and is difficult to accept; it may seem like giving up. A holistic hospice plan, however, offers countless services for mind, body, and spirit to help the patient and family achieve peace and comfort for the inevitable final months. Often, many families wait too long to take full advantage of the benefits available. 

Hospice is a type of palliative (or comfort) care, but not all palliative care is hospice. We’ll explore FAQs and the differences of hospice versus palliative care to help families understand these services when the need arises.

What is palliative care?

Palliative care focuses on the pain, symptoms, and stress of an advanced chronic illness or serious disease, such as cancer, lung disease, strokes, heart conditions, and more. Curative treatments for the condition, such as chemotherapy, typically continue along with palliative care (also called comfort care). Palliative care teams work alongside a primary physician for treatments and care plans. There is no time limit on palliative care, which is often intermittent and increases as needs progress.

What is hospice care?

Hospice care is provided when patients have a terminal disease, discontinue treatments, and doctors give a prognosis of six months or less for life expectancy. The goal is to provide pain management, comfort, and stress relief for end-of-life issues. Hospice also provides practical support and guidance for caregivers. A terminal patient can requalify for hospice if they exceed the six-month period.

Do I need a referral for palliative care and hospice?

Yes. Physician’s orders are required to start palliative or hospice care, but hospice consults (a family meeting to better understand hospice services) don’t require a physician’s orders or referral. Anyone can call to request a consultation. Ask your doctor if you feel it’s time for either hospice or palliative care. 

Physician orders are not required for palliative care. Anyone with a serious illness can call to request more information and access to care.

Where does palliative or hospice care take place?

While palliative care can take place in any care setting (home, hospital, clinic, nursing home), hospice is provided in many settings, but most often wherever the patient calls home. This includes the patient’s or caregiver’s home, a facility (skilled nursing, long-term care, assisted living), group home, and sometimes a hospital. For short periods of time, qualified patients can receive hospice services at a hospice inpatient center for a medical crisis or when the caregiver needs a break from their duties.

Who administers palliative or hospice care?

Both types of care offer an interdisciplinary medical team. Palliative care specialists coordinate with other active participants in the care team, including primary care physicians, disease specialists, nurses, social workers, and chaplains. For hospice, a physician leads a team of nurses, social workers, chaplains, and additional support from aides, volunteers, and therapists. Some hospice programs even offer pet therapy and music therapy. The hospice team acts as the primary coordinator.

How often do visits take place?

It depends on the patient’s needs. Hospice visits are typically more often and have specific guidelines for frequency. Palliative care visits will vary based on the level of need and acuity, and take into consideration the other appointments/treatments scheduled. 

Depending on the patient’s needs, hospice visits are typically more frequent as palliative care patients are also seeing treating physicians. Hospice nurse visits are typically once a week or more frequent. The levels of care change depending on the patient’s needs, from in-home routine care to continuous care to inpatient or respite care. Hospice provides 24/7 on-call support for medical and emotional needs, whereas palliative care is available during regular business hours and doesn’t replace emergency care.

What other practical support is provided?

Palliative and hospice can provide practical help such as: 

  • Legal planning (like advanced directives). 
  • Connecting with outside resources like grief support. 
  • Linking to organizations that help with healthcare costs. 
  • Hospice also offers help with funeral planning and bereavement support for 13 months after a patient’s death.

What are the benefits of palliative care?

Palliative services help patients navigate treatment options, specialist referrals (such as nutrition, sleep, or stress management), pain and symptom management, and improved quality of life while pursuing treatments for a serious illness. Patients have less stress and anxiety and often a longer life expectancy. Caregivers and patients receive guidance for difficult medical decisions, conversations, and planning. Plus, they get resources for spiritual and emotional support.

What are the benefits of hospice care?

Hospice care provides pain and symptom management for unique end-of-life needs. Plus, comprehensive caregiver training and support is provided for every step, including navigating the patient’s final wishes and increased visits as death approaches. Medications for comfort, medical equipment like hospital beds, wheel chairs, oxygen, and medical supplies are included and delivered to wherever the patient receives their care. Other resources include assistance for practical planning, like healthcare power of attorney, DNR directives, and funerals.

Spiritual and emotional support is provided in the home as well. Less stress and support for patients and caregivers means a better quality of life and patient/family satisfaction. Hospice is about living well for as long as possible. A “good death” means patients have minimized pain and a peaceful exit surrounded by who and what they love.

Is palliative care or hospice care covered by insurance?

Palliative care is covered by Medicare Part B, Medicaid, and most private insurances. Some co-pays may be required, and medications are subject to individual health plan coverages and some services might not be covered. Services typically include symptom management, emotional support, resource identification, disease education and anticipatory guidance for complex medical decision making and coordination of care with other providers participating in the patient’s care.

Hospice care is covered by Medicare, Medicaid, VA Benefits, and most private insurances with little to no out-of-pocket cost. Services included are: nursing care, social services, spiritual care, bereavement care, patient medications, medical equipment and supplies intended to provide comfort and related to the terminal diagnosis. Room and board is covered only when a patient qualifies for general inpatient or respite level of care.

Relief, comfort, and improved quality of life are outcomes for those receiving both palliative care and hospice. These extra layers of support are vital for patients facing chronic or terminal diseases.

Heart to Heart Hospice is a hospice provider in Indiana, Michigan, and Texas, offering comfort, support, and dignity to patients and families.

Source: National Hospice and Palliative Care Organization