What's the Difference Between Palliative Care and Hospice?

*Image by Americannursetoday.com

Palliative care and hospice are sometimes used interchangeably, but in reality they are two separate programs.

To start, let’s discuss the similarities. Palliative care and hospice both focus on providing comfort and alleviating symptoms for someone with a severe illness. Both use a multidisciplinary approach to meet the patient’s emotional, physical, psychosocial, and spiritual needs. The services are provided by an interdisciplinary team that can be comprised of nurses, social workers, chaplains, doctors, nurse practitioners, occupational therapists, dietitians, and massage therapists.

Palliative care and hospice both help people with severe illnesses feel better and increase their quality of life through addressing all of the ways that the illness impacts them.

So, how then are they different?

*Image from Seasons Hospice

Prognosis. To qualify for hospice, your prognosis must be six months or less and you must have a diagnosis of a terminal illness.

Palliative care does not have a prognosis requirement. You can receive palliative care beginning at the diagnosis of a serious illness. Some of the illnesses that people utilize palliative care for include cancer, heart disease, AIDS, kidney failure, and dementia and other neurological disorders.

Treatment. Curative treatments, such as chemotherapy, are no longer covered while on hospice services. Hospice care is solely focused on providing comfort and symptom relief.

You can choose to continue all curative treatments with palliative care. The palliative care team will help to minimize or counteract the side effects of curative treatments.

Location. Hospice care is provided wherever the patient lives, most often the home, care facility such as a nursing home, or hospice facility.  The hospice team comes to the patient wherever they live.

Historically, palliative care was provided by a team of professionals in the hospital setting. Palliative care team was called in when the physicians had determined that there was little to no chance of recovery for the patient. Palliative care was often seen as the conversation starting team for hospice care.

While the above scenario does continue to take place in some hospitals, luckily, there has begun to be a shift in the scope of palliative care. This is largely due to palliative care professionals increasing awareness and advocating for increased funding and insurance coverage for palliative care. Today, we are seeing palliative care coverage expand to outpatient settings, such as doctor’s offices. Even more exciting, palliative care professionals are starting to provide care in the home.

Funding

Lastly, the main difference between palliative care and hospice is the funding source.

Hospice is a Medicare benefit. All care provided by the hospice team is covered by Medicare including equipment, medications, 24 hour hotline and bereavement support after the death.

When someone signs on to hospice, they are signing over their Medicare benefit to hospice care. Because Medicare will not cover both “aggressive treatment” and hospice care, hospitalizations are no longer covered when someone is on hospice. The hospice team manages any crisis that arise.

For individuals who do not have Medicare, private insurances and Medicaid typically have a hospice benefit.

With palliative care, there is more variation in coverage. While most insurance plans have some palliative care coverage, the medical providers typically bill individually for each service provided. This means that the services are often paid for by insurance, the patient, and sometimes charity (some palliative care programs have a charity component for those that cannot pay.)

There is a lot of overlap within hospice and palliative care. Because palliative care is experiencing rapid growth at this time, we can expect to see both insurance coverage and general awareness increase over the coming years. 

If you are interested in learning more about hospice and palliative care:

https://medlineplus.gov/ency/patientinstructions/000536.htm

https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care

http://palliativedoctors.org/faq