Hospice vs. Palliative Care: What's Better for Your Loved One?

By Jose Escobar

Hospice or palliative care? Many people think they are one and the same, but that is not exactly accurate. Each type of care helps patients at specific times and may have different insurance coverage options.

What is hospice?

According to the National Institute on Aging, a division of the U.S. Department of Health & Human Services, “Hospice care focuses on the care, comfort and quality of life of a person who is approaching the end-of-life[i].”

In order to qualify for hospice, a patient needs to meet certain criteria to gain hospice benefits under insurance.  People can be designated as being at end-of-life if they have advanced, incurable illnesses or conditions that make them exceptionally high risk. They could also have experienced sudden, life-threatening conditions like strokes or accidents from which they are not expected to recover. Consequently, end-of-life care can take place over a matter of days, weeks, or months. The goal of hospice is to treat patients with terminal illness having a six-months or less prognosis for life.

Hospice care is specialized care involving an interdisciplinary team of professionals focused on patients and families. The hospice team addresses symptom management, communication and decision-making, and coordination of care services.  Hospice has a regulated, well-planned payment and care system. The types of clinicians are specified and must hit certain milestones; hospice also outlines the frequency of meetings for the patient with the care team and identifies particular levels of care and last days of life care.

How does non-hospice palliative care differ from hospice?

Palliative care can occur at any point in a person’s illness, not just end-of-life. Fighting a long or severe, acute illness may cause emotional or mental trauma. Aggressive treatment of an illness may exacerbate this trauma, and it may go untreated while healthcare professionals are treating the primary illness. It is crucial to care for the patient’s emotional well-being while still treating the primary illness.

Palliative care is often referred to as “comfort care” because it is a holistic healthcare approach to keep the patient as comfortable as possible. Palliative care teams, like hospice teams, may include specialized doctors, nurses, social workers, nutritionists, and chaplains, who treat the trauma while treating the primary illness.

However, the insurance support of palliative care is typically less than that of hospice, depending on the particular illness being treated and the types of therapy being used, which could range from chemotherapy to surgery, or other types of curative treatment. The frequency is also less than with hospice and may be once a month or once a week to support symptom management – but is not dependent on it being end of life.

How do these types of care work?

When patients enter hospice, they designate a primary caregiver—often a family member or close friend—to help them through their hospice journey. The primary caregiver works with the patient’s hospice care team throughout the process[ii].  The hospice team provides medical care that will help someone in end-of-life stages live with the best quality of life as possible.

Palliative care, on the other hand, can begin during an initial diagnosis, and is flexible. Healthcare professionals can provide palliative care wherever patients require treatment—hospital, outpatient clinics, home. Patients can receive palliative care regardless of diagnosis type and duration, at any point in treatment, if ordered by their primary physician. Different types of healthcare professionals administer palliative care during other treatments.

How does non-hospice palliative care help?

Palliative care, not through the hospice benefit, can be concurrent with aggressive treatment focused on acute or chronic illness. Palliative care addresses alleviation of pain and anxiety, in other words, symptom management during curative care. Curative care seeks to promote recovery; non-hospice palliative care helps provide comfort from serious illnesses that may not be life-threatening.

In addition to helping relieve pain, palliative care creates an open dialogue among patients, families, and caregivers, building a deeper understanding of illnesses and treatments. This process helps patients and families work through complex emotions and choose treatments best for them.

Frank conversations at the non-hospice care stage are extremely helpful if a transition to hospice becomes necessary. Families and patients already familiar with palliative care are more prepared to assess whether quality of life care is more crucial than daily care to smooth the transition to hospice.

When is hospice called in?

The goal of hospice is to help meet a patient’s holistic needs—physical, mental, spiritual—when curative efforts are no longer warranted by the illness nor desired by the patient.

Hospice care is only available for patients who are terminally ill, having six months or less to live. Patients must receive certification from their doctors and designated hospice doctors, and sign statements indicating their choice of hospice care over other insurance-approved efforts to treat terminal illnesses and related conditions.

Patients can continue to receive Medicare-certified hospice care beyond six months, provided their doctors (regular and hospice) re-certify them. Patients in hospice can also choose to transition to curative or palliative care at any time if their case becomes more hopeful.

Both hospice and non-hospice palliative care can be especially vital for patients in serious illness and end-of-life stages.

Jose Luis Escobar is Vice President and Executive Director of Parentis Health Hospice, where he shepherds patients and families through a complex process with compassion and genuine care for everyone, providing compassionate and genuine care for everyone, providing knowledge and comfort through every stage of life’s journey.