The Difference Between Palliative Care and Hospice Care
For families navigating serious illness, understanding the distinction between palliative care and hospice care becomes crucial to making informed decisions about treatment approaches and quality of life. While these two types of care share similar philosophies, they serve different purposes and become appropriate at different stages of illness.
The Core Similarities
Both palliative and hospice care focus on improving quality of life and providing comfort for people facing serious illness. They share a holistic approach that addresses physical symptoms while also supporting emotional, social and spiritual needs. Each employs interdisciplinary teams that typically include physicians, nurses, social workers, chaplains and other specialists working together to provide comprehensive care.
The fundamental principle uniting both approaches is the focus on the person rather than just the disease—treating the whole individual while supporting their families and caregivers through difficult health challenges.
Palliative Care: Support at Any Stage
Palliative care offers specialized medical care for people living with serious illnesses, regardless of prognosis or treatment choices. Its primary goal is improving quality of life by managing symptoms, pain, and stress while helping patients navigate complex healthcare decisions.
When Palliative Care Is Appropriate
Unlike hospice, palliative care becomes available from the moment of diagnosis and can be provided alongside curative or life-prolonging treatments. Patients receiving chemotherapy, undergoing surgery, or participating in experimental treatments can simultaneously benefit from palliative care services.
Palliative care proves particularly valuable for those managing conditions such as:
- Cancer
- Heart disease
- Lung disease
- Kidney disease
- Alzheimer’s disease
- Parkinson’s disease
- ALS (amyotrophic lateral sclerosis)
- Other progressive illnesses
Early integration of palliative care often leads to better symptom management, improved understanding of treatment options, and enhanced overall quality of life.
How Palliative Care Works
Palliative care services typically involve:
- Expert symptom management for pain, fatigue, nausea, sleep difficulties and other issues
- Help with treatment decision-making and establishing goals of care
- Emotional and psychological support
- Coordination among healthcare providers
- Guidance with advance care planning
- Assistance accessing community resources
These services may be delivered in various settings, including hospitals, outpatient clinics, nursing homes, or even patients’ homes, depending on local availability and patient needs.
Hospice Care: Specialized End-of-Life Support
Hospice represents a specific type of palliative care designed for people nearing the end of life. It focuses on comfort and quality of life when curative treatments are no longer desired or effective.
When Hospice Care Becomes Appropriate
To qualify for hospice, a physician must determine that the patient likely has six months or less to live if their illness follows its natural course. At this point, the focus shifts from curative treatments to maximizing comfort and quality of remaining time.
Choosing hospice means embracing comfort care while discontinuing treatments aimed at curing the underlying disease. However, patients always retain the right to change their minds and return to curative treatments if they choose, which would mean discontinuing hospice services.
The Hospice Approach
Hospice care typically provides:
- Comprehensive pain and symptom management
- Regular visits from hospice team members
- 24/7 on-call support for emergencies
- Emotional and spiritual counseling
- Respite care for family caregivers
- Bereavement support for families after the patient’s death
- Medical equipment and supplies related to the terminal illness
- Medications for symptom management related to the terminal diagnosis
Most hospice care takes place wherever the patient calls home—whether that’s a private residence, nursing home, or residential hospice facility. The goal is creating a comfortable, supportive environment without unnecessary hospitalizations.
Key Differences: A Comparison
Understanding the practical differences between these two approaches helps families determine which best meets their current needs:
Timing and Eligibility
Palliative Care: Available at any time during a serious illness, regardless of prognosis. No specific life expectancy requirements exist.
Hospice Care: Typically requires a physician’s certification that life expectancy is six months or less if the disease follows its expected course. Patients must recertify their eligibility periodically.
Treatment Approach
Palliative Care: Can be provided alongside curative or life-prolonging treatments. Patients continue working with their treating specialists while adding palliative support.
Hospice Care: Focuses exclusively on comfort rather than cure. Patients discontinue treatments aimed at curing the underlying terminal illness, though they continue receiving care for unrelated conditions.
Care Setting
Palliative Care: Available in various settings including hospitals, outpatient clinics, and sometimes homes, depending on local programs and resources.
Hospice Care: Primarily delivered wherever the patient calls home, which may include private residences, nursing facilities, or dedicated hospice centers. Focuses on keeping patients comfortable in familiar surroundings when possible.
Insurance Coverage
Palliative Care: Coverage varies depending on insurance plans. Medicare Part B, Medicaid, and private insurance typically cover palliative physician services, though coverage for other team members may vary.
Hospice Care: Comprehensive coverage through the Medicare Hospice Benefit, Medicaid Hospice Benefit, and most private insurers. These benefits typically cover all services, medications, equipment, and supplies related to the terminal diagnosis.
How Insurance Coverage Works
Medicare Coverage
Palliative Care: Medicare covers physician services through Part B, subject to deductibles and coinsurance. Other palliative team members’ services may have limited coverage.
Hospice Care: The Medicare Hospice Benefit provides comprehensive coverage including:
- All care related to the terminal illness
- Medications for symptom management and pain relief
- Medical equipment and supplies
- Hospice team visits
- Short-term inpatient care when needed for symptom management
- Respite care for family caregivers
This benefit continues as long as patients remain eligible, beginning with two 90-day benefit periods followed by unlimited 60-day periods as needed.
Private Insurance
Most private insurance plans cover palliative care similarly to other medical services, though benefits vary by plan. Hospice coverage through private insurance typically mirrors the Medicare benefit, though specific coverage details depend on individual policies.
Medicaid
Medicaid coverage for both palliative and hospice care varies by state but generally follows Medicare guidelines. The Medicaid Hospice Benefit provides similar comprehensive coverage to the Medicare benefit.
Transitioning Between Care Types
The relationship between palliative and hospice care isn’t strictly sequential. Some patients receive palliative care for years before eventually transitioning to hospice. Others may move directly to hospice care upon diagnosis of a terminal condition.
Importantly, choosing hospice doesn’t mean giving up all medical care—just shifting focus from cure to comfort. Patients who improve while on hospice or decide to pursue curative treatments can discontinue hospice services and return to standard medical care, including palliative services if desired.
Making Informed Decisions
When considering palliative or hospice care, several factors help determine the most appropriate approach:
Questions to Consider
- What are the goals of care at this stage of illness?
- Is cure still possible or desired?
- How burdensome are current treatments relative to their benefits?
- What level of symptom management is needed?
- Where would the patient prefer to receive care?
- What support do family caregivers need?
Starting the Conversation
Discussions about palliative and hospice care often begin with primary care physicians or specialists treating the serious illness. Patients and families can initiate these conversations by asking:
- “Would palliative care help manage symptoms more effectively?”
- “How might palliative care complement current treatments?”
- “What would hospice care look like in this situation?”
- “How do we know when it’s time to consider hospice?”
These questions open important dialogues about care priorities and available support services.
The Value of Support Through Serious Illness
Both palliative and hospice care recognize that serious illness affects not just the body but the whole person and their family. By addressing physical symptoms alongside emotional, social and spiritual needs, these specialized approaches provide crucial support during difficult health journeys.
Whether receiving disease-modifying treatments with palliative support or focusing exclusively on comfort through hospice, patients benefit from specialized care that prioritizes quality of life and personal values.
Understanding the differences between palliative and hospice care empowers patients and families to access appropriate support at the right time—ensuring the best possible quality of life throughout the course of serious illness.
For families navigating these difficult decisions, speaking with healthcare providers about specific situations helps clarify which approach aligns best with current needs and goals. Professional guidance regarding available resources can make a significant difference in accessing timely, appropriate care.
Call us today at 603-669-1660 to learn more about navigating care options for serious illness. Maple Leaf Health Care Center, located at 198 Pearl St, Manchester, NH 03104, is committed to providing information and resources to help families make informed healthcare decisions.
