Palliative Care vs. Hospice Care
What is Palliative Care?
Palliative care has been a board-certified medical specialty since 2006 in the US, but palliative care has been around for centuries. We’ve all had palliative medicine, also called comfort care. If you break a bone, you seek a cure: the doctor sets it and keeps it immobile in order for it to heal. But she prescribes painkillers to make you comfortable. The painkillers are palliative: they improve the quality of your life while you and your physician cope with your broken bone.
Generally when we talk about palliative care, it’s in the context of serious illness: chronic, progressive pulmonary disorders; renal disease; chronic heart failure; HIV/AIDS, progressive neurological conditions, cancer, etc.
An example: as you go through chemotherapy, which is prescribed to cure your cancer, your physician also addresses your nausea, depression or anxiety by prescribing a drug, directing you to a talk therapist or arranging for pet visits. If your family is stressed, a social worker or chaplain would provide support. All of these coping mechanisms are considered palliative: they improve the quality of your life while you and your physician cope with your cancer.
What is the Difference Between Palliative and Hospice Care?
Hospice care is similar to palliative care, but there are important differences. Because more than 90 percent of hospice care is paid for through the Medicare hospice benefit, hospice patients must meet Medicare’s eligibility requirements, which palliative care patients do not.
1. The objective of both hospice and palliative care is pain and symptom relief.
2. The prognosis and goals of care tend to be different. Hospice is comfort care without curative intent; the patient no longer has curative options or has chosen not to pursue treatment because the side effects outweigh the benefits. Palliative care is comfort care with or without curative intent.
Who Rejects Curative Treatment?
The American Society of Clinical Oncology has identified the characteristics of a patient who should receive palliative care but not curative treatment; these characteristics are applicable to patients with other diseases, too.
- The patient has limited ability to care for himself.
- The patient has received curative treatment and is no longer benefitting from it.
- The patient does not qualify for an appropriate clinical trial.
- There is no evidence that further treatment would be effective.
3. Hospice eligibility requires that two physicians certify that the patient has less than six months to live if the disease follows its usual course. Palliative care is begun at the discretion of the physician and patient at any time, at any stage of illness, terminal or not.
4. Interdisciplinary teams deliver both hospice and palliative care. They address physical, emotional and spiritual pain, including such common worries as loss of independence, the well-being of the family and feeling like a burden.
5. Hospice is paid 100 percent by Medicare, Medicaid and private insurance; it is the only Medicare benefit that includes pharmaceuticals, medical equipment, 24/7 access to care, nursing, social services, chaplain visits, grief support following a death and other services deemed appropriate by the hospice agency. Whereas palliative care, from office visits to prescription charges, is paid for by insurance, by the patient or by charity.
6. Hospice care is delivered at home or in home-like hospice residences, nursing homes, assisted living facilities, veterans' facilities, hospitals and other facilities. Palliative care teams typically work in a hospital.
Talk to your family and your doctor about your goals of care and whether palliative care and/or hospice might improve your quality of life.