The Differences Between Palliative Care and Hospice Can be Confusing

Carol Bradley Bursack | May 17, 2017

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Many people have heard of hospice care but they mistakenly think that it’s just a way to help cancer patients be more comfortable at the end of their lives. Fewer people have heard of palliative care, and they may have no idea what it is. The truth is that hospice and palliative care are related but used for different reasons at different times, and everyone should be well-versed in what they offer. Here, we’ll clarify some points of confusion.

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What is palliative care?

Palliative (pronounced pal-lee-uh-tiv) care is supportive care. It is specialized medical attention, provided by a specially trained, interdisciplinary team of medical experts to help people who have serious, often painful illnesses. The care covers management of physical and emotional pain, as well as stress relief and feelings of helplessness. The palliative care team works to provide quality of life for the patient as well as the patient’s family.

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Where is palliative care provided?

Since palliative care can be offered alongside curative treatments such as chemotherapy, the services are available in a hospital setting as well as in a clinic; these services may also be provided in the home or care facility where the person lives. Smaller community hospitals may not be able to offer the services of a complete team specifically trained in palliative care, but most will do what they can to provide supportive care with the resources they have available.

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Who is on the palliative care team?

A typical team would include a doctor trained in palliative care and, often, board-certified in Hospice and Palliative Medicine. Additionally, the team generally includes a palliative care nurse, a social worker, a chaplain or someone who can help with spiritual support if the patient requests it, plus a patient navigator or someone who can coordinate the process. Teams will vary, depending on the size and location of the treating facility.

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When does palliative care start and who qualifies?

Palliative care can be provided throughout an illness. It’s probably best known for cancer patients, but people with chronic obstructive pulmonary disease (COPD), heart disease, or other illnesses that cause chronic pain or discomfort can also qualify. The focus of palliative care is to provide relief from the symptoms of the disease and even the treatment side effects, as well as help with emotional and spiritual issues. Palliative care is not curative but can be used alongside curative methods such as chemotherapy.

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Are palliative and hospice care covered by insurance?

Most insurance plans will cover all or part of the cost of palliative care but a prior authorization may be required. Hospice care, on the other hand, is covered by insurance (at the time of this writing, April 2017). The difference is that to qualify for hospice care, a person must have been certified by the doctor as terminal, with a life expectancy of six months or less. At that time, they can choose hospice care if they wish.

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So, what is hospice care?

Hospice care is also supportive comfort care. The focus is to provide physical, emotional, and spiritual comfort to people who are in a terminal condition, as well as for the family. The main difference with palliative care is that with hospice care, curative treatment is stopped. Through hospice, people who choose to end treatment that has perhaps stopped being helpful and often adds pain to their existence can then navigate the end of their lives in a pain-free, dignified manner.

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What hospice is not

Many people, including some doctors, will say, “Well, there’s nothing we can do now so you may as well go on hospice care.” That is misguided thinking. Hospice care is not giving up. Hospice is an active choice to provide people who has been diagnosed as terminal with a pain-free life for the time that they have left. They can enjoy family and friends in a setting of their choice. When the time comes, patients die naturally, with dignity, and with loved ones by their side if they choose.

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Don’t wait too long to go on hospice

Many people actually improve once they are on hospice care because the whole cocktail of drugs they’ve been taking is now gone. That is why hospice workers say the most frequent comment they hear is, “We wish we hadn’t waited so long.” The misconception that going on hospice means giving up is the reason why so many families wait until the last weeks of a patient’s life to obtain help when they could have had several months of care.

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People often live longer when receiving supportive comfort care

Researchers have found that people receiving palliative and hospice care often live longer. Most choose to spend more time with family and friends. Some travel. Many plan the funeral or life celebration that matches their specific wishes. Palliative and hospice care allow each person to live the best life possible until their health takes them close to the end of their lives. When that time comes, people die comfortably and with dignity.

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Can you leave either program if you change your mind?

Absolutely. The freedom to change one’s mind is always there. If patients decide they no longer want curative drugs and opt for a hospice program, then later hear of a new drug they want to try, they can return to palliative care and try the new drug with the doctors’ approval. Also, a significant number of people get so much better on hospice that they are forced off the program, but they can return as their health once again declines.

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Planning ahead

It’s wise to research palliative and hospice care just as you gather information about other health care options. We don’t know the future, so having this knowledge before a crisis can help you or a loved one obtain the best quality of care if an illness becomes a long-term or terminal condition. Both types of supportive care allow many choices for the patient, mitigating the effects of the often cold world of medicine.