Both palliative care and hospice focus on providing comfort for those with life-limiting illnesses, and as such, the two terms are easily confused. However, there are some important differences between the two. Understanding how palliative care differs from hospice and the benefits of each will help you advocate on behalf of your aging or disabled loved ones and make informed decisions regarding their care.
A Definition of Palliative Care
Palliative care is an approach to care for those with serious illnesses, with a focus on improving quality of life by reducing the symptoms of disease and unwanted side effects of treatment. Palliative care aims to treat the whole person, encompassing not only the physical aspects of an illness but also the emotional, social, and practical impacts of disease.
Palliative care may be received at the same time as a person is also receiving treatments to cure a disease and is often a treatment approach used for people with health conditions such as heart disease, cancer, lung disease, kidney disease, HIV/AIDS, dementia, and other life-limiting conditions. It may begin upon diagnosis and continue through the end of life.
A Definition of Hospice
Like palliative care, hospice also aims to provide comfort to those with life-limiting illness and addresses the physical, social, emotional, and spiritual needs of not only the patient but also the patient’s family caregivers. Palliative care is administered as a part of hospice care. However, while palliative care may begin upon diagnosis and continue through the end of life, hospice is reserved for the later stages of disease. Typically, hospice care is offered when a person’s prognosis is six months or less and curative measures have been exhausted or are no longer desired.
Hospice covers treatments for symptom control or pain relief, durable medical equipment (such as a walker or wheelchair), medical supplies (such as catheters and bandages), and a variety of services covered by Medicare necessary to manage the person’s pain and other symptoms related to the terminal illness. This may include physical, speech, and occupational therapy, short-term inpatient and respite care, regular visits and oversight from a care team including a nurse, home health aides, a social worker, the hospice chaplain, and the hospice physician.
Who Pays for Palliative Care and Hospice Care?
Hospice care is covered by Medicare, Medicaid, The Veteran’s Health Administration, and some private health insurance providers. Medicare and Medicaid cover hospice care for people with a terminal illness who meet admission criteria (both disease-specific criteria and a prognosis of six months or less) at no cost to the patient, in most cases, while those who are covered by private health insurance plans may be responsible for co-pays and some other charges. The Veteran’s Health Administration offers coverage similar to that provided by Medicare.
Note that hospice coverage covers treatments and services related to the person’s terminal diagnosis and related conditions, and does not cover medications, other treatments, and services for unrelated conditions. Coverage for these unrelated conditions continues to fall under the patient’s traditional Medicare, Medicaid, or private insurance benefits. Also, hospice coverage does not include medications and treatments intended to cure the life-limiting illness – only those for comfort, such as symptom relief, and quality of life.
Similarly, palliative care is covered by both public and private insurance plans, including Medicare Part A, which covers aspects of care such as social services, nursing visits, and spiritual care, and Medicare Part B offers palliative care coverage for medications and supplies. Medicaid may offer palliative care services as well, although coverage may vary from state to state. Likewise, many private health insurance plans offer some form of palliative care coverage as part of their long-term care or chronic care benefits, but specific coverage may vary from insurer to insurer, and even among individual insurance plans.
If you’re considering palliative care or hospice care for a loved one covered by Medicaid or private health insurance, get in touch with your insurance provider to find out if coverage is offered, what services are covered, eligibility criteria, and what costs – if any – the patient will be responsible for.
Benefits of Palliative Care and Hospice
Both palliative care and hospice care focus on improving quality of life for people with chronic, life-limiting disease or illness. Both types of care take a comprehensive approach to care, aiming to treat the whole person as well as the individual’s family and caregivers. Hospice care allows people with terminal illnesses to remain in the comfort of their own homes by providing on-call access to a hospice nurse and physician 24 hours a day, 7 days a week, regular visits from a hospice nurse, home health aides, and other staff, and ongoing oversight and care management by the hospice care team.
While hospice care is often provided in the patient’s home, it may also be provided in inpatient settings such as nursing homes and assisted living communities. The hospice benefit covers everything a patient needs for their terminal diagnosis and related diagnoses, while unrelated conditions remain covered under the patient’s traditional health coverage (Medicare, Medicaid, or private insurance).
While hospice is intended for people with a life expectancy of six months or less, coverage isn’t typically limited to a six-month period. Under Medicare, for instance, hospice is provided to eligible patients for two initial 90-day benefit periods, followed by an unlimited 60-day benefit periods. Patients may continue to receive hospice care for a year and sometimes longer, provided that the patient continues to meet eligibility criteria.
A patient may receive palliative care from diagnosis onward, and when curative measures are no longer beneficial or the patient opts to discontinue curative treatments and has a life expectancy of six months or less, they may opt to transition to hospice care. Both palliative care and hospice care result in benefits such as improved quality of life, a lower risk of depression, and a greater sense of independence and control. Families and caregivers also benefit from the social and emotional support offered, as well as support provided through the grieving process. Additionally, both hospice and palliative care have been found to result in decreased costs thanks to improved utilization of healthcare resources.
Despite the many benefits of palliative care and hospice for patients, their families, and caregivers, they are underutilized. If you or a loved one has a life-limiting or terminal diagnosis, talk to your healthcare provider about palliative care and hospice options that can improve comfort and quality of life.