July 6th 2023
By Ari Parker
Hospice and palliative care provide comfort care. Palliative care allows for curative treatments. Hospice requires stopping treatment for illnesses.
By Ari Parker
Many older Americans develop serious health conditions that can be painful and debilitating. Some illnesses are so severe that they’re terminal. When these illnesses arise, it is essential to plan ahead so that your end-of-life wishes are honored.
Some patients have terminal or life-limiting illnesses that are expected to lead to death within a few months, while others have incurable conditions that could respond to treatment.
One way to cope with incurable illness is to seek comfort care that offers physical, emotional, social, and spiritual support for patients and their families. Understanding your options and the differences between different types of care is important.
Both palliative and hospice care provide comfort care, but palliative care allows for curative treatments, whereas hospice requires stopping all treatment for your illness. For those in their final months of life, when no cure is likely, hospice care can make their end of life comfortable. Those who can benefit from curative treatments might opt for palliative care instead.
Palliative care is a specialized type of treatment for people with serious illnesses. It focuses on improving your quality of life by addressing physical, emotional, and spiritual needs as you undergo treatment.
Palliative care can occur alongside treatments to cure your condition and often provides medical care for symptoms of the disease as well as side effects from treatments. For example, someone with cancer may receive chemotherapy to treat the disease while simultaneously receiving palliative care to help manage pain or nausea caused by chemotherapy.
A palliative care team, including doctors, nurses, social workers, nutritionists, chaplains, and other professionals, coordinates the care you need. It provides support for the patient and their families throughout treatment. The team would prepare a care plan that covers the following.
Symptom management
Your palliative care plan will consider what might relieve your symptoms and improve your comfort levels. Your team will answer any questions you may have and discuss whether your pain medicines will affect the treatments you receive from your primary healthcare provider.
Support and advice
When you're facing a serious illness, you and your family might experience stress, have spiritual questions or financial concerns, or wonder how your family will cope if a loved one dies. Palliative care services include support for the many difficult decisions you and your family must make. Talking with a palliative care social worker, chaplain, or other team member may offer guidance or connect you with community resources.
Care techniques that improve your comfort and sense of wellbeing
The team might suggest techniques for managing your wellbeing, such as deep breathing exercises, healing touch, meditation, visualization, or listening to soothing music through headphones.
Referrals
Your palliative care specialist may refer you to other care providers, such as specialists in psychiatry, pain medicine, or integrative medicine.
Advance care planning to discuss goals and wishes for your care
This discussion could help you develop a living will, advance directive, and a health care power of attorney.
Candidates for palliative care include people diagnosed with severe illnesses such as cancer, heart failure, COPD, Parkinson's, dementia, and other illnesses that can cause debilitation or extreme discomfort. These patients may receive curative care, such as medications, surgeries, dietary intervention, chemotherapy, or other treatments, alongside their palliative care.
When people undergo these treatments, they may be in extreme pain and feel fatigued, depressed, and hopeless—but their stage of illness may not be terminal. They are not ready to be at the end of their life and have confidence that treatments can help them.
Anyone dealing with pain and discomfort from medical conditions can receive palliative care to help improve their quality of life and provide symptom management.
Palliative care can address common symptoms, such as:
Anxiety or nervousness
Constipation
Depression or sadness
Difficulty breathing
Loss of appetite
Nausea or vomiting
Pain
Trouble sleeping
Symptom relief can make a sick person feel less overwhelmed and more at ease with the reality of their condition.
Palliative care can be provided in a variety of settings. Some patients receive palliative care in a hospital, nursing home, or assisted living facility. Palliative care clinics and other specialized clinics can also provide palliative care services. You may even receive palliative care at home, allowing some patients to feel more comfortable than they would in a hospital setting.
Medicare covers palliative care. Original Medicare and Medicare Advantage cover inpatient hospital stays, doctor visits, mental health counseling, and durable medical equipment. If you have prescription drug coverage from a Medicare Part D or a Medicare Advantage plan, your medications should also be covered under those plans. Out-of-pocket costs, including deductibles, copays, and coinsurance may apply for palliative care services.
Hospice care focuses solely on comfort and quality of life for those with a terminal illness or condition who doctors think only have a short time to live. Usually only those with a life expectancy of six months or less go on hospice care. Hospice patients either have an end-stage disease that does not have a cure or have chosen not to undergo treatment.
When hospice care begins, all curative treatment stops, and care focuses on alleviating discomfort and improving quality of life. This does not mean you stop taking any medication. For example, patients can continue medications such as blood pressure medications or pain medications that are not meant to cure their terminal illness but do improve their quality of life.
A hospice team can include doctors, nurses, social workers, spiritual advisors, and trained volunteers. The hospice team specializes in end-of-life care and replaces your usual team of healthcare providers. As with palliative care, the team prepares a care plan.
Hospice care is for people who have a terminal illness or condition that does not have a cure. It is also appropriate for people with a serious illness who choose not to undergo or stop current curative treatments, such as chemotherapy, for cancer patients.
Most people with serious illnesses need several types of care:
Routine home care involves the hospice team visiting to provide medical care, manage symptoms, and support patients
Continuous home care for periods of symptom flare ups
General inpatient care may be needed if symptoms become too difficult to manage at home
Respite care is covered by Medicare for up to 5 consecutive days to support fatigued family caregivers
Hospice care can take place at home or in a facility—such as a hospital, nursing home, or specialized hospice care home. If you are more comfortable at home, you can use a home health agency specializing in hospice care. Just make sure you use a Medicare-approved provider to receive Medicare coverage.
Medicare covers hospice care if you meet hospice eligibility requirements. You meet the requirements if all of the following apply:
Your doctor or healthcare provider has determined that your condition is terminal and you have less than six months to live.
You decline all curative treatment.
You sign a statement requesting hospice care over other Medicare-covered care.
If you have Medicare, accepting the Medicare hospice benefit means you pay nothing for your hospice care. A $5 copay applies for outpatient medications filled at your pharmacy. Respite care, an inpatient stay that allows your regular caregiver to rest, is covered with only a 5% coinsurance cost.
If you live in a facility (like a nursing home or assisted living), you will still need to pay for your room and board.
While both types of care put patient comfort first, some critical differences exist between hospice and palliative care. Knowing how they compare can help you and your family decide which care best suits your needs.
With both hospice and palliative care, the overall goal is to reduce pain and discomfort, honor and value the patient's wishes, and offer individualized care to meet these wishes. Both options offer more than just medical care by providing a team of caregivers, including chaplains, social workers, and other professionals who coordinate care and offer emotional and spiritual support.
Hospice and palliative care are offered in various settings, including in your home. They offer supportive services and include the patient and family in decision-making regarding end-of-life care. You have the option to discontinue either type of care at any time.
The most important difference between hospice and palliative care is that palliative care allows for curative treatments to continue alongside comfort care. Choosing hospice care means you will no longer pursue treatments to cure your illness or extend your life. The sole focus is on comfort.
The length of treatment also differs. Palliative care can occur continuously for long periods or may be intermittent if your condition changes. Hospice care typically occurs continuously until the end of your life, generally for six months or less.
Your doctor will recommend hospice for two 90-day periods. They can then extend the order to an unlimited number of 60-day extensions. If your condition improves, you can stop hospice care and get back on regular Medicare benefits.
Both palliative and hospice care improve the quality of life for patients with serious medical conditions. Many times, palliative care can be a transition into hospice care. Usually you don’t move to hospice care until your illness becomes terminal or you choose to stop receiving curative treatments.
