What is the difference between hospice and palliative care?

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Both palliative care and hospice care aim to reduce discomfort and pain, honor a person’s values, support the family, and offer individualized care. According to the National Institute on Aging, other similarities include:

• Both offer medications to help ease pain and other burdensome symptoms.
• They offer more than medical care, providing access to chaplains, social workers, and other experts to help coordinate care.
• They include the family in the care of the person, involving them to the extent that the person wishes. They also offer support services, such as grief counseling and illness support groups, to family members.
• Both can happen in a variety of settings, including a home, hospital, or long-term care facility. However, people seeking palliative care usually get care where they are receiving treatment.

People receiving palliative care may eventually become eligible for hospice care. For example, a person with cancer who is undergoing active treatment may also receive palliative care for symptom management and support throughout the course of their illness. If the cancer progresses or does not respond to treatment, and the person’s condition declines, they may become eligible for hospice care.

People who choose palliative care may have a terminal illness or be near the end of life. However, this is not always the case, and some people receiving palliative care recover from their illness.

Hospice care is exclusively for people who have a terminal illness and are approaching the end of their life. In most cases, a person is only eligible for hospice care when their estimated life expectancy is 6 months or less. Other key differences between hospice care and palliative care include:

• Treatment: A person receiving palliative care may continue to have curative treatment, such as chemotherapy or surgery for cancer. Hospice care is for people who no longer want treatment or whose illness has stopped responding to treatment.
• Prolonging life: People receiving palliative care may continue to pursue aggressive measures to preserve and prolong their life, whereas those in hospices usually elect to avoid such measures. For example, a person with advanced cancer who develops an infection might choose not to treat the infection because they want to avoid the hospital and would prefer to be at home when they die.
• Length of eligibility: People are eligible to receive palliative care for as long as they have a life threatening or life limiting illness. Hospice eligibility continues for as long as a medical director can certify that if a person’s disease follows its expected course, their life expectancy is 6 months or less.
• Medical team: Palliative care does not replace treatment from the person’s usual medical team. Conversely, hospice care usually does, although a person may still see their primary care physician.
• Period of care: Palliative care happens on an as-needed basis, so a person may only get it intermittently when their symptoms warrant more support. A hospice offers ongoing care until a person dies. A person in a hospice may also continue to receive specialty care for other illnesses that they may experience.

There are two forms of hospice and palliative care eligibility:

Eligibility for insurance coverage

Many insurance plans, including Medicare and Medicaid, offer some coverage for both hospice and palliative care. However, coverage amounts and eligibility vary. In most cases, a person is only eligible for hospice care if their life expectancy is 6 months or less. A doctor must certify that they are terminally ill and have a short life expectancy.

However, if a person lives longer than this, their insurer may continue paying benefits, depending on the terms of their policy.

A person is eligible for palliative care if they have a serious illness such as cancer. However, the willingness of the insurer to cover care depends on the terms of the policy. There is no time limit on palliative care.

Provider-specific eligibility

Hospice and palliative care professionals usually conduct an evaluation to assess whether a person is a suitable candidate. In some cases, the assessment involves determining whether hospice or palliative care is more appropriate. Factors that may influence the outcome of an evaluation include:

• what insurance will cover
• the specific diagnosis and whether it is a terminal condition
• a person’s life expectancy
• how limited a person is in their daily activities
• the wishes of the person and their family

Medicare and Medicaid both cover palliative care. However, a person may have to pay a copay, and their plan might not fully cover some medications.

Medicare typically pays all costs associated with hospice care, with the possible exclusion of some drugs. In most states, Medicaid offers similar full coverage, but it is important to check state Medicaid rules to gauge the out-of-pocket expenses.

For people with private insurance, coverage varies from insurer to insurer. If the coverage is insufficient, a person can check their eligibility for Medicare or Medicaid.

In most cases, the choice between hospice and palliative care depends on the specifics of a person’s illness and situation rather than their personal preference. For example, a person is not eligible for hospice care if they do not have a terminal illness or are undergoing curative treatment for a chronic illness.

A hospice may be the best choice if a person:

• has a terminal illness
• is likely to live less than 6 months
• is no longer pursuing disease-directed treatment

Palliative care may be the best choice for a person who:

• has a serious or life threatening illness with an uncertain trajectory
• has a life expectancy longer than 6 months
• is still pursuing aggressive treatment aimed at curing or treating the illness

Some questions that a person may wish to ask when considering hospice or palliative care include:

• What will my insurance cover?
• What evaluations do I need to undergo to be eligible for coverage?
• What documentation do I need to provide?
• What specific services am I eligible for?
• If I get palliative care and later need hospice care, can I get it from the same treatment team?
• What happens if I enroll in hospice and live longer than 6 months?
• Who should I call if there is an emergency or if I feel unsatisfied with the care I get?
• Can I choose my healthcare team or give certain criteria, such as a preferred gender?

Both hospice and palliative care can help an ill person and their family cope with the many aspects of a serious disease, including managing pain, handling family conflict, and resolving spiritual and cultural issues.

Facing the decision between the two types of care can be difficult, especially when a person is terminally ill, but a doctor can help guide the process and suggest the most suitable option. The right hospice or palliative care provider can also offer an evaluation that determines which choice is the best fit for a person’s needs and treatment goals.