They are important types of care designed to improve a person’s quality of life
With the announcement that former President Jimmy Carter is entering hospice care, there’s been a lot of interest in and questions about hospice and palliative care.
As a family medicine doctor certified in hospice and palliative care, I often get questions about these types of care. While these terms are often used interchangeably, there are significant differences between them.
Hospice care is a specialized type of care for people who are nearing the end of their lives. It is typically provided at home, but it can also be given in a place like an assisted living or a skilled nursing care facility. The team members visit the person and family multiple times a week to provide care and support.
Hospice care focuses on providing comfort and support to the patient and their family during this challenging time. The goal of hospice care is to improve the quality of life for the patient by managing symptoms such as pain, nausea, and breathing difficulties. Once hospice is started, most primary care physicians defer care to the hospice team.
Palliative care is provided to people who have a serious illness, regardless of their life expectancy. Its goal is to improve the quality of life for patients by managing symptoms and providing emotional support. It can be provided through clinic visits and house calls or through regular hospital visits. The primary physician continues to care for the person, while the palliative care team provides support as a specialist.
There are many medical conditions that are appropriate for these types of care. These include cancer, Parkinson’s disease, heart disease, emphysema, dementia, Lou Gehrig’s disease, kidney disease, cirrhosis of the liver, stroke, and HIV. Associated symptoms may include weight loss, chest pain, weakness, and trouble breathing at rest or with little activity. If the person no longer wants to be hospitalized, have further testing done, and wants support at home, then hospice care may be the better choice.
Hospice care is for people who have a life expectancy of less than six months. Palliative care can be provided to anyone with a serious illness. Healing or aggressive treatments (i.e., chemotherapy, surgery, hospitalization, etc.) can continue while receiving care. Hospice care should be considered when the burden of any given curative treatment outweighs the potential benefit.
Another difference between the two is the level of care provided. Hospice care is more focused on end-of-life care and managing symptoms to ensure the patient is as comfortable as possible. It has a defined start date of services. It provides a complete panel of services including a 24-hour on call service, medical equipment (like a medical bed), respite care (temporary nursing home placement for caregiver relief), volunteers, spiritual care, and bereavement counseling. Palliative is focused on managing symptoms and providing emotional support to improve the person’s quality of life. It has no time limit and can be used intermittently as needed.
Neither takes the place of caregivers. Family or paid caregivers provide the day-to-day necessary care. Medicare, Medicaid, and most private insurance companies cover these types of care with some limitations. Caregivers are sometimes covered on Medicaid.
In summary, both are important types of care designed to improve a person’s quality of life. Hospice is specifically for people nearing the end of their lives. Palliative can be provided to anyone with a serious illness. Ultimately, the type of care that is best depends on a person’s individual needs and circumstances. If you think you or a loved one may benefit from these kinds of care, I recommend contacting your doctor to discuss your options.
Daniel Knorpp, DO is board certified in hospice and palliative medicine and is the Medical Director at Enhabit Hospice, a partnership with Saint Alphonsus Health System