What Is Palliative Care?

A plain-language definition

Palliative care is medical care that treats the symptoms and the stress of a serious illness, rather than only the disease itself. The goal is to help a person feel better and live as well as possible for as long as possible.

Two things are worth saying clearly, because they are the most common misunderstandings. Palliative care is not only for the last weeks of life. And palliative care is not the same thing as hospice. A person can receive palliative care for years while continuing chemotherapy, dialysis, cardiac medication or physical therapy.

Palliative care is provided by clinicians who are trained in symptom management and in the conversations that serious illness requires. It is added to the existing care plan. The primary care physician and the specialists stay involved.

What a palliative care team actually does

Families often ask what happens in a palliative care visit that is different from a regular appointment. The work generally falls into five areas.

Symptom relief

The team assesses symptoms in detail and adjusts treatment for them: pain, shortness of breath, nausea, constipation, fatigue, poor appetite, disturbed sleep, anxiety and low mood. Because appointments are dedicated to symptoms rather than to a single organ system, there is time to work through them one at a time.

Communication and understanding

Serious illness produces a lot of information from a lot of sources. The team helps a patient and family understand the diagnosis, what the tests mean, what the options are and what each option would involve day to day.

Support with decisions

The team helps a patient identify what matters most to them, and translate that into decisions about treatment. That may include advance care planning, naming a medical decision-maker, and documenting preferences so they are known before an emergency.

Caregiver support

Caregiving is demanding. The team can talk through what to expect, how to manage medications safely, which symptoms warrant a call, and where to look for community resources.

Coordination

The team communicates with the other clinicians involved so that the pieces of the plan fit together, medication lists stay current, and the family is not left carrying information between offices.

Who qualifies for palliative care, and at what stage

Palliative care is based on need, not on prognosis. There is no requirement that a physician predict a life expectancy, and no requirement to stop treatment in order to qualify.

In general, palliative care is appropriate for a person living with a serious or long-term illness who has symptoms that are hard to control, frequent hospital or emergency visits, several conditions being managed at once, complicated medication lists, or decisions ahead that would benefit from a longer conversation. It is also appropriate when a family is struggling to hold the plan together.

Earlier is generally better than later. Starting while a person is relatively stable gives the team time to learn what matters to that patient before a crisis forces quick decisions.

Conditions palliative care commonly supports

Palliative care is used across many serious illnesses, including:

• Cancer, at any stage, including during active treatment
• Heart failure and other advanced heart disease
• COPD and other chronic lung disease
• Chronic kidney disease, including patients on dialysis
• Dementia, including Alzheimer's disease
• Parkinson's disease, ALS and other progressive neurological conditions
• Advanced liver disease
• Frailty in older adults living with several conditions at once

Palliative care for dementia

Dementia deserves a note of its own, because families are often told that palliative care does not apply until very late. It applies earlier than that. Dementia progresses over years, and symptoms such as agitation, pain that a person cannot easily describe, difficulty eating, sleep disruption and repeated infections are exactly the kind of problems a palliative team is trained to work on.

Palliative care also gives families a structured place to discuss decisions that come up in dementia: how to weigh hospital transfers, what to do about feeding difficulties, and how to record the person's wishes while they can still take part in the conversation.

How palliative care differs from hospice

The short version: palliative care may begin at any stage and can accompany treatment. Hospice is a distinct end-of-life benefit with its own eligibility and treatment rules, and under the Medicare hospice benefit it generally requires certification that a person is terminally ill with a life expectancy of six months or less if the illness follows its normal course.

The full comparison, including timing, coverage and questions to ask, is in our companion guide: Palliative care vs. hospice: what's the difference?

How it works alongside ongoing treatment

Adding palliative care does not mean giving anything up. The oncologist keeps treating the cancer. The cardiologist keeps managing the heart failure. The nephrologist keeps managing dialysis. The palliative team works on symptoms, on understanding, and on keeping the plan coherent.

That division of labor is the point. Specialists have limited time and a narrow focus by design. Palliative care supplies the time for the questions that do not fit inside a fifteen-minute specialty appointment.

How Home Doc delivers palliative care by telehealth

Home Doc's palliative care program is delivered by telehealth. The patient joins the visit from wherever they are, using a phone, tablet or computer, and a family member or caregiver may take part when the patient agrees and privacy requirements are met. The clinician does not travel to the patient.

Telehealth suits this kind of care well. Symptom review, medication changes, planning conversations and coordination with other clinicians are largely conversation and record review. It also removes the travel that makes appointments hard for people who are unwell.

Two supporting details are worth knowing. Medical Assistants can provide in-person vitals and technology help within twenty-five miles of Denver and Colorado Springs. And in-person rounding happens only at select participating long-term-care and rehabilitation facilities.

What a first visit looks like

A first palliative care visit is longer than a routine appointment, because most of it is listening. Expect the clinician to go through the current diagnoses and treatments, the full medication list, recent hospital or emergency visits, and every symptom that is affecting daily life.

Expect questions that are not strictly medical too: what a normal day looks like, what has become difficult, who helps at home, and what the patient hopes the next few months will allow them to do.

It helps to have a few things ready: a current medication list including over-the-counter medicines, recent discharge paperwork if there was a hospital stay, insurance information, a list of the other clinicians involved, and a written list of questions.

What it costs and how Medicare generally treats it

Unlike hospice, palliative care is not a single bundled benefit. It is generally billed as medical care. Medicare typically covers medically necessary services from a palliative care clinician under Part B the way it covers other outpatient care, subject to the usual deductible and coinsurance rules. Medicaid and commercial plans have their own rules.

Coverage always depends on the individual plan, the specific service and the situation. Home Doc accepts plans from Medicare, Medicaid, Aetna, Cigna and UnitedHealthcare. Listing an insurer does not mean that every plan or every service is covered. Home Doc's intake team verifies each patient's specific plan before care begins, so nobody has to guess. More detail is on the insurance page.

How to ask for a referral

Patients and families do not have to wait to be offered palliative care. A simple sentence at the next appointment is usually enough: "I would like a referral to palliative care to help with symptoms and planning."

If it helps to be more specific, name what is hardest, pain that is not controlled, breathlessness, repeated hospital visits, or decisions the family is struggling with. Clinicians can also refer directly through Home Doc's provider referrals page.

To start with Home Doc, use the Become a Patient page, or read more about the program on the palliative care in Colorado page.

This article is general education for patients and caregivers. It cannot determine eligibility, coverage, prognosis, medication changes or the right clinical plan for an individual. Please speak with a clinician who knows your situation. More guides are available in the Resources center.

Sources: Medicare.gov, Hospice Care; National Institute on Aging, What Are Palliative Care and Hospice Care?; Merck Manual, Hospice Care and Palliative Care.