Palliative Care vs. Hospice: What's the Difference?

What palliative care is

Palliative care is specialized medical support for people living with a serious illness. Its purpose is to ease symptoms and to reduce the strain that illness places on the patient and the family.

A palliative care team works on pain, breathlessness, nausea, fatigue, poor appetite, difficulty sleeping, anxiety and low mood. It also helps with the parts of illness that are not strictly physical: understanding a diagnosis, weighing options, keeping specialists informed of one another, and writing down what matters most to the patient.

Palliative care is defined by need, not by prognosis. A person may receive it soon after a diagnosis, during active treatment, or years into a long illness. It does not replace the rest of the care plan. It runs alongside it. Our companion guide, What is palliative care?, covers this in more detail.

What hospice care is

Hospice is a distinct end-of-life program. It is intended for people whose illness is no longer expected to respond to treatment aimed at curing it, and whose care has shifted entirely toward comfort.

A hospice team commonly includes physicians, nurses, aides, a social worker, a chaplain and trained volunteers. Hospice supports the family as well as the patient, and the Medicare hospice benefit includes bereavement support for the family after a patient dies.

Hospice and palliative care share the same emphasis on comfort. The difference is that hospice is a defined benefit with its own eligibility rules, its own team and its own rules about which treatments it covers.

Timing and eligibility

This is where the two are most often confused, and it is the clearest place to separate them.

Palliative care is specialized support for people living with serious illness. It can begin at different stages of illness and may be provided alongside treatment intended to cure, control or slow disease. No one has to predict how long a person has to live in order to start it.

Hospice works differently. Under the Medicare hospice benefit, eligibility 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. Medicare describes hospice care in benefit periods that a doctor can recertify if the person lives longer than expected, so that six-month figure is a clinical judgment made at a point in time. It is not a deadline.

In practice, palliative care usually comes first, and hospice may or may not follow later. A person can move from palliative care to hospice. A person can also stop hospice if their condition improves or if they decide to return to treatment aimed at the illness.

Treatment goals and what continues under each

Palliative care can accompany chemotherapy, dialysis, rehabilitation, disease-modifying medication or other treatment. The palliative team focuses on symptoms, stress, communication and goals while the broader treatment plan continues. Nothing has to be given up in order to add it.

Under the Medicare hospice benefit, the patient elects comfort care instead of Medicare-covered treatment intended to cure the terminal illness and related conditions. Care for conditions unrelated to the terminal illness is handled separately. Electing hospice is a formal step, and a patient may revoke that election.

Where each kind of care happens

Palliative care is delivered in many settings: clinics, hospitals, long-term-care and rehabilitation facilities, and by telehealth. Home Doc's palliative care program is delivered by telehealth, so a patient can join a visit from wherever they already are. The clinician does not travel to the patient.

Hospice care is usually provided wherever the person lives, which may be a private residence, an assisted-living community or a nursing facility. Some hospice programs also operate inpatient units for short periods when symptoms cannot be managed elsewhere.

Who pays for each

Coverage is one of the most common sources of worry, and it is worth asking about early rather than late.

There is no single, separate "palliative care benefit" in the way there is for hospice. Medicare generally covers medically necessary services from a palliative care clinician the way it covers other outpatient medical care, under Part B, with the usual cost-sharing rules.

The Medicare hospice benefit is a defined benefit under Part A. When a person elects hospice, Medicare generally covers the hospice team's services, medications for symptom relief related to the terminal illness, and medical equipment and supplies related to it, with limited copayment 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. You can read more on the insurance page.

How families decide

Families rarely face a single either-or choice. The more useful question is usually what the illness is doing now, and what kind of support would help most over the coming weeks.

A few questions tend to make the picture clearer:

• Is treatment aimed at the illness still helping, and does the patient want to continue it? If so, palliative care can be added alongside it.
• Are symptoms the hardest part of daily life? Palliative care addresses symptoms at any stage.
• Has treatment stopped helping, or become harder to tolerate than the illness itself? That is often when a hospice conversation begins.
• What does the patient say matters most to them? That answer should shape the plan.

It also helps to know that asking about hospice is not the same as choosing it. A conversation with a care team can be purely informational, and families often find it easier to decide once they know what each program actually includes.

Questions to ask a care team

Whether the discussion is about palliative care or hospice, these questions are worth bringing to the next appointment:

• What symptoms or decisions can this program help with?
• Can current treatment continue?
• Who remains responsible for each part of the care plan?
• How are after-hours needs handled?
• What does my insurance cover, and what will I be responsible for?
• Who do I call when something changes?
• If we start this program, can we change our minds later?

Writing the answers down during the appointment gives the family a shared record, which is helpful when several people are involved in decisions.

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; Merck Manual, Hospice Care and Palliative Care.