Articles

What’s the Difference Between Hospice & Palliative Care?

February 11th, 2008 by Ami Icanberry

Comments (19)

American hospice service started with the Connecticut Hospice in March 1974. Today, there are over 2,884 Medicare-certified hospices, and an additional 200 volunteer hospices in the U.S., with as many as 1.5 million Americans seeking hospice treatment in recent years. As a program designed to facilitate “palliative” care for terminally ill patients and their families—many people wonder, what then is the difference between hospice and palliative care, or are they one in the same? While palliative care addresses patients with life-threatening illnesses, anyone—regardless of life expectancy—can receive this type of care. Hospice, meanwhile, provides for patients who can no longer benefit from regular medical treatment, per a doctor’s determination, and are in the last stages of a terminal illness. Hospice and palliative care share the philosophy of maintaining and managing the patient’s quality of life.

Palliative care programs generally address the physical, psychosocial, and spiritual needs and expectations of a patient with a life-threatening illness, at any time during that illness, even if life expectancy extends to years. Palliative care does not preclude aggressive treatment of an illness, and provides comfort to patients and their loved ones. Patients receive palliative care from a team of doctors, nurses, social workers and clergy in their home or a hospital, but also in nursing or assisted living facilities. Hospitals, hospices, skilled nursing facilities and health care clinics provide these services, which may include a monthly visit to a doctor, or weekly home visits from a social worker or nurse to help manage pain and symptoms.

The goal of hospice care is to keep pain and suffering of a person with a terminal diagnosis to a minimum, and not to cure the illness. Provided in the patient’s home or in hospice centers, hospitals, skilled nursing homes and other long-term care facilities, hospice is based on the belief that every person has the right to die pain-free and with dignity, and with family and friends nearby. Like palliative care, a hospice team is comprised of doctors, nurses, caregivers, social workers and trained volunteers who manage the patient’s pain and symptoms; assist with the emotional and spiritual aspects of dying; provide needed medications and supplies; coach the family on how to care for the patient; and, provide bereavement counseling to surviving loved ones.

While Medicare, Medicaid, most private insurance plans, HMOs, and other managed care organizations provide hospice coverage, Medicare or Medicaid does not currently cover palliative care. Some private insurance companies cover the costs of palliative care, but it is important for you to ask the palliative care provider how or if the services will be covered and what, if any, costs you will be asked to pay.

Posted in: Elder Care, Finding Hospice, Homecare, Hospice, Hospice & Palliative Care, Hospice & Palliative Care: The Difference, Pain Management, Skilled Nursing, Terminal Illness

Comments (19)

COMMENTS
19 Responses to “What’s the Difference Between Hospice & Palliative Care?”

K_Jacoby Says:

I\’m a nurse at a skilled nursing facility and my staff have often wanted to report hospice groups for fraud! Hospice organizations market our facility like crazy, bearing gifts for all the nurses. They enlist our residents into hospice for \”end stage dementia\” and \”Debility\”. All most every resident we have could qualify for hospice according to their guidelines!
winchesterstation Says:

Hospice workers have one of the hardest jobs and I have a great deal of respect for the work that they do. When my mother was dying there were quite a few people taking care of her. One of the workers would read to her. Cancer had spread to her brain making her unable to speak, but she could still understand. This woman took her job to mean more than just feeding and bathing her–she made her last days better and was there doing things that i could not have done myself. And to think that after she passed this woman is supposed to move on to the next case–it’s mindblowing the amount of resilience and hope a person must have in order to do this kind of work.
Kat Says:

Palliative Care is about LIVING with illness, about getting the health care you want and NOT getting health care you DON’T want. These pts can live for a long time, and are usually refered to Hospice when the time comes.
Ami Icanberry Says:

Great points, Kat. Thank you for your post. Gilbert Guide really is always interested in hearing directly from health care professionals!

Ami Icanberry
Laura Baumgardner Says:

My father was diagnosed with stomach cancer and chose to have hospice care when he realized that he could not receive chemo or radiation. We had a horrible time with our hospice. We could not get adequate pain medication to keep him comfortable towards the end and the nurses did nothing to help us! Our family is furious that our father had to suffer in his final few days while we begged for medication! The promise that the company made to keep my father’s pain to a minimum was ignorned. Please, families do research on the hospice company you choose for a loved one. Some seem to be in it only for the dollars, not the individual’s needs.
Ami Icanberry Says:

Dear Laura—I’m deeply sorry for your loss. Thank you for sharing your difficult experience with us—it is stories such as these, sadly, that help inform our readers on what to look out for if they are ever in a situation similar to yours.

When a loved one is diagnosed with a terminal illness, family members want and need to act fast to find the appropriate care. This can be a highly stressful and emotional time for everyone involved, and it is incredibly difficult to make these types of decisions under duress. One would hope a hospice service who advertises itself as reputable, offering quality care at end-of-life, would in fact deliver. In your case, this did not happen.

Any time you are going to engage in professional care, whether it be hospice or long-term care, it is important to do your due diligence and really research the services you need. Gilbert Guide helps our readers with their research by sending long-term care experts into the field to review local facilities and services in person, and publishing the results. From there, consumers can create a shortlist of places to check out on their own. We think it’s the most practical and efficient way to celebrate the best care options that an area has to offer.
Barb Boyd Says:

My husband has been with hospice for an extended period of time. They have showed their caring continually. He was home for 10 months, and has been in an assisted living for 6 months. I have nothing but praise for their help.
Gina Y. Davis Says:

My mother was diagnosed with adno carcinoma( head and neck cancer)back in July and the doctors recommended chemo and radiation 5x a week for 7wks because,the cancer was so advanced. When palliative care was no longer an option we were forced to find another solution to help relieve the pain and suffering my mom was experincing. The social worker @ the hospital mentioned hospice and the American Cancer Society as a way to get help. I had heard so many negative comments about hospice so I was reluctant. When speaking with one of my best friends about my reservations, she quickly put them to rest. I did decide to call hospice and I AM TRULY GRATEFUL TO GOD I DID. We started with home hospice and then 6 days before she passed we put her in the hospice facility.
They had the most beautiful rooms and the hospice care professionals were the absolute BEST. They treated my mother like she was the only patient they had to care for. I was very pleased with the care she was given from beginning to end. My mom passed away September 24 and although it was the most heartbreaking experience of my life it was also the most peaceful.

A lasting impression has been left in my heart and on my mind. I plan to become a volunteer @ the new hospice facility opening in the summer 2007.
LIL DAHM Says:

I WANT TO THANK THE KLAMATH FALLS HOSPICE AND HIGH DESERT HOSPICE OF KLAMATH FALLS. IN THE LAST COUPLE OF YEARS MY FAMILY HAS HAD IT SHARE OF LOSS. THE CARE GIVERS FROM HOSPICE HAS BEEN THERE. THEY HELP WITH QUESTIONS , PROBLEMS, PAIN MEDS, BATHING,EMOTINAL SUPORT. THE MEDICAL PERSONS, DR’S, NURSES, HOSPITALS, THAT HAS HELP MY FAMILY. MY MOTHER DIED OF CANCER, WHILE BEING TREATED FOR A PAIN IN HER HIP FOR OVER 4 YEARS, THIS IS WILE SEEING SO MANY DR.’S AND NO ONE EVER CHECK FOR CANCER ON HER. WHEN SHE COULDN’T WALK AND THE PAIN WAS SO GREAT SHE JUST WANTED TO DIE. MY FATHER AND FAMILY DIDN’T KNOW WHAT WAS WRONG. I QUIT WORK AND STARTED GOING WITH MY MOTHER TO DR VISITS. FINALLY TOOK HER OUT OF TOWN TO GET HELP. THAT IS WHEN WE FOUND OUT THAT SHE HAD CANCER BUT, IT WAS TO LATE TO HELP MY MON, IT WAS IN HER BONES, AND WENT TO HER BRAIN. WE FOUND OUT IN JUNE AND IN AUGUST MY MOM HAD PASSED. MY MOTHER-IN-LAW, HAD HEART PROBLEMS AND WE KNEW THAT HER TIME WITH US WOULD BE SHORT. WAS HELP WITH HER PAIN FOR ALMOST 8 MONTHS FROM HOSPICE. MY DAD JUST PASSED AWAY AND THE WHERE THERE AT THE HOSPITAL WITH ME. BECAUSE I COULDN’T BRING HIM HOME WITH OUT HOSPICE. MY DAD HAD IMFLUZEMEA. I HAD SO MUCH SUPPORT FROM HIGH DESSERT HOSPICE, THEY HELP MANAGE HIS PAIN, HELP ME BATHE AND DRESS HIM, FEED HIM, JUST GENRERAL CARE. MY FATHER PASSED NOT QUITE 2 MONTHS WHEN I BROUGHT HIM HOME. MY BEST FREIND FATHER JUST PASSED AWAY 1 WEEK AGO AND I HELP TAKE CARE OF HIM WITH HIGH DESSERT HOPSICE, AGAIN HE GOT THE SAME CARE AND RESPECT, AS MY FAMILY DID. HE DIED OF BONE CANCER. THERE IN A VERY DIFFERNT TYPE OF JOB. 1 THAT IS VERY TAXING ON THE MIND AND BODY AND SOUL. MY HAT GOES OFF TO YOU ALL FOR THE RESPECT, CARING, LOVE, UNDERSTANG, GUIDEANCE, AND A HELPING HAND OR EMBRACE THAT YOU HAVE TOUCH MY FAMILY WITH. YOUR JOB IS UNSURPASSED BY ALL.
WRITTEN TO YOU BY THE DAHM FAMILY.
April Smith Says:

I am responding to what K_Jacoby said about hospice being a fraud. I am the Marketing Director for a hospice and I do know that some hospices are in it for the money. I actually know of some that would refuse serving a patient because they wouldn’t be able to make any money. I think this is horrible and let me just say that not all hospices run this way. I work for a non-profit organization that focuses on the patients and their families. We will provide services to anyone no matter what their financial situation and do not cheat the system by giving false diagnosis.

I do market to Nursing Facilities, but only to provide information on our services and to thank them for previous referrals. We really do care about the patients and want people to know we are here to help. Our hospice works with the nursing staff to ensure the patients receive the best possible care.

I encourage everyone to seek hospice care when someone you know is in the final stages of life, but please research hospices before making the decision. Remember, these are our loved ones we’re talking about.
Irene O'Brien Says:

I M LOOKING FOR A REPUTABLE HOSPICE IN cA{sAN dIEGO}
Any recommendations??
Ami Icanberry Says:

For more information on how to find quality hospice care in your area, check out my most recent blog post at GilbertGuide.com/blog!

Best of luck…

Ami Icanberry
Becky Bailey Says:

My 59 year old brother was diagnosed with esphogeal cancer, has a nephrostomy tubes in his back and we have been told his time is probably only 1 month or so. The social worker at the hospital and the physician have placed my brother on Palliative Care instead of Hospice…..why? Do they get more money from insurance by doing this?
carmen perez Says:

This pass summer ,iwas faced by the reality of my aging moms illness.the doctors coulnt make a determination as to the best way to treat her.In between vacation time for those who were involved in her treatment was hoorifing .So, I decided to call an ambulance when my mothers home health aid called early one saturday morning. O had been going back and forth that month to minitor my moms condition. On that dreadful day,hjer doctor was on vacation I took mom directly to the emergency room.She had an infection ih her intestines and she was treated with antibiotics-she improved some what. I then took her to see her primary physician-who determined that my mother was having a heart attack.My mom-did not get better,she had less good daysthan bad days-three months later I made the determination for hospice.Cabrini Hospice provided the comforting care that I perceived as both of us needed. The interns continued to check on her and I refused their poking and their agravating my mothers comfort. A swollowing evaluation was performed which aggravted her and at that point they wanted to intervine causing her to be fed directly into her stomach-I refused that.My mom was put on a baby food diet,everything mashed- she would eat little at a time. but she could savor every deliciuse little bit she took as her child ,I did also.She loved the sweet non dairy milk-the rice smooth pudding and the warm herbal teas.My mom had stopped eating all together.This was not her baseline.Iknew she was leaving and I wanted to stay near her til her last braeth of life. Cabrini Hospice had provided room and board fro both mom and me.This to include a volunteer guistarist which she enjoyed so much. Peer group counseling and care. I truly believe that the end of life and our final days shoul be a dignify one.my mothers birthday was in january,she would have become 100yers old.Mother Cabriniscare was invaluable,especially to poor people who had no money in life and none in death.my mother was a patron of mother cabrini,she died in her mothers arms and in her daughters grace.The nurses were angels from heaven-the volunteers who helped us were god sent.My summer vacation was scheduled as staying close to that most gentle woman who brought me into this chaotic life.RIP-mom.As I was in goodd hand at cabrini hospice care. They provided a space for my nad my family to say good-by in a dignify way.
Janice Strang Says:

I am investigating palliative care for a presentation I will be giving soon to a professional group I belong to. My spouse died in March of 2006, and the palliative care that was forced down our throats by one of our local hospitals led to the absoluately most stressful time for both of us in his seven year battle with cancer. The nurses and social workers were unprofessional, rude, did not explain our options, and the “training” they gave me for his in-home care was laughable. As an individual who has a sensitive stomach and no medical training, learning to change g-tube bags and give nutritative and medication infusions via a port and pic line was a scary endeavor, for which the “professionals” gave me no compassion, and explained little to my spouse and myself. I have since taken two graduate level college courses dealing with social work and stress management, and by all standards the individuals that “served” us should not be practicing their trade. Do I sound bitter? Yes, I fear I am, and for me, an extremely positive, upbeat individual, that is not my style. I only hope that via this upcoming presentation I may help others to realize the choices that are out there before their time of need.
kat Says:

i was very reculenting to going on hospice care. And at first I quickly began to change my mind. Now while the hospice was with was the greatest and i do not find fault with them. THE NEW INSURANCE regulations are just enough to make you want to take your own life. Since I was so young being only 46 when i was enrolled i soon found out what happens when you do not die by a certain time. As my sister said my failure to meet their deadline (Not the hospice’s but the insurance companies) i was ‘released’. Although far from being healthy i did stablize and though the hospice did fight and was able to get me 6 extra months that unfortunately all they could do. The insuurances companies were too afraid that since i was so young i might have the audacity to live for years. Even though the heart specialist who gave me my original diagnosis after being forced to wear a montior for 3 weeks and the heart did show additional damaged from the original only 50% of the heart functioning, of five years this was just much too long for the health insuriences companies to agree too. Now i am going to have to go back to a barge of doctors with all of them wanting to retake their tests to see again that although, there is damage there is nohing the can do to help. It means more tests to see if they can finally find out where the blood i spit up every a.m. and is in my urine, tests that even if the found out something they cannot do anything about. For example my right hip and leg if detoriatiting painfully and quickly but because of my heart’s history the cardologist cannot give the okay to operate because he is sure i won’t wake up from the operation. And since i have only one working kidney my kidney specialist is in totally agreement with him because of the fear of putting too much pressure on the only working one. To make matters worse everyone thinks i should be jumping up and down with happiness(But even if i wanted to my arthrities would not allow it!) when i am now just frightnted that i am going to be like many others out there and just fall through the cracks of the new medical policies. Once again this not that my hospice didnot try their best but rather that even they have their hands tied to the mercy of the insurences companies!
Nola Says:

I am very much interested in learning more about Pallative Care. I spent several years in Home Health. I started during the time when you could “keep” a patient. Now I am also working with Hospice. I understand there is no medicare guidance or reimbursment on Pallative Care. Home Health is becoming more geared towards the illnesses that are expected to improve so the agencies can report good outcomes. Home Health is also being encourage to deny coverage to the chronic patients because their outcomes would not be as good. I have a problem with this because it is leaving a whole lot of the elderly population out. At this rate, no home care service will be available because Hospice’s criteria is
usually probable death within 6 months.
Medicare wants to keep seniors out of the hospital so it is my take that they should provide coverage and guidelines for pallative care to the chronic patients who may live several more years. It seems home health is becoming more of an industry instead of a service. What can we do to facilitate a change?
April Smith Says:

I agree that palliative care should be more widely used for patients in pain. Part of the problem is that physicians have to prescribe the medications and a lot of them are afraid of giving too much. Most of them have been trained to avoid the strong medications required to provide proper palliative care. Physicians worry about harming the patient and tend to prescribe a lower dosage then are necessary to ease the pain. According to research, educating physicians as well as the general public is the best way to help people understand the benefits of palliative care.

I definitely believe that Home Health is not what it should be. As the population ages, there is a greater demand for Home Health. Unfortunately, some people see this as an opportunity to make money. If the goal is making a profit, then it’s not serving the patient. This is a problem and the patient is the one who suffers. I don’t really know what can be done to facilitate a change. Maybe just being aware of the situation is a good start. I guess I’m left with the thought, “How do you teach people to care?”

Please read my latest blog post on hospice care here.
Terri Says:

To respond to hospice groups who market to nursing facilities:
Yes, probably most of the residents in nursing facilities would qualify for hospice and I think the families would benefit greatly from it. My father has been in and out of different nursing facilities for 3+ years and we are currently considering hospice (we probably will go for it). It has been our experience that nursing facilities ALWAYS look out for their bottom line! They have wanted to put my dad on a feeding tube 3 years ago (he still enjoys eating and is doing ok) and they have put him on behavioral and anti-seizure drugs that have ROBBED HIM of quality of life and left him so drugged at times we couldn’t wake him on certain days and VERY groggy at other times. Nurses and doctors want him feed properly (feeding tube) and not to have a seizure (drugged) and not to have any emotions (drugged) (he gets feisty and angry with certain staff people). Medical prof only concern themselves with keeping the person alive- not their quality of life!! Our family has been very vigilant and I think that there is not enough involved families in nursing facilities and that hospice would be important to those individuals in facilities to help maintain QUALITY of life for as long as possible. By the way my dad is turning 90 tomorrow!