When facing serious illness or the health decline of a loved one, it’s vital for you to understand the care options available to them. Palliative care and hospice care are two common choices designed to improve quality of life, but they serve distinct purposes and are appropriate at different stages of illness. This article from our team at Apex Health Services will explore the key differences between palliative care and hospice, so you can determine which is best suited for your loved one.

What Is Palliative Care?

Palliative Care is medical treatment provided by an interdisciplinary team, and a consultative service that focuses on management of a persons symptoms that arise as a result of a serious or chronic illness.  Palliative Care attends to the patient's continuous education of their illness, allowing them to make choices in their healthcare journey.  It attends to the physical, functional and psychological impact.  It is a person-centered approach that can optimize quality of life, while facilitating personal autonomy and collaboration across healthcare providers.

Is Palliative Care a Step Before Hospice?

Palliative care is not necessarily a precursor to hospice care. While it's true that palliative care can transition into hospice care if a patient's condition deteriorates to the point where medical treatment is no longer curative, this is not always the case. Palliative care aims to enhance the quality of life through symptom management and support at any stage of a serious illness, which can sometimes lead to significant improvement in a patient's condition. In such cases, patients may recover enough to discontinue palliative care and return home without the need for further intensive treatment.

Conditions Benefiting from Palliative Care

Palliative care is beneficial for a wide range of conditions, particularly those that are serious and may cause significant symptoms or distress. This type of care is designed to improve quality of life through symptom management, stress relief, and support for both patients and their families. Here are some conditions that commonly benefit from palliative care:

• Heart disease: Such as congestive heart failure or chronic coronary artery disease, where symptom management can greatly improve quality of life.
• Lung diseases: Chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, and cystic fibrosis are examples where palliative care can help manage breathing difficulties, fatigue, and other symptoms.
• Kidney failure: Especially for patients undergoing dialysis, palliative care can help manage the symptoms and decisions about treatment options.
• Liver disease: Advanced liver diseases such as cirrhosis can lead to complex symptoms that are well-managed by palliative care.
• Cancer: Patients at any stage of cancer may benefit from palliative care, which can help manage pain, nausea, loss of appetite, and other symptoms related to the disease or its treatment.
• Stroke: Palliative care can assist with recovery by managing pain, mobility issues, and other complications arising from a stroke.
• Dementia: Including Alzheimer’s disease, where palliative care provides crucial support in managing the progressive symptoms and offering respite for caregivers.
• Parkinson’s disease: Helps in managing tremors, rigidity, and other motor symptoms, as well as non-motor symptoms like depression.
• HIV/AIDS: Managing symptoms and improving quality of life as the disease progresses.
• ALS (Amyotrophic Lateral Sclerosis): Providing care for symptoms and assisting with the emotional and physical challenges faced by patients and their families.

How Serious Does an Illness Need to Be for Palliative Care?

Palliative care is appropriate for any serious illness at any stage of the illness that significantly impacts a person’s daily functioning or quality of life, not just life-threatening conditions. The severity of an illness that warrants palliative care can vary widely; it is more about the complexity and symptoms of the condition than the specific diagnosis or the immediate risk of death.

Criteria for Palliative Care:

• Symptom burden: If the symptoms of an illness — such as pain, fatigue, nausea, loss of appetite, difficulty breathing, or depression — are severe and interfere significantly with day-to-day activities, palliative care may be appropriate.
• Chronic conditions: Diseases that are long-term and deteriorate over time.
• High medical needs: Illnesses that require complex care management, frequent hospitalizations, or intensive medical interventions are prime candidates for palliative care.
• Serious acute illnesses: Even conditions that are expected to improve can benefit from palliative care. For example, patients recovering from serious injuries or surgeries may receive palliative care to manage pain and complications during their recovery process.

What Is Hospice?

Hospice care is a specialized type of care designed for patients who are in the final stages of a terminal illness, where the focus shifts from curative treatment to comfort and quality of life. Hospice is specifically intended for patients who have a prognosis of six months or less to live, as determined by a physician. The care provided is not about curing the illness but about providing comfort and support. Hospice care aims to ensure that patients live their last days as fully and comfortably as possible by managing pain and other distressing symptoms.

Transitioning to Hospice

Transitioning from palliative care to hospice is a significant part of managing end-of-life care, guided by the "Five Stages of Palliative Care."

1. Initially, when a patient's condition is stable, a palliative care strategy is designed and implemented, which includes advance care planning to express the patient’s medical wishes (Stage 1).
2. As the condition worsens, the strategy adapts to ensure both the patient and their loved ones are emotionally prepared for potential outcomes (Stage 2).
3. If the condition deteriorates significantly, this marks the transition to end-of-life care, indicating that while hospice may not yet be necessary, improvement in long-term outlook is unlikely (Stage 3).
4. When the condition becomes terminal, transitioning to hospice care becomes the most appropriate course, shifting the focus entirely to comfort care (Stage 4).
5. Finally, bereavement support is provided to family, loved ones, and caregivers as they cope with the impending loss (Stage 5).

What Do Palliative Care and Hospice Care Have in Common?

Palliative care and hospice care share several key similarities, despite serving different purposes and populations. Understanding these commonalities can help patients and families appreciate the comprehensive support available through both approaches:

• Focus on comfort and quality of life: Both palliative care and hospice care prioritize the comfort and quality of life of patients. They aim to alleviate physical symptoms such as pain, nausea, and fatigue, as well as address emotional, social, and spiritual needs to enhance overall well-being.
• Multidisciplinary team approach: Both types of care involve a multidisciplinary team of healthcare professionals who work together to provide holistic support. This team typically includes doctors, nurses, social workers, and spiritual counselors, ensuring that all aspects of a patient's care are addressed.
• Patient-centered care: Both palliative care and hospice care emphasize patient-centered care, which means that treatment plans are tailored to the individual needs, values, and preferences of each patient. Care is provided in collaboration with the patient and their family, empowering them to make informed decisions about their care.
• Emotional and spiritual support: Both palliative care and hospice care offer emotional and spiritual support to patients and their families. This includes counseling, bereavement support, assistance with advance care planning, and help navigating difficult decisions related to end-of-life care.
• Family involvement: Both types of care recognize the importance of family involvement and support. Family members are encouraged to participate in care planning, decision-making, and providing comfort to their loved ones. Additionally, both palliative care and hospice care offer resources and support to help families cope with the emotional challenges of caring for a seriously ill or dying loved one.
• Home-based care options: While palliative care can be provided in various settings, including hospitals and skilled nursing facilities, both palliative care and hospice care offer the option of receiving care in the comfort of one's own home. This allows patients to remain surrounded by familiar surroundings and loved ones during their illness.

Palliative Care vs. Hospice: Differences

Palliative and hospice care share similar goals, such as improving quality of life and symptom management, but they differ significantly in their availability and focus. The table below explains some key differences between palliative and hospice care.

Who Is Eligible?

Determining eligibility for palliative care relies on various factors beyond insurance coverage. Most individuals facing serious or chronic illness qualify for palliative care services tailored to alleviate their symptoms and enhance their quality of life.

Hospice care, on the other hand, follows more stringent guidelines:

• A certified physician, either an MD or DO, must confirm your terminal illness prognosis, estimating a life expectancy of six months or less.
• As part of hospice care, you agree to forego curative treatments and prioritize symptom management as you approach the end of life.
• Hospice care offers flexibility in location, allowing you to receive services at home, in a nursing facility, hospital, or a licensed hospice center. However, it's important to note that hospice insurance benefits typically cover expenses related to care but may not include room and board if you opt for a facility-based setting.

Who Provides Care?

Upon enrollment in either a palliative care or hospice program, you'll receive a dedicated team comprising diverse specialists to address your unique needs and preferences.

This interdisciplinary team includes:

• Physicians, nurses, and other primary healthcare providers offer expert medical guidance.
• Therapists specializing in palliative care.
• Nutritionists provide tailored dietary plans to support your overall well-being.
• Social workers offer emotional support, assistance with care coordination, and access to community resources.
• Spiritual counselors, such as rabbis or pastors, provide guidance and comfort according to your beliefs and values.

These professionals collaborate closely with your primary healthcare provider to deliver comprehensive care aligned with your goals and preferences.

During hospice care, it's essential to recognize that all treatments require approval from your hospice physician. Without prior authorization, certain treatments may not be covered by your insurance, underscoring the importance of clear communication and coordination within the hospice team.

Insurance Coverage

Navigating insurance coverage for palliative care necessitates understanding the specific benefits offered by your insurance plan. It's advisable to review your plan details to ascertain the extent of coverage. Medicare typically covers palliative care services through its Part B benefit, with a standard 20% coinsurance for each service received.

As for hospice benefits, coverage varies among private insurance plans. However, Medicare and TRICARE provide coverage for hospice care. Additionally, the Veterans Administration (VA) offers coverage, albeit with potential variations, and Medicaid covers hospice care in select states. Most individuals access hospice care through Medicare's Part A benefit, where no deductible is required, and the majority of hospice services are either free or offered at minimal cost.

Hospice coverage encompasses all care related to the terminal condition, including hospitalizations. Nonetheless, if you require treatment for an unrelated condition, Original Medicare benefits apply, necessitating payment of standard Part A or Part B costs.

For those enrolled in Medicare Advantage plans (Part C), coverage for non-hospice-related services may be available. While in Medicare-authorized hospice care, out-of-pocket expenses typically include a $5 co-pay for hospice-approved medications and a 5% contribution towards respite care.

Learn more about Insurance Coverage at APEX Health Services.

How Long Can a Person Receive Care?

The duration of care varies for both palliative care and hospice care:

Palliative Care:

• There is no set limit on the duration of palliative care. It can be provided at any stage of a serious illness, from the time of diagnosis onward.
• Palliative care is often integrated into a patient's overall treatment plan and can continue alongside curative treatments for as long as needed to manage symptoms and improve quality of life.
• Patients may transition from receiving palliative care to hospice care if their condition progresses to a terminal stage and they choose to focus solely on comfort care.

Hospice Care:

• Hospice care is typically provided when a person has a prognosis of six months or less to live, as certified by a physician.
• While hospice care is intended for end-of-life support, there is no strict limit on how long an individual can receive hospice services.
• Hospice care continues as long as the patient's condition remains terminal and they choose to forgo curative treatments in favor of comfort-focused care.
• Patients can continue to receive hospice care beyond the initial six-month prognosis if their condition remains terminal and they meet hospice eligibility criteria.

How to Decide on the Right Type of Care

Deciding on the right type of care, whether palliative or hospice, involves careful consideration of the individual's medical condition, treatment goals, and preferences. Here are steps to help make this decision:

1. Understand the difference: Learn about the distinctions between hospice and palliative care. Palliative care focuses on improving the quality of life for individuals with serious illnesses at any stage, while hospice care provides comfort and support for those nearing the end of life.
2. Assess medical needs: Evaluate the individual's medical condition, prognosis, and treatment options. Consider whether curative treatments are still being pursued and if symptom management is a priority.
3. Clarify goals of care: Engage in open discussions with the individual and their healthcare team to clarify their goals of care. Determine whether the primary focus is on symptom management, comfort, and quality of life, or if curative treatments remain a priority.
4. Consider personal preferences: Take into account the individual's values, beliefs, and preferences regarding medical care, including their desired level of involvement in decision-making and their preferred care setting.
5. Consult healthcare professionals: Seek guidance from healthcare professionals, including primary care physicians, specialists, palliative care teams, and hospice providers. They can provide valuable insights and recommendations based on the individual's medical needs and circumstances.
6. Review insurance coverage: Review the individual's insurance coverage to understand the benefits and limitations associated with palliative care and hospice care. Consider how insurance coverage may impact the choice of care.
7. Evaluate support system: Assess the availability of caregiver support and resources within the individual's personal network and community. Consider how caregiving responsibilities may influence the decision-making process.
8. Reassess over time: Recognize that care needs and preferences may evolve over time, especially as the individual's medical condition progresses. Regularly reassess the appropriateness of the chosen type of care and be open to adjusting the care plan as needed.