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Explaining the difference between hospice and palliative care programs

by Pam Eimers
March 18, 2007

Hospice and palliative care are terms heard often today but not always understood. While palliative care is an important component of hospice care, today there are palliative care programs that operate independently of hospice. It can be confusing until you understand the differences.

To palliate is to relieve or sooth the symptoms of a disease or disorder. Palliative care focuses on making patients comfortable rather than curing their illness.

The primary goal of both hospice and palliative care is to improve the quality of a seriously ill person’s life by easing symptoms and supporting the person and the family. While the two care approaches are similar in many ways, there are important differences to understand in order to select the care model that best suits your needs.

Hospice providers are experts in end-of-life care. Hospice care focuses on persons with a terminal illness who are not seeking aggressive curative treatment. Medicare criteria for hospice requires that the person’s physician believes that if the disease runs its normal expected course the person may have six months or less to live. Because each person’s response to his or her disease is unique, individuals may remain on hospice well beyond six months as long as they continue to meet hospice criteria.

Palliative care programs treat seriously ill persons before and after other specialists administer curative treatments. In these programs patients do not need to meet life-expectancy criteria as they do with hospice programs. Palliative programs provide a continuum of care through which a person transitions over the course of time from aggressive treatment to end-of-life care. Typically patients are referred to hospice when they meet hospice criteria.

Both palliative and hospice care providers advocate for patients, assisting in their coordination of care.

Hospice providers are regulated by federal healthcare guidelines. A complete package of care is provided, adjusted to meet individual needs. Care is provided by teams of registered nurses, social workers, hospice aides, chaplains and trained patient care volunteers. A medical director leads the teams while each patient’s personal physician usually remains their primary care provider. The family and caregivers are included in the scope of care which includes education about the disease process and care giving, emotional support and assistance in accessing community resources. Up to 13 months of individual and group bereavement support if offered to families as they adjust to life without their loved ones.

Palliative care is not regulated like hospice care and takes many forms depending upon the provider. It can be as simple as nurses offering comfort care during a patient’s hospital stay, or may entail a full compliment of services much like hospice.

Most palliative care programs are hospital-based with services offered to patients during their hospital stay. Other palliative care programs are structured similarly to Yolo Hospice, operating independent of other health care organizations.

Medicare and Medi-Cal pay for hospice care including medications and medical equipment related to the diagnosis for persons with these benefits. In California private insurance plans and HMOs are required to provide a hospice benefit. Most hospices, including Yolo Hospice, provide care without charge to those without any coverage.

Medicare and Medi-Cal pay for some treatments and medications associated with palliative care, but there is no specific palliative care benefit. Each palliative care provider can help you determine what coverage you have.

Experts generally agree that the best medical care, whether end-of-life or curative, treats the whole person - body, mind and spirit - and includes educational and emotional support for the family. That is the essence of hospice care and comprehensive palliative care programs.

Seeking palliative care during hospital treatment for an acute or chronic illness may ease the stress on both patient and family. Transitioning to hospice care when entering the last six months of life provides optimal end-of-life care for the patient and support for the family.

For more information on hospice care, call Yolo Hospice at 758-5566 or visit our website at www.yolohospice.org or the National Hospice and Palliative Care Organization at www.nhpco.com.

 

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Ted Skiera
"I've worked for 20+ years in cardiovascular and oncology nursing, most recently working as a nurse coordinator in cardiovascular research. My work with Yolo Hospice has enabled me to focus all of my acute clinical experiences into caring for patients, and their loved ones, during a most challenging period of their lives."
~Ted Skiera, RN