While the objective of both hospice and palliative care is pain and symptom relief, the prognosis and goals of care tend to be different. Hospice is comfort care without curative intent; the patient no longer has curative options or has chosen not to pursue treatment because the side effects outweigh the benefits. Palliative care is comfort care with or without curative intent.
The definition of hospice care is compassionate comfort care (as opposed to curative care) for people facing a terminal illness with a prognosis of six months or less, based on their physician’s estimate if the disease runs its course as expected. The definition of palliative care is compassionate comfort care that provides relief from the symptoms and physical and mental stress of a serious or life-limiting illness. Palliative care can be pursued at diagnosis, during curative treatment and follow-up, and at the end of life.
Hospice eligibility requires that two physicians certify that the patient has less than six months to live if the disease follows its usual course. Palliative care is begun at the discretion of the physician and patient at any time, at any stage of illness, terminal or not.
Interdisciplinary teams deliver both hospice and palliative care. They address physical, emotional and spiritual pain, including such common worries as loss of independence, the well-being of the family and feeling like a burden.
Hospice care costs are paid 100 percent by Medicare, Medicaid and private insurance; hospice is the only Medicare benefit that includes pharmaceuticals, medical equipment, 24/7 access to care, nursing, social services, chaplain visits, grief support following a death and other services deemed appropriate by the hospice agency. By comparison, palliative care costs—from office visits to prescription charges—can vary.
Hospice care is delivered at home or in home-like hospice residences, nursing homes, assisted living facilities, veterans' facilities, hospitals and other facilities. Palliative care teams typically work in a hospital.
The American Society of Clinical Oncology has identified the characteristics of a patient who should receive palliative care but not curative treatment; these characteristics are applicable to patients with other diseases, too.
Talk to your family and your doctor about your goals of care and whether palliative care and/or hospice might improve your quality of life