Palliative Care vs. Hospice Care—What You Need to Know - Connecticut Hospice (2023)

December 21, 2021

Palliative Care vs. Hospice Care—What You Need to Know - Connecticut Hospice (1)

Palliative Care Definition

“Palliative Care is specialized medical care for people with serious illness, focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for the patient and the family. Palliative care is an essential part of the care of anyone with a serious illness, including people who are continuing to be actively treated, and can not only help people get relief from symptoms like pain and shortness of breath, but also help them to better understand their illness and its treatment so they can choose the care that is right for them -- from ongoing active treatment to hospice.

Palliative care is different from hospice care because it is appropriate for people who are seriously ill and are continuing treatment. With exceptions, such as continuing routine medications for problems like high blood pressure or diabetes, people in hospice care are no longer being treated for serious or terminal illness. For example, people in hospice care are not treated with chemotherapy or radiation for cancer, and focus instead on the relief of symptoms.”

(Video) Palliative Care and Hospice Care

Joseph Sacco, Chief Medical Officer, The Connecticut Hospice
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Palliative Care is Not the Same as Hospice Care.

The terms “palliative care” and “hospice” are often used interchangeably, confusing patients and families alike. Many hospitals now offer palliative care services to those in pain. Some are in hospice care as well, some are having active treatment for their diseases, and some are only receiving palliative care for pain management.

Patients and Families Sometimes Balk at the Term, “Hospice”

Those of us in the field are often guilty of this confusion as well. Often, people who are resistant to the term “hospice”, but are past the point of curative care, are referred for palliative care instead, either to a home health agency or to a home hospice agency.

Treating Terminal Patients with Palliative Care Instead of Hospice Affects the CMS Rating of the Medical Service.

We have traditionally provided both palliative and hospices of care at the Connecticut Hospice, but have found that, almost without exception, the level of services is fairly comparable. For this reason, we have begun limiting the intake of palliative care patients, as we are judged by CMS, (Centers for Medicare & Medicaid Services) by their level of functional improvement.

Since many are at or near the end of life, little progress in the tasks of daily living is achieved, causing us to get very few stars in the government’s rating system. Hence our hesitancy in taking on patients with whom we cannot succeed, by the Federal definition, yet who truly need our help and care. This is a problem that needs addressing, both by the Federal government, and by physicians. Busy doctors are more likely to suggest palliative care, because it doesn’t carry the weighted overtones of “hospice”.

Palliative Care vs. Hospice Care—What You Need to Know - Connecticut Hospice (3)

The Costs of Palliative Care vs. Hospice Care

All of this overlap really goes back to the original Medicare definition of hospice eligibility, which was apparently set more or less randomly at six months of life expectancy at the normal disease trajectory. While that may mean very little in the case of an individual, it has become a catchphrase for our industry, depriving those who cannot be certified of important services, and deterring others who are loath to accept an arbitrary six-month prognosis.

Medicare’s Six-Month Prognosis Standard for Hospice Eligibility Needs to Change.

Those of us in the hospice line of business believe that it’s past time to change that standard since the evidence is clear that many, if not most, hospice patients have their lives extended with the skilled and compassionate care that hospice workers give. In addition, people in the care of home hospice are frequently able to avoid or minimize time spent in hospitals and urgent care settings, which patients find very taxing and debilitating, without even considering the expense of multiple hospitalizations. If the time frame being discussed were twelve or eighteen months, more patients would likely choose home hospice, and possibly live as long or longer than with aggressive treatment.

(Video) Hospice vs Palliative Home Care Explained

Palliative Care vs. Hospice Care—What You Need to Know - Connecticut Hospice (4)

Medical Facility Costs for Treating Terminal Disease can be Prohibitive

The issue of continuing treatment is complicated and also seems to be transitioning. There are many patients who continue to seek treatment for their disease because they can, and, even if it’s a long shot, they don’t want to stop. Since hospice care is considered to be CMO (comfort measures only), and since hospices are required to pay for all treatment and equipment related to the patient’s diagnosis under hospice care rules, this means that we can’t afford to take someone who is undergoing treatment.

Palliative Care as Compensated by Medicare at a Much Lower Rate.

Palliative care is compensated at a much lower rate, meaning that caring for a very ill patient continuing treatment, but needing end of life care, doesn’t make financial sense for a home care agency, if that means that they are providing hospice level care, but being paid for routine palliative care. A terminal patient still having treatment is just as sick, or sicker than, a patient receiving comfort measures only, yet the payment for palliative care is far less than for hospice care. In the case of hospice care, even if an exception is made for certain types of treatment, the expense of that treatment puts it out of reach for hospice budgets.

Is Palliative Care or Hospice Care Better?

When deciding on care for a loved one, all of these factors can come into play. It’s hard to discontinue treatment from an emotional point of view, even if it is causing side effects (although newer infusion therapies and immunotherapies are much more likely to be tolerated easily). Also, doctors are taught to cure, not to counsel acceptance of death. However, many patients live fuller, and even longer, lives when symptoms are managed and care is compassionate but not meant to be curative.

The Confusion Around Palliative Care vs. Hospice Care

This is where the confusion of terms comes in: We would consider that symptom management is both hospice care and palliative care. From a home care billing point of view, however, the two are separate, with palliative care used to mean care for a serious illness where improvement is expected, and hospice care used to mean care for the same illness, once the goal of curing the disease has been foregone. To confuse matters further, Palliative care in hospitals can be “comfort measures only”, which is technically hospice care, or pain management. It’s no wonder that families get confused!

Honest Conversations about Prognosis and Disease Trajectory are Critical

The most important starting point is for the patient and his/her support team to have an honest conversation among themselves, and with their treating physicians, about the effectiveness of current and future treatment, a true prognosis for the disease at hand, and the goals for that person’s life trajectory. Some will choose length of life, some will choose quality of life. Sadly, it often happens that assumptions are made, or hard truths are not voiced, so that treatment and care can be working at cross purposes.

Palliative Care vs. Hospice Care—What You Need to Know - Connecticut Hospice (5)

Palliative Care Can Mean More Discomfort, Both from the Disease and From the Treatment

If treatment is still desired, a hospitalized patient may still see a palliative care doctor, but the medical team’s efforts are aimed at gaining a cure, or a remission, of the illness. In many cases, this aim means that the patient may have more discomfort, both from the disease and from the treatment. Doctors also can’t know for sure how different people will be able to tolerate, or not, various regimens for treatment. Often, it is not clear early on whether treatment will work, so all of these factors need to be revisited regularly.

(Video) Palliative and Hospice Pastoral Care Explained

When a patient and his/her family come to the decision that comfort care is the way to go, our full attention can be mobilized in that direction. After decades of experience, we have become experts in delivering care whose aim is to fulfill wishes, promote comfort and closure, and relieve pain. Since our goals are less long term, tolerable pain levels are often left to the patient; he/she might choose to remain more lucid, albeit with discomfort, or to be more sedated and have more relief.

The Patient and Family Get to Choose How to Spend their Remaining Time

It should be clear by now that the patient and family are at the center of this choice, as they should be. All people should be given enough information to make the decisions that are in their own best interests. In fact, that was a primary reason for our founder, Florence Wald, to establish The Connecticut Hospice as the country’s first hospice. She believed passionately that patients and their families needed to be considered as a unit, and that they should be given their diagnoses and prognoses, which wasn’t commonly done fifty years ago. She trusted in the innate wisdom of those at the end of their lives to decide how to spend their remaining days, months, or years, and in the ability of nurses and other medical professionals to help those wishes to come true. And that is as true today at The Connecticut Hospice as it was at our inception.

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Palliative Care vs. Hospice Care—What You Need to Know - Connecticut Hospice (7)

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(Video) Common Read: Palliative Care vs. Hospice Care


What are the 3 foundational concepts of hospice palliative care? ›

Hospice palliative care is based on three foundational concepts: effective communication, effective group function, and the ability to promote and manage change.

How does hospice work in Connecticut? ›

In order to be eligible for hospice care, a person must have a terminal illness (i.e., an illness that cannot be cured by medical intervention) and a prognosis of six months or less. In order to be admitted to inpatient hospice care, a person must also have symptoms that cannot be safely managed in another setting.

Do people prefer to receive palliative care in their homes or in a hospice hospital? ›

Dying in the preferred setting is an indicator of good palliative care quality. Most people prefer to die at home.

Does palliative care always mean terminal? ›

No. Although it can include end of life care, palliative care is much broader and can last for longer. Having palliative care doesn't necessarily mean that you're likely to die soon – some people have palliative care for years. End of life care offers treatment and support for people who are near the end of their life.

What are the 5 priorities of palliative care? ›

 The five priorities focus on: recognising that someone is dying; communicating sensitively with them and their family; involving them in decisions; supporting them and their family; and creating an individual plan of care that includes adequate nutrition and hydration.

Who pays for hospice in CT? ›

If you do live longer than 6 months, you can keep having hospice care. If your illness gets better, you can stop getting hospice care. You may no longer qualify for it. Hospice care is generally paid for by Medicare, Medicaid, and private insurance.

Is palliative care the last step before hospice? ›

Both palliative care and hospice care provide comfort. But palliative care can begin at diagnosis, and at the same time as treatment. Hospice care begins after treatment of the disease is stopped and when it is clear that the person is not going to survive the illness.

What are the four stages of hospice? ›

Routine home care, general inpatient care, continuous home care, respite.

How do I choose between hospice and palliative care? ›

If you have a diagnosis of a life-altering, long-term illness, you can access palliative care. Hospice care is only available for people with terminal illnesses, or less than 6 months to live.

At what stage do you get palliative care? ›

Palliative care is appropriate at any stage of a serious illness. You can also have this type of care at the same time as treatment meant to cure you.

Does palliative care include bathing? ›

Caregiving may include lifting, bathing, delivering meals, taking loved ones to doctor visits, handling difficult behaviors, and managing medications and family conflicts.

How long can a patient stay in palliative care? ›

The maximum length of eligibility for hospice is six months. This means that patients are not expected to live beyond six months at the time of their admission.

Why do doctors recommend palliative care? ›

They focus on the stress, other symptoms and side effects from your disease and its treatment. Palliative care helps with pain, depression, anxiety, fatigue, shortness of breath, constipation, nausea, loss of appetite, difficulty sleeping and much, much more.

What happens when someone is put on palliative care? ›

Palliative care is an approach to treatment which aims to: Improve the quality of life of patients and their families facing the problem of life-threatening illness. Prevent and relieve suffering. Identify, assess and treat pain and other problems, physical, psychosocial and spiritual.

What are the 6 C's in providing quality in palliative care? ›

Results: Six essential elements of quality palliative homecare were common across the studies: (1) Integrated teamwork; (2) Management of pain and physical symptoms; (3) Holistic care; (4) Caring, compassionate, and skilled providers; (5) Timely and responsive care; and (6) Patient and family preparedness.

How do you prepare for palliative care? ›

  1. Educate yourself about the different key treatments for end-of-life care, so that you can make informed decisions. ...
  2. Start conversations with loved ones so that they are clear about your wishes for care. ...
  3. Understand the benefits of palliative care and hospice care and know when to ask for them.
17 Oct 2016

What are two 2 benefits of a palliative approach to care? ›

The benefits of palliative care

People receiving early palliative care reported: Feeling better. Fewer symptoms. Improved mood.

Who pays for palliative care? ›

Who pays for palliative care? Palliative care is often covered by Medicare, Medicaid and most private insurance. Every financial situation is different in regard to who pays for palliative care, so we recommend you contact your insurance company to find out about any possible copays or deductibles.

What are the 3 main goals of palliative care? ›

The goals are:
  • Relieve pain and other symptoms.
  • Address your emotional and spiritual concerns, and those of your caregivers.
  • Coordinate your care.
  • Improve your quality of life during your illness.
22 Aug 2021

Is end of life hospice care free? ›

Hospice care is free, paid for through a combination of NHS funding and public donation. You can contact a hospice directly yourself, but the team will usually also ask for a referral from your doctor or nurse. Places are limited, but you can contact your local hospice to see what is available.

Are hospices free of charge? ›

Hospices can provide care for anyone with a terminal illness, sometimes from the time they receive a terminal diagnosis. Hospice care is free, so you don't have to pay for it. Hospices provide nursing and medical care.

What percentage of hospice patients survive? ›

According to the National Institutes of Health, about 90% of patients die within the six-month timeframe after entering hospice. If a patient has been in hospice for six months but a doctor believes they are unlikely to live another six months, they may renew their stay in hospice.

Why do doctors push hospice? ›

There are a number of reasons why hospitals might be motivated to push patients towards hospice care. First, hospice care is typically less expensive than traditional medical care. Second, hospice care is often seen as a way to hasten death.

Does palliative care begin when hospice starts? ›

A. Palliative care is whole-person care that relieves symptoms of a disease or disorder, whether or not it can be cured. Hospice is a specific type of palliative care for people who likely have 6 months or less to live. In other words, hospice care is always palliative, but not all palliative care is hospice care.

What is usually not included in hospice care? ›

Hospice, however, doesn't cover room and board fees at senior communities. Instead of providing endless surgeries and treatments, hospice focuses exclusively on the comfort of the patient. The palliative portion of the care may offer an array of pain medications while not treating the cause of the terminal illness.

Does hospice provide around the clock care? ›

In any setting, hospice care is designed to be available 24 hours a day, 7 days a week. Your doctor, hospital social worker, case manager, or discharge planner can be helpful in deciding which type of hospice program is best for you and your family.

Is hospice care and palliative care the same? ›

Palliative Care vs Hospice Care

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.

What is a comfort kit? ›

A hospice comfort kit, commonly called a Hospice Emergency Kit or E-Kit, is a small supply of medications kept in the home so that they will be available to rapidly treat symptoms that may occur in a patient with a terminal illness.

What is the downside of palliative care? ›

The greatest disadvantages of palliative care at home are commitment, extra work and demand, and frustration. People in this situation may be able to optimize living after death and manage the situation with resources, if support, resources, and other resources are available.

Which patient is the most suitable for palliative care? ›

Persons with advanced cancer and their families are a key target group for palliative care. International research has established that most people with advanced cancer would like to remain at home among family until they die [1,2,3].

When should I switch to palliative care? ›

You may start palliative care at any stage of your illness, even as soon as you receive a diagnosis and begin treatment. You don't have to wait until your disease has reached an advanced stage or when you're in the final months of life. In fact, the earlier you start palliative care, the better.

What medications do they give in palliative care? ›

They include medicines such as codeine, morphine and pethidine. Pain is an unpleasant sensation, suffering or distress and it can also make you irritable, make it hard to sleep, reduce your appetite, and make it difficult to be active and enjoy life. Not everyone with a terminal illness will experience pain.

What questions should I ask about palliative care? ›

Questions to Ask About Palliative Care
  • Are you recommending palliative care for me? ...
  • How do I find out if I'm eligible?
  • What is included in palliative care that's different from the care you can give me?
  • Who will be part of my palliative care team?
  • Where will I receive palliative care?
10 May 2019

Does hospice care change diapers? ›

The hospice team also teaches the family how to properly care for the patient – such as changing adult diapers, bathing the patient and preparing the right meals according to the patient's recommended diet plan.

Do patients eat in palliative care? ›

Your health care team may want to have a swallowing assessment done to determine whether your loved one can swallow foods safely and without difficulty. While your loved one can still eat and swallow, offering easy-to-take foods, such as ice cream, apple sauce and pudding can be refreshing and pleasurable.

Do you feed someone on palliative care? ›

Patients usually become less interested in food in the last days of life. This is normal and is not usually distressing for the person who is dying. But it can be very difficult for those around them. Providing food for people can be a way of showing that we care for them.

Does hospice withhold food and water? ›

Hospice care does not deny a patient food or drink. If someone has the desire to eat or drink, there are no restrictions on doing so.

Can you live alone on palliative care? ›

What if I live alone or don't have family nearby? The hospice team can talk to you about choices for staying safe and comfortable in your home, even if you live alone. Hospice services may also be available in your region through nursing home facilities or residential hospices.

What are the 3 stages of hospice care? ›

The early stage, the middle stage, and the final stage are the three stages of death. Various alterations in responsiveness and functionality characterize them. It's crucial to remember, though, that the timing of each stage, as well as the symptoms encountered, might differ from person to person.

What is the injection given at end of life? ›

Morphine is sometimes used when a person is in the advanced stages of illness, and his or her overall condition is declining. If the person is experiencing moderate to severe pain or shortness of breath, his or her doctor will often prescribe morphine.

What is the last breath before death called? ›

Gasping is a brainstem reflex; it is the last respiratory pattern prior to terminal apnoea. Gasping is also referred to as agonal respiration and the name is appropriate because the gasping respirations appear uncomfortable, causing concern that the patient is dyspnoeic and in agony.

What are the fundamental domains of hospice palliative care? ›

By relieving suffering and improving quality of life, hospice palliative care aims to promote health and healing – physical, psychological, social and spiritual well-being – for everyone affected by illness and bereavement, including those who provide care.

What are the fundamentals of palliative care? ›

It means prevention and relief of suffering by means of early identification, assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

What are the most important concepts of palliative care? ›

Palliative care uses a team approach to support patients and their caregivers. This includes addressing practical needs and providing bereavement counselling. It offers a support system to help patients live as actively as possible until death. Palliative care is explicitly recognized under the human right to health.

How long can a person live on palliative care? ›

According to a study that was published in the Journal of Palliative Medicine, roughly half of patients who enrolled in hospice died within three weeks, while 35.7 percent died within one week.

What are the key differences between palliative & hospice levels of care? ›

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.

What are the 6 qualities of palliative care? ›

The subjective views of patients and relatives repeatedly show six elements that are considered essential for good-quality primary palliative care provision: medical proficiency, availability, a focus on the person, proactivity, proper collaboration and information transfer between professionals, and clear and rapid ...

At what stage do you start palliative care? ›

Palliative care is available when you first learn you have a life-limiting (terminal) illness. You might be able to receive palliative care while you are still receiving other therapies to treat your condition. End of life care is a form of palliative care you receive when you're close to the end of life.

When should someone be offered palliative care? ›

Palliative care can be helpful at any stage of illness and is best provided soon after a person is diagnosed. In addition to improving quality of life and helping with symptoms, palliative care can help patients understand their choices for medical treatment.

What can I expect from palliative care at home? ›

Following are the palliative services that can come to your home: Medical evaluations, including monitoring for common symptoms like nausea, vomiting, pain, and anxiety. Prescribing medications to ease these symptoms. Additional medical applications like treating wounds and other medical needs.

What is the biggest barrier to quality palliative and end of life care? ›

Commonly reported barriers in the critical care setting include communication gaps (Coelho & Yankaskas, 2017), difficult end-of-life decisions (Wiedemann et al., 2012), and minimal access to education (Wolf et al., 2019). Efforts have been underway to improve the quality of palliative critical care.

Who is the most important person on the palliative care team? ›

Someone from the team, most often the nurse, will communicate with you frequently to make sure your needs are being met. You and your loved ones are the most important members of the team. Team members providing care are not limited to doctors and nurses and the care you receive is not limited to medications.


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