Hospice care and palliative care are both specialized forms of care that support people with serious, life-altering illness, but their aims and intent are different. Hospice care is a concept and a program of care designed to minimize suffering and improve the well being and quality of life for people living with a terminal illness. Palliative care is specialized medical care that aims to improve the symptoms and experience of people living with a serious illness.
Hospice Care
Hospice is a concept and a program of care that is specifically designed to minimize suffering for dying people and their family members. In the United States, hospice is the only widely available comprehensive program to support very sick people where they live. Hospice programs forgo most diagnostic testing and life-prolonging treatments in favor of symptom relief. They also educate dying people and family members about appropriate care and comfort care. Although hospice programs do not emphasize prolonging life, good hospice care may well extend life a little bit, perhaps by avoiding the serious potential side effects of surgery and aggressive medications that people might otherwise receive.
Hospice programs focus on symptom relief, comfort care, and emotional support for the patient and family.
Hospice programs do not emphasize diagnostic testing, finding a cure, or extending life.
In typical hospice care, a family member, a close friend, or both help make decisions for the seriously ill person when he or she is no longer competent or capable. The hospice staff usually visits the person as much as the person needs, as often as daily, and someone is available on call around the clock. Hospice personnel are specially trained to help manage symptoms and provide emotional and spiritual support and hands-on health care.
Hospice always involves different types of professionals, such as doctors, nurses, social workers, attendants (for example, home health aides), and, if needed, speech, physical, and occupational therapists. Pharmacists, nutritionists, and other therapists may also be involved.
Hospice program personnel care for people at home or in nursing homes. Although hospice program personnel do not usually care for people in hospitals and rehabilitation centers, many hospitals are establishing care programs that treat symptoms fully and help with decision making (palliative care services) to address the same care issues.
Hospice programs differ from each other in the services they readily provide and in treatments and devices they support and use. Whether hospice care serves a particular person and family best depends on their needs and wishes, on financial considerations, and on the skills and capacity of the local programs.
Hospice care can provide most necessary medical treatments, and doctors stay involved. Nurses ordinarily oversee the general plan of care, including medications, oxygen therapy, and intravenous lines or other special equipment. Social workers, chaplains, and trained volunteers help address interpersonal, spiritual, and financial issues. Bereavement counselors provide support and insight during the grieving process. Hospice plans of care help family members prepare for the challenges of facing the death of a loved one and dealing with the situation at the time of death, including their roles and how to obtain needed help.
Most people ill enough to require hospice also require some assistance with daily activities (for example, dressing, bathing, and preparing food), and some may be completely dependent. Family members and friends often provide this care, and the hospice or the family can provide additional paid help from home health aides.
Medicare or insurance typically pays for hospice services, but usually only after a doctor certifies that the person has a fatal disorder and is expected to live less than 6 months. People are still covered by their regular medical insurance for conditions unrelated to the hospice diagnosis. Hospice care may be discontinued at any time, for example, if the person's health improves or the person wishes to try a promising treatment for the underlying condition.
Palliative Care
Palliative care aims to improve quality of life by helping people determine goals for their care and relieving them of bothersome symptoms and psychosocial and spiritual distress. Palliative care is compatible with many curative or life-extending treatments. For example, the palliative aspect of care emphasizes treatment of pain or delirium for a person with liver failure who remains on a liver transplant list. However, to say that a person's focus has changed from curative to supportive care or from treatment to palliation would be to oversimplify a complex decision process. Most seriously ill people need a mix of treatments to correct, prevent, or ease the effects of various illnesses and disabilities.
Palliative care can be provided by individual health care professionals, interdisciplinary teams, and hospice programs. Individual palliative care specialists focus on the recognition and treatment of pain and other bothersome symptoms. Interdisciplinary palliative care teams are made up of various professionals (for example, doctors, nurses, social workers, and chaplains) who work together with the person's primary and specialty clinicians to relieve physical, psychosocial, and spiritual distress.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
Compassionandchoices.org: Provides end-of-life planning tools and information about end-of-life care advocacy
Hospice Foundation of America, Inc.: Detailed information about hospice services, costs, choosing a hospice provider, and grief resources
Medicare: Hospice Compare: Provides a search tool to find and compare hospice agencies serving a specific area
