By Dr. Allen Naygauzen, a board-certified internal medicine physician in Philadelphia specializing in palliative care, hospice medicine, and house-call services.
The difference between hospice vs palliative care comes down to two things: when the care can start, and what it is aimed at. Palliative care can be provided at any stage of a serious illness, even while someone is still receiving chemotherapy. Hospice is for people approaching the end of life who have chosen to focus on comfort rather than cure. Neither one means giving up.
What’s in this guide
- Neither Choice Means Giving Up
- What Is Palliative Care?
- What Is Hospice Care?
- Hospice vs. Palliative Care: What’s the Real Difference?
- Common Myths, Answered Honestly
- When Should You Consider Palliative Care or Hospice?
- How Long Does Hospice Care Last?
- Who Pays for Hospice Care?
- What to Say to Someone in Hospice
- Frequently Asked Questions
- Talk to Humanitas Hospice
- About the Author
Neither Choice Means Giving Up
Choosing palliative care does not mean someone is giving up, and going on hospice does not necessarily mean someone is about to die.
Palliative care is about helping someone feel as well as possible while they are dealing with a serious illness. It works as an extra layer of support for pain, shortness of breath, anxiety, and the stress that comes with being sick. A person can still receive treatment for their illness while getting palliative care.
The rest of this guide works through the questions families ask about both: what each type of care is, how they differ, when to start asking, how long care lasts, who pays, and what to say to someone receiving hospice services.
What Is Palliative Care?
Palliative care is specialized care for someone living with a serious illness, and the goal is to make that person’s day-to-day life better.
It works on two fronts. The first is symptoms: pain, nausea, shortness of breath, and anxiety. The second is decisions. A serious illness produces a steady stream of difficult medical choices, and part of palliative care is helping the patient and the family navigate them.
Timing matters here too. Palliative care can be provided at any stage of a serious illness. Someone receiving chemotherapy can have it. Someone going to the hospital for treatment of heart failure or chronic obstructive pulmonary disease can have it. Palliative care can be helpful much earlier than most people realize.
What Is Hospice Care?
Hospice care is care for someone with a serious illness who is approaching the last phase of their life and has decided to focus primarily on comfort rather than treatment aimed at curing the underlying illness.
The goal is to keep the person comfortable, preserve their dignity, and support both the patient and their family.
When a patient enrolls, the hospice team meets with the patient and the family and develops a plan based on what the person needs and what matters most to them. In most situations that plan includes:
- A nurse who comes to the home
- Aides
- Access to social workers
- A chaplain or other religious leader
- Access to a physician, usually by phone
Hospice also provides medications, equipment such as a hospital bed or oxygen, and other supplies related to the terminal illness. The biggest part of hospice, though, is access: making sure the family and the patient can reach the hospice team if there is a change in condition. Our hospice care at home page walks through how that plan comes together.
Hospice vs. Palliative Care: What’s the Real Difference?
The real difference is when the care can begin and what it is aimed at.
Palliative care can be provided at any stage of a serious illness, even while someone is receiving treatments like chemotherapy, or going to the hospital for treatment of heart failure or chronic obstructive pulmonary disease. Hospice is specifically for people who are approaching the end of life and have chosen to focus on comfort rather than treatment intended to cure their terminal illness.
| Palliative care | Hospice care | |
|---|---|---|
| When it can start | Any stage of a serious illness | When the person is approaching the last phase of life |
| Main goal | Make day-to-day life better by treating symptoms and helping with medical decisions | Comfort, dignity, and support for both the patient and the family |
| Treatment aimed at curing the illness | Can continue at the same time | The person has decided to focus primarily on comfort instead |
| Timing relative to prognosis | Can begin at any stage of the illness | Generally about six months or less to live, if the illness follows its usual course |
One consequence of that is worth stating plainly, because it is one of the most important things to understand: someone receiving chemotherapy, dialysis, surgical interventions, or other treatments can receive palliative care at the same time.
Common Myths, Answered Honestly
“Palliative care means we have stopped treating the illness”
A person can still receive treatment for their illness while getting palliative care. Chemotherapy, dialysis, surgical interventions, and other treatments can all continue while palliative care runs alongside them, handling symptoms and the stress that comes with being sick.
“Hospice means death is days away”
Going on hospice does not necessarily mean someone is about to die. Hospice is for people with a serious illness when the focus has shifted from trying to cure the illness to keeping the person comfortable and helping them have the best quality of life possible. Some people are on hospice for days or weeks. Others receive hospice for many months. A terminal diagnosis does not necessarily mean the person is going to die within days.
“Hospice means the team stops caring for someone”
This is one of the biggest misconceptions, and it is quite the opposite of what happens. In hospice, the team is still treating symptoms, managing medications, and providing nursing care, equipment, and support for the family. What changes is the goal of care: from trying to cure the illness to achieving comfort and optimal quality of life.
When Should You Consider Palliative Care or Hospice?
Palliative care can be helpful much earlier than most people realize.
If a serious illness is causing difficult symptoms, repeated hospitalizations, or a lot of stress on the patient or the family, asking about palliative care is very reasonable. Hospice becomes a conversation when the illness is progressing despite treatment, and the person and the family are beginning to feel that comfort and quality of life are more important than continuing burdensome treatments.
The thing to look at is the overall pattern of the illness rather than any single day. Signs worth noticing:
- Getting weaker
- Eating less
- Sleeping more
- Losing weight
- Recurrent falls
- Needing more help with daily activities
- Repeated trips to the hospital
Sometimes when a patient goes to the hospital a couple of times in one month, every month for six months, it is very possible that it is time to consider hospice because of an illness that is progressing and terminal.
One slight change by itself does not necessarily mean it is time for hospice. When several of these things are happening together, it is worth having a conversation. Humanitas has a short set of questions built around exactly this on the Is It Time for Hospice? page, and a referral form when a family is ready to start the process.
Starting hospice is not a one-way door
Choosing hospice is not an irreversible decision. A patient can choose to leave hospice if they decide they want to pursue treatment that is not consistent with the hospice plan, and they can return to hospice later if they remain eligible.
How Long Does Hospice Care Last?
There is really no standard amount of time.
Some people do not enter hospice until their final days, while others receive hospice for several months. Hospice eligibility is generally based on the expectation that the patient has about six months or less to live if the illness follows its usual course.
That six month figure is an eligibility expectation, not a stopping point. Hospice does not automatically stop at six months, and someone can continue receiving hospice beyond six months as long as they continue to meet eligibility requirements.
Who Pays for Hospice Care?
Medicare pays for hospice through the Medicare hospice benefit for eligible patients.
The benefit covers the hospice team, medications related to the terminal illness, medical equipment and supplies, nursing care, social work, hospice aide services, and other care related to the hospice diagnosis. Families are often surprised by how much of that is included.
There is a second surprise, and it is better heard early. Medicare is not simply paying for someone to come to the house around the clock. Hospice provides a team and a plan of care, but routine hospice care at home is not usually 24 hour bedside caregiving. Room and board, and 24 hour custodial caregiving, are not usually covered just because someone is on hospice.
That is an important conversation to have early, so families understand what hospice provides and what they may still need to arrange separately.
What to Say to Someone in Hospice
You do not need to find the perfect words.
Sometimes the most meaningful thing you can say is simply, “I’m here with you,” or “What can I do to make today a little easier?” Sometimes just sitting with someone, listening, or sharing a memory is more valuable than trying to say something profound.
Usually welcome:
- “I’m here with you”
- “What can I do to make today a little easier?”
- Sitting quietly, listening, or sharing a memory
Better left unsaid:
- “Stay positive”
- “Keep fighting”
Telling someone they need to stay positive or keep fighting is worth avoiding. Even when it is meant with love, it can make someone feel like they are disappointing people if they are tired or afraid. Giving them permission to talk honestly about how they are feeling is the better instinct. You do not have to fix it. Sometimes the best thing you can do is listen.
Frequently Asked Questions
Is palliative care the same as hospice?
No. Palliative care can be provided at any stage of a serious illness, including while someone is receiving chemotherapy or being treated in the hospital for heart failure or chronic obstructive pulmonary disease. Hospice is specifically for people who are approaching the end of life and have chosen to focus on comfort rather than treatment intended to cure their terminal illness.
Does palliative care mean I have to stop treatment?
No. A person can still receive treatment for their illness while getting palliative care, and that is one of the most important things to understand about it. Someone receiving chemotherapy, dialysis, surgical interventions, or other treatments can receive palliative care at the same time. It works as an extra layer of support for pain, shortness of breath, anxiety, and the stress that comes with being sick.
Does going on hospice mean someone is about to die?
Not necessarily. Hospice is for people with a serious illness when the focus has shifted from trying to cure the illness to keeping the person comfortable and helping them have the best quality of life possible. Some people are on hospice for days or weeks. Others receive hospice for many months. A terminal diagnosis does not necessarily mean the person is going to die within days.
How do you qualify for hospice care?
Hospice eligibility is generally based on the expectation that the patient has about six months or less to live if the illness follows its usual course. That is not a stopping point. Hospice does not automatically stop at six months, and someone can continue receiving hospice beyond six months as long as they continue to meet eligibility requirements.
Does Medicare cover hospice care?
Medicare pays for hospice through the Medicare hospice benefit for eligible patients. It covers the hospice team, medications related to the terminal illness, medical equipment and supplies, nursing care, social work, hospice aide services, and other care related to the hospice diagnosis. Room and board, and 24 hour custodial caregiving, are not usually covered just because someone is on hospice.
Does hospice provide 24 hour care at home?
Routine hospice care at home is not usually 24 hour bedside caregiving. Medicare is not simply paying for someone to come to the house around the clock. Hospice provides a team and a plan of care, and the biggest part of it is making sure the family and the patient can reach the hospice team if there is a change in condition.
Can someone leave hospice and come back later?
Yes. Choosing hospice is not an irreversible decision. A patient can choose to leave hospice if they decide they want to pursue treatment that is not consistent with the hospice plan, and they can return to hospice later if they remain eligible.
Talk to Humanitas Hospice
If you are weighing hospice or palliative care for someone you love, you do not have to sort it out alone. You can contact the Humanitas Hospice team to talk through what you are seeing, what care would actually involve, and what your options are, or call (215) 302-9955.
Humanitas serves families across Bucks, Montgomery, Delaware, Berks, and Lehigh counties, and Philadelphia.
Related Reading
- Hospice care questions families ask most
- How Humanitas approaches hospice care
- What families say about Humanitas Hospice
About the Author
Dr. Allen Naygauzen is a board-certified internal medicine physician in Philadelphia. His practice focuses on palliative care, hospice medicine, and house-call services.
This article is general information about hospice and palliative care, not medical advice about any individual patient. Decisions about hospice or palliative care should be made with the patient’s own physician and care team.