Palliative Care and Hospice: What's the Difference?

Creating the best possible quality of life when you have a serious illness: That’s the core goal of both palliative care and hospice

“Palliative care and hospice are really not about death,” Suzanne Pertsch, M.D., medical director of Palliative Care at Mills-Peninsula, says. “They’re about living each day to the best of your ability given the circumstances that confront you.”

Both take a whole-person approach to relieving the symptoms and stress of illness, but they focus on different stages. Palliative care can address any stage of a serious illness and can include disease treatment. Hospice serves people who have stopped treatments to cure or reverse a disease and who likely have six month or less to live. You have access to palliative care and hospice at any age.

Palliative Care

A palliative care consultation starts by understanding what matters to you, and your wishes and care goals.

“In the purest sense, the concept of palliative care is to be present, attentive and emotionally supportive, physically providing comfort and accepting you for who and where you are,” Dr. Pertsch says.

Your palliative care team, tailored to your needs, typically includes a board-certified palliative care doctor, a nurse practitioner, a social worker, a care coordinator, a chaplain and others with specialized training. They work with you to develop a care plan that helps you manage your symptoms so you can focus on the activities and relationships that are important to you.

“Shifting control back to you alleviates a lot fear and anxiety,” Dr. Pertsch says.

Your palliative care team will also discuss what you can expect as your illness progresses, explore options for pain management and help you prepare documents detailing your healthcare wishes, such as an advance healthcare directive.

“These conversations are not easy but they need to happen,” Sharon Tapper, M.D., palliative care medical director at the Palo Alto Medical Foundation, says. “Most people know when they are getting sicker. They want to know their choices so they can make informed decisions.”

Palliative care can start when you get a diagnosis, and you can receive it at the same time you receive disease treatments, such as surgery or chemotherapy. When you face aggressive treatments, palliative care can help you cope with the side effects. And it’s not just for cancer patients. People living with heart or lung disease, kidney failure, AIDS and many other illnesses benefit from palliative care.

Hospice

If you decide to stop treatments, you may want to transition to hospice care, a special type of palliative care for the end of life.

In order for you to qualify for hospice, your doctor must certify that your life will likely end within six months. But hospice can continue longer if needed. You always have the option to stop hospice care if your condition improves or if you want to resume curative treatments.

Like palliative care, hospice brings together a team of specialists to address you and your family’s practical, emotional and spiritual needs. For family members, hospice also provides bereavement counseling for up to 13 months after a death.

In most cases, hospice care happens in the home, but hospice staff also serve freestanding hospice centers, hospitals, nursing home and assisted living facilities. When done at home, a family member or home health worker serves as the primary caregiver; hospice staff visit regularly and are always available by phone.

Be open to the idea of hospice. Many people hesitate to accept hospice services until their disease is very far along and they have only a few days or weeks to live.

“I think that happens because, in spite of all of our efforts to change perceptions, most people still consider hospice to be about dying,” Dr. Pertsch says. “Hospice is about supporting each day with good quality and meaning.”

Benefits of Hospice and Palliative Care

“Studies show that patients and families who receive palliative care and hospice experience better quality of life and a better quality of death,” Dr. Tapper says.

A 2010 study found that people with advanced lung cancer who received treatment and palliative care soon after diagnosis lived two months longer than those who did not get palliative care. They also experienced less clinical depression and a better quality of life than those who received cancer treatment alone.

Other research indicates that hospice care recipients experience fewer hospitalizations, intensive care admissions and invasive procedures that those who don’t receive hospice.

Palliative care can also help you avoid repeated, panicky trips to the hospital because you and your family have more confidence in managing the illness.

“We empower you to feel like you have tools in your toolkit so that when things come up, you have resources to manage it,” Dr. Pertsch says.