Palliative care and hospice are presented as separate services when in reality, they offer the same type of support but with different goals. Hospice is given when a disease has progressed to its final stage and the patient is nearing the end of their life.
On the other hand, palliative care is given at any stage. Its objective is to ease suffering while doctors treat the disease. When a patient is in hospice, their comfort is top priority. It is a more robust program, with better funding and access to staff and resources. It is important patients understand the divergence of palliative care vs. hospice, so they can take full advantage of their options.
Why choose palliative care vs. hospice?
Palliative care is given when doctors think there may be a chance of a cure. Patients usually choose it because they want to hold out for as long as possible. Hospice workers support every patient who decides to fight as hard as they can. However, they think patients should know what they are agreeing to when they choose palliative care vs. hospice.
Hospice is funded by Medicare Part A, which means it is free for nearly every patient who uses it. A small number of people go through private insurance or pay out of pocket instead. However, everyone who chooses hospice can be confident 100 percent of their costs will be covered. In addition, the high level of funding ensures better care through training certificates and licenses. Government support also ensures there are organizations in place for patients and families who do not agree with the decisions made by hospice staff.
Unfortunately, palliative care does not enjoy the same level of funding. As a result, access to it is limited. Some hospitals, particularly in rural areas, do not offer palliative care at all. Even in hospitals with palliative programs, teams are overstretched. Administrators do not have the money to hire enough personnel to meet demand. Funding is available through private insurance but may not be enough to guarantee access to the multi-disciplinary teams available through hospice.
Staff & support
Palliative care and hospice exist along the same spectrum, so ideally each team would be able to offer the same level of assistance. However, due to funding, the size of palliative care teams varies from one organization to the next, while hospice is consistently well-staffed. Regardless, a well-funded team should provide a wide range of expertise to help patients cope with the physical and emotional issues accompanying a major illness.
Every patient in palliative care or hospice is under the supervision of a doctor who monitors their condition, tracks their progression, and prescribes pain medication. If a complication arises or the patient contracts a secondary infection, such as pneumonia, the physician will develop a treatment plan. This might require curative measures like anti-biotics, but in hospice, the doctor will never recommend anything that would seriously impair the patient’s comfort.
Case managers are registered nurses (RN) who directly oversee the patient’s care. They train family and caretakers to identify and respond to symptoms. They assess the patient’s home, determine what equipment the patient needs, and teach their caregiver how to use it. The case manager also directs and coordinates other team members, such as the Licensed Vocational Nurse (LVN), home health aide, social worker, and chaplain.
Licensed vocational nurse
LVNs provide hands-on care. They visit the patient, perform examinations, and arrange medication. The case manager might also ask the LVN to provide bedside care as the patient’s health declines further. Their reports help the RN and physician determine whether treatment is working and what changes might be necessary to improve the patient’s quality of life.
Home health aide
Aides assist patients with daily tasks of living such as bathing, dressing, and grooming. If the patient has mobility issues, they might help them out of bed or into their favorite chair. To prevent bedsores, aides also turn and reposition patients who are bed bound. They make sure bedsheets are clean as well and may perform some light housekeeping when they visit.
However, home aides are not nurses so they cannot provide any direct medical care. But they can clean catheters, massage painful areas, and help patients exercise.
Social workers help families navigate the financial, logistical, and emotional challenges surrounding hospice and palliative care. They work with Medicare, insurance companies, and the Veteran’s Administration to secure funding. They help with funeral arrangements and legal matters. If there is a disagreement between family members, the social worker would mediate and help them find a resolution. Because they work closely with families, social workers are also trained to provide emotional support.
Chaplains offer spiritual comfort. They help people reflect on the deeper significance of life and counsel them as they work through feelings of grief and loss. Fostering a spiritual outlook helps patients find peace as they transition from this life to the next.
Medical specialists work exclusively in palliative care. Their job is to treat the disease and restore the patient’s health. When planning surgery or therapy, specialists work closely with the rest of the team to make sure none of their efforts to reduce pain will interfere with treatment.
Responsiveness: palliative care vs. hospice
When it comes to the patient’s well-being, the most notable difference between palliative care vs. hospice is how long it takes each team to react. Because doctors are still working towards a cure, palliative teams cannot always move quickly. First, doctors must run tests to determine whether their care will impede efforts to fight the disease.
For example, before oxygen can be given to a patient who is short of breath, physicians must perform a diagnosis. Because any symptom may be a complicating factor, doctors cannot authorize additional oxygen until they have identified the cause of the patient’s difficulty. By contrast, a hospice physician can prescribe oxygen right away because their only goal is patient comfort. Their unique mandate allows them to circumvent normal bureaucracy in order to relieve symptoms fast as possible.
How to choose
The only person who can make the choice between palliative care vs. hospice is the patient. There is no wrong choice, but patients should understand the benefits of hospice and palliative care before they decide. They need to ask their doctor about the likelihood of a cure, and ask themselves what they want their life to look like six months from now. Only when they know the answers to these questions will they be ready to make the right decision.
Jose Escobar is the Hospice Executive for Parentis Health. He works with patients and families across Southern California, providing support and education, in order to alleviate the pain and suffering of chronic and terminal illness.