When a terminally ill person and his or her family is trying to choose the right path for end-of-life care, emotional stakes can be high and picking the course of action that is best for everyone involved can be painful, confusing and difficult. The first step to choosing the best option for both the patient and their family is in understanding the subtle differences between the available options.
Many people often confuse hospice and palliative care; some people might even use these terms interchangeably. But while the distinction between hospice and palliative care can be somewhat difficult to explain (depending on the country and/or medical facility in which they are put into practice), they are not the same.
What is Hospice Care?
Hospice care first came into practice in the United States in the 1970s. However, it was not a medically recognized concept until 1982 when Medicare began to cover the associated expenses. The term itself dates back to the 11th century during the time of the Crusades, when ‘a hospice’ was a refuge for those who were terminally ill. Modern hospice care did not come into practice until the middle of the 20th century when it began being practiced in London.
Many people believe that hospice is a place where terminally ill patients go to die. In fact, modern hospice is a type of care for those with a terminal illness seeking support and provision for their end-of-life care.
Hospice care is defined in as ‘the belief that all people have the right to die with dignity and without pain’ and focuses on supporting the patient and their family through the final months of life by providing comfort and abatement of pain rather than aggressive treatment for the disease. By choosing to forego life-prolonging treatment options, patients receiving hospice care can reserve their strength and concentration for spending time with their loved ones and facing the emotional and practical issues of death.
That is not to say however, that hospice care patient receives no treatment. Patients undergoing hospice care continue to receive medical support and care for anything they wish or need. But any attempt to fight or cure their major complaint (such as cancer) will be greatly reduced or stopped entirely, depending on the wishes of the patient and their family.
While hospice care is available in any number of facilities such as nursing homes, hospitals or specialized hospice care centers, the overwhelming majority of patients elect to have all further treatments carried out in the comfort of their own home. Those who choose hospice are usually cared for by specialized hospice staff, nurses and their own family rather than their regular physicians and/or specialists.
While hospice care is usually covered by most private healthcare insurance policies, Medicaid and Medicare, there are certain criteria that must be met. The patient must be considered terminally ill with fewer than six months left to live to be eligible for most hospice care programs or in order to receive coverage.
Also, while it is common for hospice to be considered an all-inclusive treatment in terms of coverage, independent policies may vary in what is or is not covered so it is important to check with your medical coverage provider before choosing hospice.
What is Palliative Care?
You might say that palliative care is the new hospice. It first came became a recognized and medically accepted practice in 2006, and many see it as the step you should take before hospice. It is not uncommon for someone to first choose palliative care in the early stages of their illness, only to eventually switch to hospice care once they have entered the final few months or weeks of their life depending on their desires for where and how they want to die, coverage options, the wishes of his or her family and the level of care they require.
Of course, opting for both hospice and palliative care is not the right option for everyone. Often times, the well-intentioned loved ones of a terminally ill patient will encourage their loved one to fight, but it is important to recognize the difference between quantity and quality of life. It is often the wish of the afflicted to spend what time they do have left with dignity, pain-free and able to experience their final days with peace and clarity.
Like hospice care, palliative care is an end-of-life course of treatment for those facing death. While certain similarities remain, subtle but important differences begin to emerge.
Palliative care is available at any stage of a terminal illness, meaning that the patient may continue to pursue life-prolonging treatments if he or she and their family choose to do so. A palliative care patient still has no hope of long-term recovery, but may wish to pursue a more aggressive approach to prolong what time they do have left.
Many people who opt for palliative care are young, just entering into the early stages of a terminal illness and still want to pursue their right to live as long as they possibly can. Of course, this greatly depends on the level of pain and quality of life that can be expected with or without further aggressive treatment.
In general, there are no limitations on when a terminally ill patient can begin receiving palliative care. While palliative care is often available in the home, most palliative care is carried out in hospitals, palliative care centers or other medical institutions. The patient usually remains under the direct care of his or her regular physicians and/or specialists.
Because palliative care is generally practiced in a hospital environment, it is more likely to be covered by your medical insurance provider. Still, there is a high probability that it will not be considered all-inclusive and that each item, procedure and prescription will be billed separately. So it is important to check with your medical coverage provider on what is or is not covered before choosing palliative care.
Palliative care has no limitation on when it can begin. The patient is usually cared for in a hospital environment, often remains under the continued treatment of their regular physicians and the patient may opt to continue life-prolonging procedures.
Hospice care is generally only available when a patient has fewer than six months to live. The patient is usually cared for at home by hospice care providers, nurses and family and generally does not wish to pursue any aggressive medical treatment in order to prolong their life.
Both options are almost always covered by private medical insurance, Medicaid or Medicare, but might be covered differently, culminating in what could be vastly varying financial outcomes for each option. Therefore, the patient and his or her family should make sure to thoroughly discuss both options with their medical coverage provider before making a decision.
Now that you know the differences between hospice and palliative care, you can better discuss with your doctor the options available to you and your family to make the choice that best suits your particular needs and wishes.
Updated: March 28, 2014