Palliative Care Vs Hospice: What’s the Difference?

If you’re confused about the differences between palliative care and hospice, you’re not alone. Many people struggle to understand how one differs from the other. In fact, the two terms are sometimes used interchangeably—or referred to as a single offering—which only adds to the confusion. 

The term “palliate” means to provide comfort and symptom relief. In this sense, hospice care always includes palliative care, but palliative care can also be offered as a standalone service without hospice being involved. 

Here, we examine the definitions of palliative care and hospice by describing the similarities and differences between the two; discussing when they’re used and the benefits of each; and offering a comparison table that provides a snapshot to support decision making about which type of care may be the most appropriate for an individual’s situation. 

How Is Palliative Care Different from Hospice?

The following comparison table offers a snapshot of key differences between palliative care and hospice.

Palliative care provides support to manage pain and other types of symptoms to improve comfort and enhance an individual’s quality of life at any point in life. Hospice care provides pain and symptom management to improve comfort and enhance the quality of life at the end of life. In both cases, these types of care can improve the quality of life for the family, as well.

Both types of care are provided through an interdisciplinary model that includes physicians, nurses, and other healthcare professionals. However, while the specific makeup of palliative care teams may vary, federal guidelines require that Medicare-certified hospices provide certain services. 

While palliative care and hospice may sound similar, there are several key differences between the two, including:

• Eligibility for care
• Goals of care
• Payment for care
• Service delivery locations

Palliative Care vs Hospice: Eligibility

Program eligibility is the first major difference between hospice care and palliative care. 

Palliative care is for anyone with serious illness, at any stage of that illness. These services can be initiated with a physician’s referral in agreement with the patient. 

However, hospice care is for those who have been diagnosed with a terminal illness and have a prognosis of six months or less if the disease takes its natural course. This prognosis must be certified by two physicians—typically the referring physician and the hospice medical director. A referral for hospice care should always be discussed first with the patient, who must agree to enrollment into hospice services. 

Palliative Care vs Hospice: Goals of Care

Patients receiving palliative care services are free to continue to pursue curative treatments while receiving pain and symptom management support from the palliative care team. This is a major benefit of palliative care that many find attractive.

In hospice, the goals of care must be focused on comfort care only. That means individuals must be willing to give up curative interventions in order to be eligible. Of course, they can enroll in hospice care and change their minds about pursuing curative care, but they would no longer be eligible for hospice care during that time. 

Palliative Care vs Hospice: Payment Methods

Another difference between palliative care and hospice is how the services are paid for. Palliative care services are typically covered in the same manner as other types of healthcare services through Medicare, Medicaid, and/or a patient’s insurance policy. 

If coverage is available through Medicare Part B, payment typically follows the coverage framework related to this benefit—which may include deductibles and coinsurance fees. If the patient has a supplemental insurance policy, that may influence whether the patient needs to pay anything out of pocket. If the patient isn’t enrolled in Medicare but has other health insurance, a copay to the palliative care provider may be required, depending upon policy terms.     

For individuals enrolled in Medicare and/or Medicaid, hospice is covered for services provided by a Medicare-approved hospice through the Medicare Hospice Benefit and the Medicaid Hospice Benefit. These are separate benefits specific to hospice care for which the hospice receives a daily or “per diem” rate based on the level of care the hospice is providing in order to meet patient needs. There are four hospice levels of care:

• Routine Home Care—which is the most common. 
• Continuous Home Care (CHC)—which is only provided during times of crisis to help a patient remain in their home. 
• Respite Care—which is short-term care that allows a time of respite for the patient’s caregiver.
• General Inpatient Care (GIP)—which is a more intense level of care provided in skilled settings (such as a hospice facility or hospital) to address pain and symptom management needs that cannot be adequately addressed at home. This is intended to be short-term care with the expectation that a patient will return to a routine level of care once their condition is stabilized. 

Medicare provides a concise breakdown of what you can expect to pay for hospice care and notes that room and board charges are not covered benefits.

Additionally, it should be noted that Medicaid is a state-based benefit, so coverage specifics may vary from state to state. 

The Veteran’s Administration (VA) also offers a separate hospice benefit that eligible veterans may want to access. Since veterans often have unique needs at end-of-life, this framework of care can be very helpful for this patient population. 

Many insurance plans also pay for hospice services, though the amount and types of coverage vary depending upon the specific policy. 

Some patients may not have available coverage from any of these payment sources. When this is the case, hospices often provide uncompensated services. Non-profit hospices typically have foundations that support fundraising efforts to help cover such care for the community. 

Palliative Care vs Hospice: Service Delivery Locations

Palliative care has been offered within the hospital setting for many years, however, it is also becoming increasingly available as community-based palliative care that is offered within clinic settings and sometimes in the patient’s home. 

While home-based palliative care is quite beneficial for individuals with mobility challenges or other disease-related issues, its availability is still limited in many communities. In addition to educational and legislative efforts to help expand access to community-based palliative care, telepalliative care is also being offered by some palliative care teams. In this framework, patients and their families can meet with members of the palliative care team from the comfort of their homes through video conferencing or over the phone. 

Hospice care can be delivered in a variety of settings—including the patient’s home, a skilled nursing facility, assisted living facility, hospital, or hospice facility. Hospice facilities may be stand-alone hospice houses or designated hospice units, typically within a hospital setting. 

When Should Someone Receive Palliative Care vs Hospice?

Palliative care is an option at any time for anyone who has a serious illness to help manage pain and other types of symptoms—and potentially gain access to other resources, such as psychosocial and spiritual support, depending upon the makeup of the palliative care team. 

As noted previously, hospice care is an option specifically for those who have a life expectancy of six months or less. It can be quite helpful if patients gain access to hospice services earlier in the course of the end-stage disease process—rather than waiting until a patient is near end of life. In this way, patients and families gain access to the comprehensive support available that can make a big difference in the patient’s quality of life. 

Additionally, Medicare-certified hospice programs must offer bereavement services for a minimum of thirteen months following their loved one’s death. In this context, referring patients earlier in the course of illness also helps the hospice care team to build relationships with both the patient and family that may be helpful to enhance bereavement support. 

Palliative Care vs Hospice: Benefits of Each

Palliative care is an excellent option for individuals with serious illness who either do not qualify for hospice or are not emotionally ready to be enrolled in hospice care. The latter refers to the negative connotation often associated with the term “hospice,” since some view this as meaning they are quite near the end of life. 

Regardless, if an individual isn’t ready for hospice, palliative care is a wonderful way to ensure they get the help needed to manage pain and other symptoms, potentially gain access to psychosocial and spiritual support, and receive help in addressing goals of care and advance care planning. Palliative care professionals are well-versed in helping patients explore and define their wishes regarding what types of treatments they do and do not want to receive. 

This is especially helpful for someone who is overwhelmed with the challenges of living with serious illness and the array of treatment scenarios that may be presented to them. The latter can be particularly problematic if care is fragmented among various specialty services without oversight and coordination by a single care provider. 

For individuals with advanced disease, palliative care can also provide a smooth transition into hospice services when the patient becomes eligible and decides they would like to receive this more comprehensive type of care that is geared toward meeting unique end-of-life needs.  

The hospice model of care is both interdisciplinary and more comprehensive in terms of support. Since the hospice care team is always comprised of professionals from several disciplines, patients have access to the physical, psychosocial, and spiritual support that they may need. Medicare provides a full list of services it covers through the hospice benefit, which include:

• Medical services
• Nursing care
• Social work support
• Counseling support
• Spiritual care support
• Hospice aide and homemaker services
• Volunteer services
• Related medical equipment and supplies
• Related medications
• Bereavement support 
• And more

Although understanding the difference between palliative care and hospice can be confusing, the bottom line is that both provide excellent options for those with serious illness who need help with pain and symptom management. However, there are specific differences between the two—including eligibility, goals of care, payment for care, and service delivery locations. 

While anyone with a serious illness can benefit from palliative care services, hospice care is geared toward meeting the unique needs of individuals who are nearing the end of life. In both instances, advance care discussions play a critical role and can be initiated by patients, family members, physicians, nurses, and other healthcare professionals. 

In fact, when a patient is eligible for hospice care but not sure if that’s the best choice, the advance care planning journey can be what helps them to decide.