Hospice vs. palliative care: what you should know

Many individuals die in hospitals or other facilities receiving (expensive) treatments that are misaligned with their values and end-of-life goals. Often, these end-of-life treatments are painful and fail to prolong life, leading to significant end-of-life suffering within the US. In recent years, however, hospice and palliative care have emerged as solutions to end-of-life suffering. This article aims to introduce and demystify hospice and palliative care so that those with life-threatening illnesses are aware of the various alternatives to disease-based therapies.

Palliative care focuses on relieving symptoms associated with a given illness or condition. To reduce suffering associated with given symptoms, palliative care works to identify and treat physical problems (such as pain) as well as psychosocial and spiritual problems. Palliative care can be administered in tandem with disease-based therapies; consequently, it can be provided regardless of whether the illness is curable, chronic, or life-threatening.

Hospice is a type of palliative care administered when curative treatment is no longer beneficial or desired. It is provided when life expectancy is measured in months. Medicare covers hospice costs when life expectancy is six months or less. An important (and often misunderstood) virtue of palliative care received during hospice is that does not work to hasten or postpone death; rather, it aims to increase quality of life by focusing on patient comfort.

Along with benefits for the patient, hospice care works to provide emotional relief to the family. Hospice services often include bereavement counseling and the development of a support system for both patient and family.

One other virtue of hospice care is that it is generally provided in the patient’s home setting. This may be the patient’s house, apartment, nursing home, or assisted living facility. In this way, hospice promotes patient comfort: many individuals would prefer to stay in a familiar environment, close to family and friends.

Unfortunately, there are various barriers to the delivery of hospice and palliative care. The foremost of these are confusion and fear surrounding their use in conjunction with life-prolonging treatments. Many individuals believe the administration of palliative care will prevent the patient from receiving disease-based treatments. However, it bears repeating that palliative care is frequently performed in conjunction with life-prolonging procedures.

Additionally, there exists the misconception that the push towards hospice care is economically motivated. On the contrary, the cost of hospice care is generally equal to the cost of typical care, while Medicare/Medicaid frequently cover most of the cost for those who are eligible.

Finally, many within the general public and medical community view hospice as “giving up.” However, this view is simply incorrect. Hospice care recognizes death as a natural aspect of life. Instead of fighting to increase quantity of life, hospice care focuses on increasing quality of life. Additionally, it is important to note that hospice care has been shown to improve disease prognosis and result in increased survival.

Ultimately, stepped-up physician and patient education about palliative and hospice care is necessary to alleviate fear and confusion as well as increase utilization. Now that you are more familiar with hospice and palliative care as options, it may be beneficial to start thinking about how to document your end-of-life care preferences via an advanced health care directive. For more information on advance directives, click here.

—Jon Scalabrini