What’s the difference between hospice and palliative care?


I’ve seen palliative care described as symptom-relieving treatment *usually* for terminal diseases, though it doesn’t have to **only** apply to terminal diseases. Doesn’t that make pretty much ALL medical treatment “palliative care”? Say if someone has epilepsy and they are treated with anti-seizure medicine to stop their seizures, would that fall under the definition of palliative care?

In: 8

An anti-seizure medication is still stopping (or at least reducing the severity of) seizures. A more conventional example of palliative care would be giving treating a cancer patient’s symptoms (pain, nausea, etc) without actually trying to treat the tumor(s).

In hospice, you cannot be undergoing curative treatment (like chemo or radiation – unless it is simply to treat symptoms) for your terminal illness, but in palliative care you can.

To receive hospice care, two doctors must certify that you have 6 months or less to live if your illness were to proceed on its natural course. Palliative care can be received anytime during a serious illness.

Hospice care is much more extensive and holistic, involving social workers, chaplains, counselors, etc — treatment for the whole person as well as the patients family. Palliative care is mostly just about treating symptoms from serious illness (“comfort” care).

Hospice care is typically covered by Medicare and most insurance; palliative care is much more variable.

To your epilepsy example… not really. Palliative care is much more specific to treating the pain and secondary symptoms that come from curative treatment of a serious illness… so if you are undergoing chemo for cancer, for example, and are struggling with low appetite from that chemo, the palliative care provider would be brought in to help with increasing appetite.

Palliative care is for when the person is in the final stages of their life and are likely to shuffle off the mortal coil. They are basically dead already. You usually put them on a syringe driver with a strong medication like fentanyl to ease their passing.

People in hospice will receive palliative care in the last 24 hours of their disease. Palliative care is basically the Death Watch.

Care homes should have a Palliative ward that residents get moved to when they are bedbound and unresponsive and their vital signs are failing. It is still possible for some people to recover from that catatonic state but this is extremely rare.

This is an area I’m super passionate about because I treat a lot of palliative and hospice patients.

Palliative is an approach. Hospice is a plan.

Palliative care means to manage the symptoms of a life limiting illness without the ability or intent to cure it. Progressive neuromuscular diseases (ALS, like Stephen Hawking, for example) are certainly life limiting, but cannot be cured. Even in the early stages of the disease, before any significant symptoms, the approach is palliative. We know the patient is going to die from this illness, but at this time we can’t do anything about it. Instead of focusing on how long someone will live, we will focus on how well they will live. Whether it is massage therapy, pain medication, even blood transfusions. All of these treatments provide the patient the best years possible, not necessarily the most years possible. We will certainly treat anything curable that comes up. We won’t let you die of infection if we can treat it, we just can’t cure the primary illness.

Hospice is what we call “End of life care”. For an expected death, hospice care focuses on providing the most peaceful final weeks/days/hours possible. In this setting, there are no limits on pain medication (a practitioner is still liable if their error or negligence caused death), no concerns over off label use of other medications. Just the most comfortable and peaceful final time possible. Hospice usually refers to a specific place, but end of life care may take place anywhere. I’ve spent hours in patients’houses providing this type of care.

Hospice/End of Life Care is a part of the palliative approach and represents just one part of the specialized care provided by palliative specialists.