By Kristin Glasure, FAIRHOPE president and CEO
When someone is diagnosed with a serious illness, it can be challenging to prioritize advance care planning conversations with their family and doctors. However, it is important to ensure care is aligned with their wishes as early as possible. Confusion can sometimes arise around the specific differences between palliative care and hospice in deciding what level of care is best. While the objective of both palliative care and hospice is pain and symptom relief, the prognosis and goals of care are different.
Palliative care seeks to enhance the quality of life of patients and families who are faced with serious illness. It focuses on increasing comfort through prevention and treatment of distressing symptoms. In addition to expert symptom management, palliative care focuses on clear communication, advanced care planning and coordination of care. It is a resource for those living with a serious illness, such as heart failure, cancer, dementia, Parkinson’s disease, and many other diagnoses. Palliative care can be provided at home, in hospitals, in nursing homes, and in outpatient palliative care clinics. Palliative care encompasses the whole self, caring for the body, mind and spiritual needs of patients and their families, while also providing relief from pain and other symptoms. Medicare, Medicaid, and many insurance plans cover the medical portions of palliative care, and veterans may be eligible for palliative care through the United States Department of Veterans Affairs.
Hospice care focuses on providing comfort care for those with a terminal illness, as well as lending emotional, spiritual, and social support to their families and friends during their illness and grieving periods. It is important to understand that stopping treatment aimed at curing an illness does not mean discontinuing treatment for all medical conditions, such as high blood pressure. Hospice care can be provided at home, in nursing and assisted living facilities, in retirement communities, hospitals, and at an inpatient hospice setting such as The Pickering House. Hospice care is most often paid for as a benefit of Medicare. Hospice may also be paid for as part of a Medicare Advantage plan, by state Medicaid plans, or by private insurance.
Palliative care can begin at the discretion of the physician and patient at any time, at any stage of illness, terminal or not. Eligibility for hospice care requires that two physicians certify that the patient has less than six months to live if the disease follows its usual course. If health changes, the kind of care being received can be changed.
Deciding between palliative and hospice care is not always easy, and it is important to discuss your options as care can be most effective when started early. Additionally, a person may receive palliative care for many years before entering hospice care. In some cases, someone may even recover from their condition while undergoing palliative care depending on factors such as illness and prognosis.
It can be beneficial to talk with someone who is familiar with palliative care and hospice care services to determine what is best for you or someone you are caring for. To help you decide, your doctor may often be able to outline benefits from either type of care. To enter hospice, all medical treatments aimed at curing the illness or prolonging life must be stopped, which can be one of the most difficult decisions to make as part of treatment. It can take substantial time and reflection with family, healthcare providers, and counselors or social workers to help make the best decision.