Before her death in April, former First Lady Barbara Bush made the decision to begin “comfort care” and die in her own home. Her decision has sparked a renewed conversation about the benefits of palliative care and how it differs from hospice.
Palliative care and hospice have a number of similarities in the care they provide for terminally ill people, but palliative care also applied to non-terminal illnesses. The terms become confusing because some hospice services fall under the umbrella of palliative care. In addition, palliative care is defined as both a formal treatment option offered by hospitals and a way of providing so-called “comfort care” in the home.
Hospice care programs are more common than palliative care programs. It is supervised by hospice professionals and typically occurs in private homes, although some individuals receive hospice services in assisted living communities, skilled nursing communities or hospitals.
Family care partners, along with visiting nurses, provide hospice care services. Generally, individuals must be terminally ill — or within six months of expected death — to become eligible for hospice programs. However, hospice services are not time-restricted.
Hospice operates under the philosophy that quality of life is as important as length of life. Individuals in hospice have chosen not to engage in life-extending treatments, potentially avoiding many unpleasant side effects. Hospice focuses on managing pain and other symptoms, while supporting the physical, emotional, social, and spiritual well-being of their clients. This can enable individuals in hospice to focus on spending time with loved ones, while hospice helps them navigate the practical and emotional issues associated with the end of life.
Insurance coverage for hospice varies, but some programs offer subsidized treatment for economically disadvantaged individuals. Medicare also covers many hospice programs.
Palliative care is specialized medical care for people living with a serious illness. Individuals undergoing medical treatment can receive palliative care at any time and any stage of even non-terminal illnesses. Palliative care is provided by medical teams including nurses, doctors and other medical professionals, often within medical establishments such as hospitals. The primary goal of palliative care is to improve quality of life by managing symptoms and relieving stress associated with serious illnesses.
Although palliative care most often is provided in hospitals or extended-care communities, it also can be provided in individuals’ homes or simply as part of a treatment plan. Because the service is most commonly offered through medical providers, health insurance will typically cover it.
Palliative care does not have time restrictions, and it often serves to provide comfort to individuals at different stages of a wide variety of both chronic and terminal illnesses. Unlike hospice care, individuals undergoing palliative care may choose to receive life-extending treatments. Exceptions to the general guidelines exist; in some cases, individuals in hospice programs may receive life-extending treatments, and those receiving palliative care may exclusively receive therapies used at the end of life.
For individuals with terminal or chronic illnesses, palliative care and hospice can provide invaluable services that help improve quality of life. Thinking about what quality of life means to you personally can be an effective frame for considering treatment and symptom management options. If you or a loved one need supportive care, speak with your doctor to determine which option may best fit your needs.