Palliative care vs. hospice: what each one is, who pays, and how to choose

Palliative care and hospice get mixed up often, and the mix-up has a cost. Families wait for hospice when palliative care could have helped for months, or they hear “palliative” and assume someone has given up. Both put comfort first. They differ in when they start, what else can happen at the same time, and who pays.

The difference in one paragraph

Palliative care is medical care for the symptoms and stress of a serious illness, given at any stage, alongside treatment meant to cure or control it.¹ Hospice is comfort care for the final months of a terminal illness, when the person and their doctors have decided to stop treatment aimed at a cure.² Every hospice patient gets palliative care, but you don’t need to be in hospice, or near the end of life, to get it.¹

What palliative care is

The National Institutes of Health describes palliative care as “a specialized type of medical care for people who have a serious or life-threatening illness.”¹ It treats pain, breathlessness, nausea, fatigue, anxiety and the strain illness puts on a family, while the person keeps seeing their oncologist, cardiologist or kidney doctor.

It can start the day of a diagnosis. NIH puts it simply: “It’s never too early to start palliative care if you have a serious illness.”¹ People get it for cancer, heart failure, lung disease, kidney failure, multiple sclerosis and other conditions that last.¹

A palliative team can include doctors, nurses, social workers and others, and the care can happen in a hospital, a clinic or at home.¹

What the research shows

The best-known study of palliative care was published in the New England Journal of Medicine in 2010. Researchers at Massachusetts General Hospital randomly assigned 151 people newly diagnosed with metastatic lung cancer to standard cancer care, or standard care plus early palliative care.³

The palliative care group reported better quality of life. Depressive symptoms showed up in 16% of them, against 38% of the standard group. Fewer received aggressive care at the end of life, 33% against 54%. And they lived longer: a median of 11.6 months, against 8.9.³

One study doesn’t settle everything, and the authors studied one cancer at one hospital. But it changed how many doctors think about timing. Starting comfort care early didn’t shorten lives in that trial. It came with better ones.

What hospice is

Hospice is for the last stretch of a terminal illness. Under Medicare, three things have to be true.²

• The hospice doctor, and the person’s regular doctor if they have one, certify that the person is terminally ill, which Medicare defines as “a life expectancy of 6 months or less, if the illness runs its normal course.”
• The person chooses comfort care instead of treatment to cure the illness.
• The person signs a statement choosing hospice for that illness.

Hospice brings a full team home: doctors, nurses, aides, social workers, counselors and volunteers, caring for physical, emotional, social and spiritual needs. At HealthView that team includes a chaplain. Medicare’s hospice benefit covers the care, equipment and supplies, the drugs for pain and symptoms related to the terminal illness, short-term inpatient care when symptoms can’t be managed at home, and grief and loss counseling for the family.²

Medicare covers hospice in benefit periods: two of 90 days, then an unlimited number of 60-day periods, with a recertification each time.² Some people live longer than six months on hospice. That isn’t a failure of the rules. Prognosis is an estimate, and the benefit allows for it.

Choosing hospice isn’t a one-way door

People can stop hospice at any time, for any reason, and return to treatment aimed at a cure. Medicare’s own booklet says: “If you’re eligible, you can go back to hospice care at any time.”² Families sometimes hold off because hospice feels permanent. It isn’t.

Who pays for each

Hospice under Medicare. There’s no deductible. Drugs for pain and symptom relief are covered when they’re part of the plan of care. Medicare allows a copay of up to $5 a prescription for them, though there usually isn’t one. Inpatient respite care, a short stay that gives family caregivers a break, can cost 5% of the Medicare-approved amount.² Hospice doesn’t pay for treatment meant to cure the terminal illness, for unrelated drugs, or for room and board in a facility.²

Palliative care. Outside hospice, what a person pays for palliative care depends on their coverage, the same way it does for other medical visits. Our intake team checks before the first visit, so there are no surprises.

Medi-Cal in California. Since January 1, 2018, Medi-Cal managed care plans have been required to cover palliative care under a state law known as SB 1004, and they can provide it alongside treatment aimed at a cure.⁴ The state’s criteria named four conditions to start: heart failure, COPD, advanced cancer and liver disease, each with clinical thresholds.⁴ Someone can’t be enrolled in that palliative benefit and in hospice at the same time.⁴

Signs it may be time to ask about palliative care

There’s no test that tells you. These are patterns that often lead families to ask:

• A serious diagnosis, even an early one, that brings pain or symptoms that are hard to manage
• More trips to the hospital or the emergency room than before
• Treatment that’s working, but taking a heavy toll
• A caregiver who is worn down and needs a team behind them

Signs it may be time to ask about hospice

• Treatment has stopped working, or the person has decided they don’t want more of it
• More time asleep, less interest in food, and a steady decline over weeks or months
• Doctors have started talking about months rather than years
• The person has said what matters most now is comfort, home and family

Asking isn’t committing. A conversation with a hospice nurse costs nothing, and it often answers questions families have been carrying alone.

How HealthView helps

HealthView gives both, at home, across Los Angeles, Orange, Riverside and San Bernardino counties, and the same team stays as needs change. A family can start with palliative care during treatment and move to hospice later without starting over with strangers.

Hospice and palliative care share one line, (626) 505-1000, and the main line is (562) 600-1000. A person answers both any hour. You can describe what’s happening in your own words, and we’ll help you figure out which kind of care fits.