What is the Difference Between Hospice and Palliative Care?

Penny’s father was being discharged from the hospital after his latest fainting spell from low blood pressure. Having suffered from Parkinson’s for more than 20 years, he regressed during his stay, and he was having serious trouble swallowing. The discharge nurse came into the room to talk to Penny and her mother about him, suggesting hospice care since Parkinson’s is a debilitating disease that won’t get better. Penny thought to herself that maybe hospice was a good option, but Penny’s mom quickly said “no.” Her dad has been in the hospital several times and each time he regressed, he was able to regain his ability to swallow with therapy.

Penny’s mom thought therapy would be a better option than hospice care, although Penny and her mother both wanted him to live in comfort and have the best quality of life. What Penny and her mom didn’t know was that palliative care could’ve been an option, but they didn’t know it existed. Penny also didn’t know all of the negatives associated with hospice care in the home, that I will provide links to information about in this article.

Medical Care Options for Loved Ones

When researching medical care options for your loved one, it can be all too easy to feel overwhelmed by the different forms of care and variants of services. One of the most common areas of confusion is the difference between palliative and hospice care. While palliative care and hospice care have a close relationship with one another, there are key differences in the overall purpose and application of these care practices. Understanding the definitions and focuses of each care method allows for a clearer picture of the differences between the two.

Please note: If hospice care is right for your loved one, it can be rendered in a nursing home setting, and this should be your preferred place based on the findings in the article in Kaiser Health News, ‘No One Is Coming’: Hospice Patients Abandoned At Death’s Door.’ Please read more in my article, “The Ugly Side of Hospice.”

Understanding the Difference Between Hospice and Palliative Care

Terminal or non-terminal illness?:

· Hospice: When a loved one is diagnosed with a terminal illness expected to end in death within six months, the impact is felt in all aspects of life and affects everyone to whom your loved one is connected. Seeking to live the remaining time in comfort, your loved one may wish hospice care to forego curative or life-prolonging treatment options and instead focus on living as pain-free as possible, pursuing time well-spent with loved ones, while living the life they wish to lead prior to death.

Palliative care: Palliative care is medical care that is focused on providing patients with relief from the symptoms, ailments, and pain that accompany a chronic or life-threatening illness, regardless of whether or not the illness is terminal or non-terminal. While receiving palliative care, patients can remain under the care of their regular doctor and still receive curative treatment for their illness.

Improving Quality of Life

· Both hospice care and palliative care provide your loved one with the ability to live comfortably and in the comfort of wherever your loved one calls home. Hospice is a holistic, patient-centered philosophy of team-based care that promotes comfort and fullness of life rather than seeking a cure to a terminal illness; palliative care is essentially the same type of patient-centered team-based care, but palliative care provides this care in addition to traditional medical care that may still be seeking to cure an illness. But the use of hospice care by no means signifies that your loved one is giving up on life. Rather, both hospice and palliative care prioritize your loved one’s wishes for personal care and pain relief when facing a terminal illness, allowing for the highest quality of physical, spiritual, emotional, and social care, along with a dignified death when that time comes.


· Hospice: Hospice care is designed to provide optimal care and comfort — physically, emotionally, spiritually, and socially — for those who have a terminal illness, defined by a life expectancy of less than 6 months. Hospice seeks to improve the quality of the remaining time your loved one has, rather than seeking curative or life-prolonging measures.

· Palliative care: Palliative care can be provided for any person with a serious illness, regardless of whether the illness is considered terminal or non-terminal. Palliative care can be introduced into your loved one’s care regimen no matter what stage the illness is in and can be incorporated alongside curative and life-prolonging treatments.


· Hospice: To qualify for hospice care, your loved one must meet a series of requirements to determine eligibility. Your loved one must have a primary care physician and hospice medical director certify a life expectancy of less than six months; your loved one must agree not to pursue curative treatments; and you must formally elect to pursue hospice care with a specific organization.

· Palliative care: To begin receiving palliative care, your loved one can simply request a palliative care referral from a physician at any stage of the illness.

Care Location

· Hospice: Hospice care is a holistic care philosophy — not a place, although there are scattered hospice “facilities” around the country which only accept patients who are in hospice care. Based on the article and survey mentioned above, it is highly recommended that hospice care take place in a nursing home or hospice facility setting. One reason is that hospices are supposed to be able to provide either “continuous” nursing care at home or inpatient care at a medical facility. But about one in six U.S. hospice agencies did not. Learn more here.

· Palliative care: While palliative care can be received at home, palliative care is often administered in a hospital setting, outpatient clinic, or extended care facility such as a nursing home. Palliative care, like hospice, works with your loved one’s current physician in order to provide you with pain and symptom relief.

Payment Options

· Hospice: While many payment methods exist for covering the costs of hospice care, hospice care is often affordable, with costs being primarily covered by the federal Medicare hospice benefit program. Hospice care costs can also be covered by your loved one’s state Medicaid program or private insurance policy.

· Palliative care: Palliative care, being most often administered by your loved one’s regular medical provider, is most commonly paid for by private medical insurance; however, Medicare Part B and some state Medicaid programs also offer coverage for forms of palliative treatment. To obtain a comprehensive understanding of your loved one’s payment options concerning palliative care, contact your loved one’s insurance provider and palliative care provider prior to receiving any care services.

Nursing Home Hospice Care is a Better Option than Home Hospice Care

As you can see, both hospice care and palliative care have advantages, depending on the needs and wishes of your loved one. Unfortunately, many hospice providers are failing to provide quality care for patients at end of life, especially when that care happens at home. Unlike hospice programs, nursing homes are staffed with nurses and doctors 24/7, making them (in many cases) a better choice for a loved one’s long-term care needs and end-of-life needs, and hospice care can just as easily be provided in the nursing home as it can at home. Many nursing homes have a contract with one specific hospice provider, so if you have a loved one in a nursing home, you might not have a choice in picking a hospice provider. However, you know that if you’re in a nursing home, you’re not going to be left without care at end-of-life even if the hospice provider fails to show up.

Protect your family’s hard-earned money and assets from the catastrophic costs of nursing home care

The best time to create your long-term care strategy is before you actually need long-term care. If you’re over 65, we recommend that you begin your asset protection planning now. Even if you are currently receiving long-term care services for yourself or a loved one, it’s still not too late to plan and protect assets and improve dignity and quality of life. Please call us to make an appointment for an initial consultation:

Fairfax Elder Law Attorney: 703-691-1888

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.