Palliative Care vs. Hospice – What Are They?
Most people are understandably confused between palliative care vs hospice. In fact, there’s a great deal of confusion about how and when each of these end-of-life care services begins. How can you choose between the two?
Palliative care is for people with severe and chronic medical conditions. A team of doctors and nurses determine and address your needs regardless of your diagnosis or prognosis. You, as the patient, decide the treatment goals in consultation with the palliative care physician.
Palliative Care vs Hospice: the Key Differences
Palliative care isn’t particularly for terminally ill people. It provides aid and comfort to patients with both terminal illnesses and other severe conditions. On the other hand, hospice care is for those who are unlikely to recover and have a short expected lifespan remaining.
Palliative care vs. hospice – both can be significant supports for you and your family. You often struggle a lot to manage the symptoms and pain of medical conditions of long-term illnesses.
It’s relatively easy to find companies that will provide hospice care. It might be more challenging to find a palliative care board-certified physician.
Is Palliative Care for End of Life?
Palliative care can give comfort care for the end of life but does not rely on a terminal diagnosis for you to start with it. You can get Palliative care together with the medical care you receive from your primary physician. Treatment options during palliative care are your personal decision.
No one knows when someone will pass away – not even palliative care or hospice physicians. Decisions about how far to go with treatment are emotional. It’d be best if you discussed them with your family, friends, and spiritual advisors. It’s not unusual for people to change their minds about the level of aggressiveness of their treatments. Talking with a palliative care physician will help you make a well-informed decision.
What Exactly Is Palliative Care?
Palliative care’s focus is on the person, not the diagnosis. The palliative care team talks to the patient to understand their symptom relief goals and emotional and spiritual needs. The quality of life of the patient is front and center of everything a palliative team provides.
Let’s look at precisely what palliative care may mean for someone suffering from a long-term illness:
Symptom management means the focus lies on addressing pain and discomfort related to your illness. Examples are:
- trouble breathing
- loss of appetite
Symptom management may or may not involve active treatment.
You get to choose how much treatment you want. It’s up to you to decide how and when to treat your symptoms. Of course, you should decide in consultation with your palliative care team.
Spiritual and mental health support
Spiritual and mental health support is part of palliative care’s patient-centered approach. Illness can bring about struggles with end of life issues and depression.
Mental stress and thoughts about how your condition will affect your aspects of care. A chaplain is part of the palliative care team.
Improving the quality of life
Quality of life might mean treatment for one person and comfort care for another. Palliative care addresses individual goals, whatever those might be.
There’s no defined or prescribed course of care under palliative care. As the patient, you’re the driving force.
Coordination and communication
For someone with a severe illness, there might be several healthcare providers involved. A palliative care team can improve and coordinate communication between all care providers.
Palliative care isn’t only for patients but also for their families. Family consultation and involvement are integral parts of the palliative care philosophy.
You’ve looked into palliative care. Read on to learn about hospice care.
What Are the 4 Levels of Hospice Care?
Hospice care supports patients who have terminal conditions. Based on Medicare guidelines, you’ll qualify for hospice if you have about 6 months to live. There are 4 primary levels of hospice care, as determined by Medicare.
- Routine home care
- Continuous home care
- General inpatient care
- Respite care
Not everyone will experience each level. You may go from one level to the other several times.
Level-1: Routine home care
If you start hospice soon enough, you’ll usually receive routine home care. A hospice nurse visits intermittently, around 3 times a week, to manage and track your conditions. An aide comes 2-3 times a week to assist with bathing, dressing, hygiene, and urinary issues.
The team includes physical and occupational therapists, aides, chaplains, volunteers, and social workers. Physical and occupational therapists help with positioning, which prevents bedsores.
The team will also aid you in stretching to help with contractures. The team orders durable medical equipment such as a hospital bed, wheelchair, and other necessary supplies.
Level-2: Continuous home care
Continuous home care occurs during a crisis when a nurse needs to stay with the patient for an extended period. Hospice isn’t intended to provide 24-hour care. But there are times when a team member needs to be present to manage severe symptoms and pain.
These continuous home care visits are usually for no more than 8 hours to get things under control.
If the hospice team can’t manage the symptoms, they might suggest general inpatient care for a limited time. Nurses and physicians will be available at all times.
Level-3: General inpatient care
If the team can’t manage the symptoms at home, a time-limited inpatient stay might be necessary.
Inpatient settings include free-standing hospice facilities, hospitals, and Nursing Homes.
These settings have 24-hour nursing and physician services to get the pain under control. They’ll also manage other severe symptoms of the terminal illness.
Level-4: Respite care
Respite care is a temporary (5-day limit) inpatient stay for the patient. It’s intended to give the family caregiver some relief. Since hospice is not providing care, 24/7 families must arrange for any extra care their loved one needs. If caring for the patient becomes too stressful, or the primary caregiver needs a break, hospice can arrange for respite. Respite takes place in a hospice facility owned by the hospice company, an inpatient hospital, or a Nursing Home.
Now that you have a clearer understanding of both palliative and hospice care read on to find out when to start each type.
When to Start Palliative Care?
Generally speaking, you should start palliative care early in your illness. If you’re diagnosed with severe diseases like ALS, cancer, lung or heart disease, or Alzheimer’s (to name a few), you’d need support and options.
The stress of receiving a medical diagnosis can be overwhelming. Some questions to ask yourself as you consider palliative care are:
- What are my treatment options and my long-term prognosis?
- What is essential to me for quality of life?
- Am I stressed about my diagnosis?
- Is pain management vital for me?
These questions will help you determine if palliative care is right for you. Palliative care teams work with your primary care physician. Make sure to ask your physician about palliative care availability.
When to Start Hospice?
Most people start hospice too late, and there is a good reason for this. Hospice means that a person has decided to give up on treatment and accept that they’ll eventually pass on; not an easy decision for anyone.
Also, it’s not unusual for family members to disagree on whether and when to start hospice.
For Medicare to pay for hospice, a physician must certify that you have a terminal illness with approximately 6 months to live. Some things to think about when considering hospice include:
- To continue to qualify for hospice, you’re unable to seek treatment for your terminal condition. If you do, hospice will discharge you. Most people on hospice stop most medications except those that provide pain relief.
- Most hospice companies discourage artificial hydration and nutrition. Yet, it’s the patient’s choice to have these interventions. Intermittent oxygen, for example, provides symptom relief and is acceptable on hospice.
- It’s possible to recertify for hospice many times as long as you meet the Medicare criteria and have a physician’s order.
- Some patients get better on hospice, at which point they stop hospice services.
If in doubt about hospice, discuss the option with your primary care physician and your family. You always have the option of beginning hospice care and changing your mind later on.
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You may start with palliative care and move to hospice once you’ve used up the treatment options.
Know that you have options available to support you during your illness. Take advantage of all available support!