Hospice care is a type of palliative care, but palliative care is not hospice. The difference between these two types of care is something that I have found difficult to clarify myself let alone explain to others. However, this supportive care is a fundamental part of treating any chronic or terminal illness.
What Is the Meaning of Palliative Care?
According to the Merriam-Webster Dictionary, the word palliate means “to make the effects of something, such as an illness, less painful, harmful or harsh.” It originates from the Latin word palliare, meaning to cloak or conceal.
Kimberly A. Curseen, M.D., director of Supportive and Palliative Care Outpatient Services at Emory Healthcare, director and primary provider for the Supportive Oncology Clinic at Winship Cancer Institute, and associate professor at Emory University School of Medicine, says that palliative care is focused on providing relief from the symptoms and stress of a serious illness—whatever the diagnosis may be.
“The goal is to improve quality of life for both the patient and their family,” Curseen explains. “This care can help with emotional and spiritual problems as well as physical problems.”
Hospice vs. Palliative Care
Palliative care, also known as supportive care, may seem straightforward, but it is not widely known or understood, particularly due to its relationship with hospice care. Curseen, who is board certified in internal medicine, palliative care and geriatrics, helps differentiate between these two modes of care and how patients and families can benefit from them.
Hospice care is provided to patients at the end of life while palliative care is appropriate at any age and at any stage in a serious illness. Unlike hospice, palliative care can be provided in conjunction with curative treatment.
“Palliation can be provided at first diagnosis or late into the disease process because access is based on the needs of the individual,” Curseen notes.
Palliative care is delivered by an interdisciplinary team of medical professionals that works closely with a patient’s current doctor(s). They collaborate to develop an individualized care plan that prioritizes symptom management and personalized treatment goals. Palliative care prevents and alleviates suffering and helps people achieve quality of life by providing:
- pain and symptom relief;
- guidance in making complex medical decisions;
- emotional and spiritual support; and
- assistance in navigating the healthcare system.
Hospice provides many of the same services but is a specialized type of palliative care for individuals who have received a terminal diagnosis and are approaching the end of life. When doctors estimate that a patient has a life expectancy of six months or less if their illness follows its natural course, then they are considered a candidate for hospice care.
It is also worth noting that hospice and palliative care are often further confused because many organizations provide both types of care. While they may be similar, this does not change the fact that each care program involves very different eligibility requirements for acceptance.
The Benefits of Palliative Care for the Elderly
Although palliative and hospice care can be beneficial to patients with countless chronic illnesses, both are commonly associated with cancer treatment. According to the American Cancer Society, “studies have shown that patients who have palliative care visits while in the hospital spend less time in intensive care units and are less likely to visit the emergency room or to be re-admitted to the hospital after they go home. Studies have also shown that people with chronic illnesses, like cancer, who get palliative care have less severe symptoms.”
Several recent studies have shown that palliative care improves patient quality of life and reduces the amount of time patients spend in acute care settings. Curseen cites one study published in the New England Journal of Medicine which shows that patients with metastatic non-small cell lung cancer (NSCLC) who received outpatient palliative care early following diagnosis not only had an improved quality of life but also lived longer than patients who did not receive this intervention.
However, Curseen urges the public to remember that these benefits are not limited to patients with cancer.
“Those with illnesses such as dementia, Parkinson’s disease, chronic obstructive pulmonary disease (COPD), heart failure and ALS have experienced benefits like symptom reduction and lower hospitalization rates as well,” she notes.
The Centers for Disease Control and Prevention (CDC) estimates that 85 percent of older adults have at least one chronic health condition, and 60 percent have at least two chronic conditions. Elderly individuals with complex medical situations are ideal candidates for palliative care, but these services don’t just benefit them. When a senior’s physical and mental health are prioritized by their professional care team, their family caregivers experience what is called a “positive downstream effect.” A study published in The Oncologist found that early involvement of palliative care for patients who were recently diagnosed with lung and gastrointestinal cancers also led to improvement in caregivers’ psychological symptoms, such as emotional distress and depression.
What Is Included in Palliative Care?
For persons with chronic illnesses, having a supportive care team provides access to expertise in symptom management. For example, cancer patients ideally receive aggressive treatments early on, targeting affected areas of the body. But, with this treatment comes a barrage of distressing symptoms, such as pain, shortness of breath, difficulty sleeping, nausea, anxiety and fatigue.
“Whether the goal is to cure, slow or simply manage the disease, equally early and aggressive management of the symptoms that arise becomes an essential part of treating the whole patient and maintaining their quality of life,” Curseen advises.
Palliative care teams are composed of doctors, registered nurses and other specialists who work together with a patient’s primary doctor. These teams can provide care in the hospital, in long-term care facilities, at clinics, and, in some programs, through home visits. Other professionals like massage therapists, dietitians, physical therapists, pharmacists, mental health professionals and chaplains may be added to a patient’s care team as well.
“The purpose of this diverse group of experts is to help the patient and their family members understand the disease as well as all available treatment options and facilitate communication and collaboration amongst all the patient’s health care providers,” explains Curseen.
Is Palliative Care Covered by Insurance?
As with other hospital and medical services, Medicare, Medicaid and most private insurance plans will cover all or part of palliative care services that a doctor deems medically necessary. The extent of coverage depends on an individual’s unique needs and their current insurance plan.
“A prior authorization may be required before an initial visit,” Curseen acknowledges, “so be sure to check with the insurance company [or CMS] for help with specific questions related to payment options. A social worker may be able to help find solutions regarding the financial aspects of this care as well.”
If you can’t find much information about palliative care on Medicare.gov or Medicaid.gov, don’t fret. The Center to Advance Palliative Care notes that neither Medicare nor Medicaid uses the term “palliative” to describe these services, but they are the same. If there is a specific palliative care service that you are seeking additional information about, try using the Your Medicare Coverage tool to search for it. For example, use queries like “mental health care,” “pain management,” “home health services” or “durable medical equipment” instead of the umbrella term palliative care.
Spreading Awareness of Palliative Care
“It is important to spread the message that this type of care is available, since there are many people who are struggling with pain and other symptoms but unaware that their life can be improved while they are undergoing treatment,” Curseen urges.
If you or a loved one has a serious illness and the symptoms are interfering with day-to-day life, talk to a primary care doctor about palliative options. This may include a referral to a palliative doctor or a palliative specialist at a local hospital. For many people, improving even one serious symptom, such as severe nausea, can make a marked difference in their overall quality of life. It can’t hurt to consult with a health care provider about all available options.