Hospice care is finally getting recognition as a meaningful way to live the rest of your life in the best manner possible, if you have a life-limiting condition.  Palliative care, however, is still widely misunderstood and far less available, though the need for it is large and growing.  How are hospice care and palliative care defined – how do they overlap, and how are they different?

Hospice Care

Hospice care is designed for seriously ill people whose illness is not responding to treatment, or who have decided not to undergo further treatment for a life-limiting illness.  Hospice provides care and support for the patient and family, but the patient will not receive treatment intended to cure or slow the progress of their disease.

Hospice is usually chosen when a patient’s doctor believes that the patient has six months or less to live.  Ironically, it can happen that a patient in hospice lives longer than they would have, had they continued to be treated.   

A patient in hospice care may still receive treatments for some medical conditions, if it is helpful.  For example, cancer chemotherapy that is no longer working may stop, but if the patient has high blood pressure, he or she may still be treated for that.

Fortunately, paying for hospice care need not be a concern.  According to the NY State Department of Health, “[Hospice] is available through Medicaid, Medicare, private payment, and some health insurers to persons who have a medical prognosis of six or fewer months to live if the terminal illness runs its normal course.”

Any person with a serious illness, especially if they are older, frail, or in poor health, should discuss hospice options with their doctor.  Many people refuse hospice for too long, and don’t take advantage of the far better quality of life that hospice services are designed to provide.  Starting hospice services sooner rather than later can end up providing months of quality time with family, and a calmer, more peaceful end.

Because it is clear that Medicare and Medicaid pay for hospice services, there are numerous providers of this type of care. 

Palliative care

The goal of palliative care is to maximize the quality of life of someone living with a serious illness such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), cancer or dementia, but who has not necessarily been diagnosed as being terminally ill.  Patients who are receiving palliative care may be treated to alleviate the symptoms of their illness, and they may also receive treatment intended to cure their condition or prolong their life.

The sooner someone with a serious illness seeks palliative care, the more effective it can be.  Anyone with serious discomfort and disability in their later years can benefit.

Palliative care’s benefits are not limited to helping to manage the symptoms of the person’s condition, and to improving their quality of life.  Establishing communication about the ongoing treatment of their illness can help patients to better understand their options moving forward, if their condition deteriorates.  Ongoing discussions can help them to be more proactive and confident about their decisions about treatment.

Palliative care is provided by a variety of health professionals, depending upon the needs of the patient.  In addition to medical needs, as with hospice care, a patient might benefit from social, emotional or practical support.  Doctors, nurses, social workers, and chaplains may be involved.  Palliative care is still a relatively new concept, so many doctors do not proactively refer patients.  A patient may request a referral for palliative care services.

Who pays for Palliative Care?

According to the website of MJHS health system, “If you have Medicare Part B (medical insurance), it may cover some medications and treatments that provide palliative care, including visits from doctors, nurse practitioners and social workers. If you are covered by Medicaid, ... it may cover some palliative care treatments and medications, including visits from doctors. Medicaid does not use the term ‘palliative,’ so standard Medicaid benefits provide coverage."

The website says further, "Many private health insurance plans provide some coverage for palliative care as part of their hospice or chronic care benefits. If you own a long-term care policy, there may be palliative care benefits provided by that policy. Check with your health insurance or long-term care insurance representative.”

A long-term care policy issued ten or more years ago may not cover palliative care, as it didn’t exist as a stand-alone service until recently.  You will need to check with your Medicare or Medicaid provider to determine what is covered. 

There are not a large number of palliative care providers at this time.  Numerous of the providers listed in Google under “palliative care” in the NYC Metro area provide only hospice care.  It may take some research to find an available provider.

The nonprofit National Hospice and Palliative Care Organization has created a chart that compares palliative care to hospice care.

Both hospice and palliative care services may be appropriate for someone with long-term care needs.  This may be another part of the long-term care planning process that can maximize your quality of life.  The sooner you begin to plan, the better your chances are of protecting yourself against both unnecessary medical treatments and discomfort, and against the enormous cost of long-term care.