Question: What is the difference between hospice and palliative care?
Answer: The contemporary hospice movement took root under the direction of Dame Cicely Saunders in the United Kingdom in the mid 1960s with a holistic, team-based approach to bringing comfort and dignity to those who were dying. Imported into North America a decade later, hospice proliferated after the adoption of hospice care as a Medicare benefit in the 1980s.
Medicare stipulates who can get hospice and outlines specific requirements for the hospice team. This team will include a medical director, nurse case manager, social worker, chaplain and volunteers. The goals are to ensure patient comfort and dignity as they approach the end of life. The main criteria for hospice eligibility is that an individual has a terminal illness, and that if the disease runs its normal course, would be expected to result in death within six months.
Medicare stipulates who can get hospice and outlines specific requirements for the hospice team.
Palliative care evolved as it became apparent there were specific resources and approaches to care adopted by hospice providers that could have utility in patients who were not imminently dying. Coined by Dr. Balfour Mount, MD, in Montreal, the term “palliative care” defined an approach to care that focused on the relief of suffering and improvement of quality of life for those living with serious illness.
Subsequently, the specialty of “palliative medicine” was born, initially offering specialty certification in 1997, and adopted formally by the American Board of Medical Specialties in 2006. Patients who receive palliative care are not required to have a specific limited prognosis. While a palliative team may include other clinicians (like in a hospice team), there are no requirements as to the structure of a palliative team—and no limitations as to who can receive it.
Patients who receive palliative care are not required to have a specific limited prognosis… there are no requirements as to the structure of a palliative team—and no limitations as to who can receive it.
As a palliative physician, I care for a variety of patients who have a current or potential burden of suffering as a result of a disease or condition. They may or may not be receiving hospice services. They may be newborns or centenarians. They may or may not be terminal. For example, I have cared for many patients with cancer whose treatments (and sometimes the cancer itself) resulted in significant pain and debility. Our treatment plans helped them overcome those issues and allowed them to live with a high quality of life.
Every medical specialist has an area of expertise that can be accessed by anyone who suffers an ailment within the realm of that practitioner—so it is with palliative medicine. My expertise is in complex symptom management, and also helping patients and families navigate the challenging waters of difficult illnesses. Many of my patients have diseases that cannot be fixed, will continue to progress, and from which the patient will die. When they reach a life expectancy consistent with hospice eligibility, I will refer them to a hospice organization, where they will continue to receive expert palliative care, but this time with the support of the hospice team who will compassionately usher them to the threshold of death.
Palliative care should be a normal and expected part of management of most progressive, advanced and serious diseases, initiated at the onset of diagnosis. Working along with the team who will be actively managing the disease itself, palliative care will optimize the opportunities for patient comfort, family engagement and a meaningful quality of life, regardless of the disease or the outcome.
Palliative care should be a normal and expected part of management of most progressive, advanced and serious diseases, initiated at the onset of diagnosis.