What do you first think of when you hear the word hospice? What about palliative?
A hospice is a home which provides care for the sick or terminally ill. Unfortunately, many simply think of hospices as a place where people go to die. This has given the word a negative connotation as it is associated with inevitable death.
However, according to Hospice and Palliative Care, hospice and palliative care is actually care-giving in the finest tradition — people who are at the end of their lives are given care that is competent, comforting, and compassionate.
As an aspiring hospice nurse, you first need to know the difference between hospice care and palliative care. Although the two terms are often used interchangeably, they are not synonymous.
According to Gabriela Kaplan, RN, MSN, AOCN, an oncology clinical nurse specialist who specializes in end-of-life care, palliative care is part of hospice care. Both are focused on managing symptoms and providing comfort to the patient during the last stages of life. However, they differ in terms of three key aspects:
Place of Treatment
While it can be provided in any setting, hospice care is often administered at home after the physician has determined that the patient has ceased responding to any conventional medical treatments.
Surprisingly, this is not exactly the case most of the time. Although 42% of qualified patients receive hospice care, they only receive the services for an average of under 3 weeks. This is mainly due to doctors who are not really trained to refer patients to hospice care and mostly focus on exhausting all options to cure diseases. As a result, hospice nurses and other members of the multidisciplinary team don’t have enough time to plan and provide adequate hospice care to terminally-ill patients.
On the other hand, palliative care is more often provided to patients in places such as hospitals, clinics, and nursing homes. As opposed to hospice patients who largely receive care at home either from a caregiver or a visiting nurse, those who are under palliative care most often stay in the hospital or other medical facilities.
Duration of Treatment
In both palliative care and hospice care, a team composed of the doctor, nurses, and caregivers attempt to give comprehensive comfort and support to the patient and his or her family. The family of the patient plays a similar role as well, providing emotional and spiritual support.
Rehabilitation efforts such as physical, occupational, and speech therapy are also considered in order to aid with the provision of end-of-life care.
Palliative care may occur at any stage, from diagnosis and hope for cure, to hospice and hope for care. Palliative care may still involve efforts to cure the patient’s disease or may be used in conjunction with life-sustaining treatments as the patient is not required to give up the fight for recovery. If the physician begins to see that the ongoing treatment is not likely to cure the patient, a transition to hospice care is possible.
Hospice care, on the other hand, involves patients who have been determined by their physician to be in their last six months of life. Similar to palliative care, comprehensive attempts at providing both comfort and support to the patient and his or her family is present, but attempts to cure the patient’s illness is halted. It is also more likely for hospice patients to be not given tests or medicines that they do not necessarily need and which would contribute to greater discomfort. The goal of the hospice care nurse and other members of the team is not to prolong life or cure diseases, but to ensure the patient approaches death without any serious pain and discomfort.
As long as the patient has been determined to be within the last six months of life, he or she may be qualified to receive full coverage of hospice care from Medicare and/or Medicaid. Services provided for the palliative care are billed separately and covered by the patient’s medical insurance.
Connor, S. R. (2009). What Are Hospice and Palliative Care?. In Hospice and Palliative Care (pp. 17-34). Routledge.
Javier, N. S., & Montagnini, M. L. (2011). Rehabilitation of the hospice and palliative care patient. Journal of palliative medicine, 14(5), 638-648.