What is Palliative Care and How Does it Differ From Hospice?

Palliative care is a form of medical care aimed at relieving the symptoms associated with a serious illness while improving a person’s quality of life. In palliative care, a specialized team of medical and allied health professionals work together to address an individual’s physical, emotional, practical, and spiritual needs.

Palliative care is often confused with hospice care, which is comfort care for patients who only have six months or less to live.

This article explores the elements of palliative care along with the types of treatments that may be involved. It also details when palliative care is needed, including the criteria used by healthcare professionals and health insurers.

What Is Palliative Care?

The ultimate aim of palliative care is to improve a person’s quality of life when faced with a serious or life-threatening illness. It can begin at any time during an illness, lasting days or even years, and be provided along with curative treatments.

Palliative care is not restricted to people receiving end-of-life care. It can be offered to anyone whose illness is reducing their quality of life, impacting their ability to function normally, or placing an undue burden on family or caregivers.

The scope of palliative care may involve:

• Providing relief from pain and/or symptoms of a disease
  
• Coordinating care between medical and non-medical providers
• Minimizing side effects from treatments
• Addressing the emotional, spiritual, and social needs of the individual
• Identifying and supporting the needs of the family or caregivers

Who Provides Palliative Care?

Palliative care is typically carried out by a team of professionals who can address multiple concerns. It may be offered by hospitals, home care agencies, cancer treatment centers, and long-term care facilities. The care team may include:

• Palliative care doctors
• Nurses and nurse practitioners
• Pharmacists
• Social workers
• Psychologists
• Registered dietitians
• Chaplains, rabbis, or other spiritual leaders
• Therapists (occupational, speech, physical, massage, etc.)

Palliative care is a specialized field of medicine. For doctors, board certification in palliative care is through the American Board of Medical Specialities (ABMS). Nurses and nurse practitioners can get certified through several credentialing organizations.

Ultimately, the most important member of the care team is you. Palliative care should be directed toward meeting your personal goals and needs. It is important to make your wishes known and to encourage your family and caregivers to do the same.

What Are the Types of Palliative Care?

Improving someone’s quality of life involves tending to more than just their physical concerns. As such, palliative care is a holistic approach intended to ease emotional, social, practical, and spiritual challenges as well.

Palliative care treatment may be aimed at any of the following, as appropriate:

• Physical problems, such as pain, sleeping problems, breathing difficulty, loss of appetite, constipation, and nausea or vomiting
• Emotional or social problems, including depression, anxiety, family issues, caregiver burnout, and lack of support
• Practical problems, including insurance, financial, legal, housing, or job-related issues
• Spiritual issues, including prayer, finding meaning, even hopelessness and a loss of faith
  

What Are the Benefits of Palliative Care?

Some of the many benefits of palliative care include:

• Symptom relief: Relief from pain and other symptoms is an important goal of palliative care.
• Longer survival times: There is evidence that people who receive palliative care tend to live longer than those who only receive curative treatment. For example, research has found that people with advanced cancer receiving palliative care had survival times more than 30% longer than those who received only standard care.
• Improved quality of life: Studies have found that people who receive palliative care early and for a longer duration have a better quality of life at the end of life.
• Improved family and caregiver experience: There is evidence that family members and caregivers are more satisfied with the treatment of loved ones receiving early palliative care. Because palliative care also provides guidance and help for family and caregivers, it helps them to feel more empowered and supported.
  

What Is the Difference Between Palliative Care and Hospice?

Hospice and palliative care are similar, but they do have important differences.

While palliative care may be given as someone nears death, it has a broader scope than hospice care and may also be given at diagnosis, during treatment, and/or after treatment to help patients with chronic or life-threatening illness, such as cancer, heart failure, and HIV/AIDS.

Hospice care is end-of-life care. It is reserved for people who are believed to be in the last weeks or months of life. People in hospice may receive palliative care, but hospice care isn't given to someone who is also receiving curative care or is expected to live for longer than six months.

What Diseases Are Treated With Palliative Care?

Historically, palliative care was used in people with incurable cancer and was largely synonymous with hospice care. Over time, the definition has evolved and broadened. Today, palliative care can be applied to many serious terminal or non-terminal conditions.

In addition to cancer, palliative care may be used in people with:

• Congestive heart failure (CHF)
• Chronic obstructive pulmonary disease (COPD)
• Stroke
• HIV/AIDS
• Advanced kidney disease
• Advanced liver disease
• Neurodegenerative disorders like Alzheimer’s disease, Parkinson’s disease, multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS)
  

Is Palliative Care Covered by Insurance?

There may also be eligibility criteria for insurance coverage. Many private insurance plans cover palliative care. Medicare only covers palliative care for certain conditions.

Furthermore, while Medicare Part B covers certain palliative care services (like doctor’s fees and some supplies), Medicare Part A benefits can only be applied to hospice care.

How Do You Get Palliative Care?

According to the Center to Advance Palliative Care, the criteria for receiving palliative care can vary based on who is assessing the patient. Criteria categories include:

• General clinical criteria: May include multiple hospitalizations, declining ability to take care of oneself, severe weight loss, a need for tube feeding in severely ill people, difficult-to-control symptoms, and extreme patient or caregiver distress
• Intensive care unit (ICU) criteria: May include two more ICU admissions during the same hospitalization, multi-organ failure, prolonged ventilator use, and ICU admissions from nursing homes in people with multiple health concerns (e.g., dementia and heart failure)
• Emergency room (ER) criteria: May include multiple prior hospitalizations for the same condition, long-term care patients with a do not resuscitate (DNR) order, and people previously enrolled in hospice or home health care
• Oncology (cancer) criteria: May include a poor performance status (PS), failure of first-line or second-line chemotherapy, painful bone metastases (cancer spread), progressive brain metastases after radiation, and the need for interventional pain management

Summary

Palliative care is aimed at relieving symptoms and improving quality of life of people with serious or life-threatening illnesses. It may be included as a part of hospice care, but it is not the same thing as hospice care. With palliative care, you can still receive curative care whether your condition is terminal or not.

Palliative care is often delivered by a team of providers, including medical and allied health professionals. The scope of care not only includes medical services like pain control and respiratory care, but may also address the person’s emotional, practical, and spiritual needs.