When your loved is diagnosed with a serious medical condition, it’s common to have a lot of questions. Initially, they often revolve around how to treat the condition and what the prognosis looks like. Questions about comfort, care needs and pain management are also common. For many families, discussions about palliative care and hospice care are part of these conversations. While both programs offer tremendous benefits to patients with serious medical conditions, how do you know what kind of support each program provides? What are the differences between the two programs, and which one is best for your loved one?

Hospice and Palliative Care – Similarities and Differences 

Hospice care and palliative care are similar in some ways. Both programs are available to patients of all ages. They provide comfort, pain management and support after a person has been diagnosed with a serious medical condition. Both programs can be offered at home, which empowers patients to maintain a higher quality of life and feel comfortable in familiar surroundings. Neither program equates to giving up hope or giving up on life. 

The programs are also different in some ways.

Palliative care can begin immediately after a diagnosis and while your loved one is pursuing curative treatments. This is also a good option if your loved one is not yet emotionally ready to transition from curative care to comfort care. Palliative care compliments treatments and can help patients to overcome nausea, insomnia, anxiety, weakness, pain and general discomfort; all are side effects that often accompany aggressive treatments. 

Hospice care is comfort care without a curative intent. The program redefines hope. Instead of searching for a cure, the patient focuses on restoring or maintaining important relationships, understanding the impact of spirituality and finding comfort and peace. Hospice is appropriate when your loved one has made the decision to no longer pursue curative and oftentimes aggressive treatments because they are not available, effective or desired. The program also offers a unique benefit to your family as support continues after your loved one has passed and throughout the bereavement process.

The differences in the programs are of primary importance to understand after your loved one has received their diagnosis. Having a general idea about your loved one’s current goals and challenges and the specifics of each program can help you and your loved one to consult with their doctor and determine which program is the best fit. Once you’ve made that determination, it’s helpful to understand the difference in who pays for care under each program. 

Coverage for Hospice Care 

Hospice care is designed to provide a higher level of care and help to ensure physical, emotional and spiritual comfort if your loved one has been diagnosed with a life-limiting medical condition and their doctor anticipates they have six months or less to live if the disease follows its expected course. This does not mean that hospice care will be discontinued if your loved one lives longer than six months. Coverage for care remains available if the doctor continues to certify the need for and benefit of the program.

As long as your loved one meets the hospice eligibility requirements established by the US Centers for Medicare and Medicaid Services, Medicare, MediCal, VA benefits and private insurance will typically cover 100% of the cost of care. The hospice eligibility requirements can include:

  • Patient has been diagnosed with a life-limiting condition and has a prognosis of six months or less if the disease follows its normal course.
  • Frequent hospitalizations in the past six months
  • Progressive weight loss
  • Increased fatigue or weakness
  • A change in cognition and functional abilities
  • Experiencing challenges with activities of daily living (eating, bathing, dressing, toileting, etc.)
  • Recurrent infections or skin breakdown
  • Specific decline in condition  

Coverage for Palliative Care 

The goal of palliative care is to help your loved one better manage symptoms and any discomfort while they continue to pursue curative treatments. Typical services provided by palliative care specialists include symptom and pain management as well as helping you and your loved one to better understand treatment options, navigate your choices and providing assistance with advanced care planning and community referrals. The requirement to receive palliative care support are not as specific as what’s required to receive hospice care, but your loved one will typically need a referral from their primary care physician to initiate services. 

Once your loved one has been referred for palliative care, Medicare Part B, VA benefits, MediCal and private insurance will typically provide coverage for care. However, coverage levels can vary, and your loved one may incur some out of pocket expenses for certain treatments and medications.

Which is Right For My Loved One?

Determining whether palliative care or hospice care is the right choice for your loved one involves having some frank conversations with the medical professions whom you trust. Understanding treatment options and the prognosis can help your loved one to determine which path will best meet their needs and improve their quality of life. Additionally, it’s important for your loved one to honestly evaluate their desire to pursue treatments, the challenges they are facing and their goals.

When you arm yourself with the right information, both palliative and hospice care can help your family to find hope in an otherwise difficult situation by offering freedom from pain while preserving awareness and a sense of control. 

If you have additional questions, we’re here to help. Contact Salus Hospice of San Diego anytime to discuss your options and schedule a consultation.