In general, hospice care falls under the category of palliative care, however the two have different indications and goals, and are often provided in different settings. The first palliative care unit was opened in 1976 at the Royal Victoria Hospital in Quebec by Dr. Balfour Mount. His motivation for opening the unit was his perceived neglect of dying patients in the acute care setting. Since then, palliative care has evolved and is used in many different settings including caring for a life-limiting illness in a patient who is not terminally ill, a life-threatening illness in a patient with symptoms but with the potential to recover, and a chronic illness like heart failure or emphysema in a patient with symptoms and on therapy, who will eventually succumb to the illness, but who is expected to live longer than someone with advanced cancer.
Many people, doctors included, confuse hospice and palliative care. Palliative care focuses on the patient’s experience of the illness rather than the disease itself. Symptom management, psychosocial support, and decision-making support are cornerstones of palliative care. Starting palliative care early in advanced cancer improves outcomes and limits overly aggressive, ineffective therapies at the end of life without hastening death. Palliative care may actually prolong life. Palliative care is indicated in someone with advanced cancer who has symptoms even though curative therapy is planned, at the time of a sentinel event like a recurrence on unexpected hospitalization, when palliative radiation is needed, and when changes in chemotherapy are needed because of disease progression. Palliative care is usually given in the inpatient setting.
Hospice care, on the other hand, is usually given at home, in a nursing home setting, or in a hospital hospice unit or private hospice facility. To qualify for hospice care the patient must have an illness, certified by two physicians, likely to cause death in six months or less. The purpose of hospice care is to provide quality of life and comfort and to avoid overly aggressive, expensive, and futile care at the end of life. Hospice care is fully covered by Medicare, including any and all devices and equipment. For example if someone who is not on hospice needs home oxygen, they must have a pulse-ox (blood oxygen percentage) of less than 90 percent. A hospice patient can get oxygen with no questions asked. Home hospice care includes 24-hour on-call services and will provide a physician specialist if so desired.
Home-based palliative care can be provided, but its scope is limited. Unlike hospice care, 24-hour coverage is not available and all equipment must be provided under Medicare or private insurance stipulations. Patients needing home-based palliative care must be homebound or severely limited in their mobility. This type of care can often serve as a bridge to hospice care for those who feel they are not ready for hospice care at the time of hospital discharge. Those who receive palliative care at home are less likely to be hospitalized at the end of life, more likely to be transitioned to hospice care at the appropriate time, and more likely to have relief of symptoms while keeping their dignity.
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