The short version
- Palliative care is extra support for anyone living with a serious illness, at any age and any stage. You can receive it alongside every other treatment, including surgery, chemotherapy, and intensive care.
- Hospice is one kind of palliative care, for when time is likely short and the goal has shifted to comfort and quality of life rather than treatment aimed at cure.
- All hospice care is palliative care. Most palliative care is not hospice.
Palliative care: an extra layer of support
Palliative care pays attention to how you are living with your illness, not only to the illness itself. That includes pain, nausea, shortness of breath, fatigue, and trouble sleeping. It includes fear and worry, the weight of hard decisions, and the strain on the people who love you.
A palliative care team usually includes doctors, nurses, social workers, and chaplains. They work alongside your surgeon and your other doctors. They don’t take over your care, and they don’t take away your treatment.
You don’t have to be dying to see a palliative care team, and you don’t have to stop anything. Some people see palliative care for years. Others meet the team for a few days in the hospital to get through a hard stretch.
What a palliative care team can help with
- Symptoms: pain, nausea, breathlessness, constipation, poor appetite, sleep, anxiety.
- Understanding: what is happening, what your options are, and what to expect.
- Decisions: weighing treatments, including surgery, against what matters most to you.
- Family: support for the people caring for you, including their own exhaustion and grief.
This isn’t only about comfort for its own sake. In a well-known study of people with advanced lung cancer, those who began seeing a palliative care team early, alongside their cancer treatment, had better quality of life and fewer symptoms of depression. In that study, they also tended to live longer, by almost three months.
Hospice: when comfort becomes the main goal
Hospice is for people whose illness can no longer be cured and who are likely in the last months of life. In the United States, Medicare’s hospice benefit asks your doctors to certify that life expectancy is six months or less if the illness follows its usual course. It also asks you to choose care focused on comfort instead of treatment meant to cure the illness.
That second part is where many people hear “giving up.” I don’t see it that way. Choosing hospice changes what your care is trying to accomplish. It doesn’t stop your care. For many people, hospice brings more attention to comfort, more care at home, and more support for their family, not less.
There’s more about the day-to-day reality in What hospice actually looks like.
Side by side
| Question | Palliative care | Hospice |
|---|---|---|
| Who it’s for | Anyone with a serious illness, at any stage | People whose illness can’t be cured and whose life expectancy is likely six months or less |
| Treatment aimed at cure | Continues alongside it | Set aside in favor of comfort-focused care, and you can change your mind |
| When it can start | At diagnosis, or any time after | When you and your doctors agree that comfort is now the main goal |
| Where | Hospitals and clinics, and sometimes at home or in a nursing facility | Most often at home, wherever you live; also nursing homes and hospice inpatient units |
| Paying for it | Covered by Medicare, Medicaid, and most private plans, with your usual copays | Covered by Medicare’s hospice benefit, usually at little or no cost to you; most other plans cover it too |
Things I wish everyone knew
- Asking about palliative care doesn’t mean your doctors have given up on you, or that you have given up.
- You can leave hospice. If your goals change or your health improves, you can stop hospice and return to treatment aimed at cure, and come back later if you are eligible.
- Hospice is not a place. Most hospice care happens at home, or wherever you live.
- Some people live longer than six months on hospice. They can keep receiving it as long as a hospice doctor recertifies that they are eligible.
- Choosing hospice does not make death come sooner. In one large study of Medicare patients with cancer or heart failure, people who chose hospice lived as long as similar patients who didn’t, and with some illnesses, longer. No study can promise that for any one person, but choosing comfort is not choosing to die sooner.
- Nothing about palliative care or hospice means care stops. What changes is what the care is for.
Questions you can ask your care team
- “Could a palliative care team help us right now?”
- “Is this a time to think about hospice? What would change if we did?”
- “What do you expect would happen with more treatment? And without it?”
- “Who do we call at night if symptoms get worse?”
To find palliative care or hospice near you, see GetPalliativeCare.org.
If you remember one thing, let it be this: you never have to choose between being treated and being cared for. Palliative care is how medicine makes room for both.
This is general information to help you ask good questions. It isn’t medical advice for your situation; please talk with your own care team.
Sources
- What is palliative care? and insurance coverage, GetPalliativeCare.org (Center to Advance Palliative Care)
- Hospice care coverage, Medicare.gov
- Temel et al., Early palliative care for patients with metastatic non–small-cell lung cancer, New England Journal of Medicine, 2010
- Connor et al., Comparing hospice and nonhospice patient survival among patients who die within a three-year window, Journal of Pain and Symptom Management, 2007