January 19, 2019
Senior woman in a hospice care talking to her doctor at home.

Hospice and Palliative Care: What's the Difference?

by Keng Lam, MD  

Q: Are hospice and palliative care the same thing?

A: No, but hospice is one of a variety of types of palliative care, which we wrote about last month. Whereas anyone with a serious illness is a candidate for palliative care (and can get it in tandem with any medical treatments they are pursuing), hospice is designed for people who are expected to die within six months due to a terminal illness, and who are opting to not pursue further medical treatment.

The term “hospice”—which has the same linguistic root as “hospitality”— originally referred to a rest house for travelers seeking food and comfort, especially the houses of refuge and shelter kept by monks in the French Alps in the 19th century, and later evolved to refer to a home for elderly and terminally ill people. The modern-day iteration of hospice in health care dates back to the 1960s, when St. Christopher’s Hospice opened in London. The first facility of its kind, it was dedicated to providing symptomatic relief to all dying patients and to caring holistically for their physical, spiritual, and psychological well-being. The first hospice in the United States, Connecticut Hospice, followed shortly after in 1974. (Both centers are still operating today.)

As with all palliative care, hospice focuses on making the patient more comfortable and maximizing the quality of their remaining life. That includes addressing symptoms that they may be experiencing, such as pain, nausea, and severe dry mouth, as well as tending to their emotional, social, and spiritual needs—and those of their caregivers—as they near the end of life. A hospice care team is generally made up of doctors, nurses, social workers, and clergy members.

A cornerstone of hospice is that it often gives a patient the option of dying comfortably at home (or in some cases, a nursing home or assisted-living facility) rather than in a hospital, as a majority of Americans currently do. Evidence suggests that this has benefits not only for the patient but also for their caregivers. For example, in a study of 342 advanced cancer patients and their caregivers, published in the Journal of Clinical Oncology, those patients who died in an intensive care unit (ICU) or elsewhere in a hospital had more physical and emotional distress and lower quality of life scores at the end of life compared with those who died at home with hospice.

The study also found that the caregivers of patients who died in the hospital or ICU were more likely to experience psychiatric illnesses, such as post-traumatic stress disorder, in the six months following the death compared with caregivers whose loved ones died with home hospice.

A person’s prognosis isn’t always ironclad, of course, and in some cases a patient on hospice care ends up living beyond the expected six months. If that occurs, the hospice team can simply recertify for additional time or, if the person is showing significant improvement, be discharged from service.

To learn more about hospice care, visit HospiceFoundation.org.

Also see Dying in America.