Palliative Care or Hospice: What Is the Difference?

Palliative care or hospice: palliative care is extra support for symptoms and stress that can begin at any stage of a serious illness, alongside treatment meant to control or cure the disease. Hospice is a form of comfort-focused care for people who are expected to be near the end of life and who choose to stop disease-directed treatment. This article explains who qualifies, where each is delivered, what changes, and which symptoms need urgent help.

Palliative care or hospice: the short version

The two terms are often used as if they were the same thing, and that confusion keeps many families from asking for help sooner. They overlap in goals, but they differ in timing and in what happens to the treatment of the illness itself.

According to MedlinePlus (NIH), palliative care is care that aims to improve quality of life for people with serious illness by relieving symptoms and stress. It can be given at the same time as treatments meant to treat the disease. MedlinePlus describes hospice care as end-of-life care focused on comfort, for people who are not expected to benefit from further treatment of the illness.

A simple way to think about it: palliative care is an added layer of support that can be present for months or years. Hospice is a specific type of palliative approach, used when the focus has shifted fully to comfort and time.

Side-by-side comparison

Programs differ in what they offer, so use the table as a general guide and confirm details with the specific program.

What palliative care looks like in daily life

Palliative care is not limited to cancer. It is used for heart failure, chronic lung disease, kidney disease, dementia, Parkinson disease, and other serious conditions. The team works alongside your regular specialists rather than replacing them.

Common things a palliative team helps with include:

• Pain and other symptoms such as breathlessness, nausea, constipation, poor sleep, fatigue, and loss of appetite.
• Emotional strain, including anxiety, low mood, and fear about what is ahead.
• Decision support, such as what matters most to you, how much treatment you want, and what trade-offs you are willing to accept.
• Coordination between specialists who may give different advice, and help with insurance and home needs.
• Family and caregiver support, which can lighten the load on the people closest to you.

Medicines for pain or breathlessness, including opioids, carry label cautions about side effects such as drowsiness and constipation. Take them as prescribed and ask the prescriber or pharmacist before changing timing or amounts. Your team can adjust the plan if the medicine is not working or is causing problems.

Asking for palliative care does not mean giving up. Many people with a serious illness use it while they continue active treatment, and it may help them tolerate that treatment better, though results differ from person to person.

What hospice care includes

Hospice is a package of care built around comfort. A hospice team typically includes a physician, nurses, home health aides, social workers, chaplains or spiritual counselors, and trained volunteers. Many hospices offer a 24-hour phone line so a nurse can advise when symptoms change at night or on a weekend.

Typical hospice services include:

• Medicines and approaches to control pain, breathlessness, anxiety, nausea, and agitation.
• Medical equipment such as a hospital bed, oxygen, or a commode, depending on the plan.
• Nursing visits at home, with aides for bathing and personal care.
• Counseling and spiritual support for the person and the family.
• Short-term respite care, which may give a caregiver a break.
• Grief support for the family after a death.

Hospice delirium, meaning sudden confusion and restlessness near the end of life, is an area where hospice teams work to match care to guidelines, and research has looked at the barriers they face in doing so. If you notice new confusion in a loved one, tell the hospice team. For background on how delirium differs from dementia, see our separate article on that topic.

Who qualifies, and who decides

Palliative care generally has no fixed prognosis requirement. A referral from your doctor is common, but you can usually ask your clinician about it directly.

Hospice has eligibility rules. In the United States, insurers including Medicare typically require that clinicians certify that the illness is likely to be life-limiting, and the person elects hospice instead of treatments aimed at the illness. Predicting how long someone will live is difficult, and estimates can be wrong in both directions. Some people live longer than expected on hospice. Ask the hospice and your insurer how their rules apply to your situation.

Choosing hospice is not always permanent. Patients can generally leave hospice if their condition changes or they decide they want treatment again, and research has examined how often disenrollment and hospital stays happen among hospice patients. Ask the hospice what leaving and re-enrolling would involve.

Where care happens and who pays

Hospice is most often provided in the person's home, wherever that is: a house, an apartment, an assisted living community, or a nursing home. Some communities also have a dedicated hospice facility. Hospital-based palliative teams visit people during a stay, and many health systems also run outpatient palliative clinics.

Coverage differs. Medicare, Medicaid, and many private plans cover hospice, though specifics vary by plan. Palliative care visits are often billed like other medical visits, so copays and deductibles may apply. A social worker at the hospital or hospice can help you sort this out before you commit.

Choosing a hospice or palliative program

Programs differ. A national survey of hospices described variation in services and community engagement that was associated with factors such as ownership status. That does not make one type of hospice better or worse, but it is a reason to compare options.

Questions that may help you compare:

• How quickly can a nurse come to the home when symptoms change, including at night?
• Which medicines, equipment, and therapies are covered under the plan?
• How often will nurses, aides, and social workers visit?
• What happens if the person does better, or wants to try treatment again?
• What support is offered to the family, and for how long after a death?

Children can receive palliative and hospice care too. Pediatric programs are organized in different ways, and some children's hospices offer a wide range of services. Families can ask the child's specialist team about local options.

When families should start the conversation

Many clinicians suggest raising palliative care earlier rather than later. Signs that it may be worth asking include repeated hospital stays, symptoms that stay hard to control, a decline in function or weight, or a person or family feeling overwhelmed by choices.

Appetite changes are common in serious illness and in later life, and our article on losing appetite with age covers that topic. In advanced illness, a smaller appetite can be part of the disease, and a care team can discuss comfort-focused approaches to eating.

Frailty is another situation where palliative support may be appropriate, as covered in our article on frailty. A conversation about goals, including what the person fears and what they hope for, can be done before any crisis.

Put wishes in writing. An advance directive, discussed in our article on that subject, records your preferences if you cannot speak for yourself. Tell your family and clinicians where it is kept.

For families caring for someone with dementia, MedlinePlus has a page of resources for Alzheimer's caregivers. Its end of life issues page gathers guidance on planning and what to expect.

Warning signs that need urgent attention

Being enrolled in palliative care or hospice changes who you call first. If the person is on hospice and wants comfort-focused care, call the hospice 24-hour line before 911 for worsening symptoms, so the team can respond in line with the person's wishes. Calling 911 may lead to treatments the person did not want, though that decision belongs to the person and family.

If the person is not on hospice, or still wants full treatment, certain situations call for 911 at once. These include stroke signs such as face drooping, arm weakness, or slurred speech; severe chest pain or severe trouble breathing; being unresponsive or not breathing; and a possible medicine overdose or poisoning (Poison Control is 1-800-222-1222). Thoughts of suicide with a plan or intent need the 988 Suicide and Crisis Lifeline, or 911 if there is immediate danger.

Uncontrolled pain, new confusion, trouble eating or drinking, and caregiver exhaustion deserve a same-day call to the care team. See the emergency box below for the full lists.

Caring for the caregiver

Family caregivers often carry much of the daily work, and exhaustion is common. Both palliative and hospice teams can offer social work, counseling, and respite options. If you are the caregiver, tell the team how you are doing, not only how the patient is. Support for the caregiver can help the patient too.

When to Seek Medical Care