Palliative Care vs. Hospice

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It is hard to face the possibility of a serious illness befalling ourselves or our loved ones. Even harder is facing the reality of a dear family member or friend’s death, to say nothing of our own. The thought of our own mortality and that of those we hold dear is painful, to say the least, and might even feel taboo to “plan for.” However, becoming aware of the healthcare support available to individuals fighting serious illnesses, as well as those at the end of life, may provide comfort and peace of mind in simply knowing that these resources are available for if and when they are needed.

Palliative care is available to individuals facing life-threatening illnesses, whereas hospice is most commonly offered to patients who are terminally ill and facing the end of their life. The services available through palliative care and hospice include tending to the physical, emotional, and spiritual wellbeing of the patient, and those in the caregiving role, whether family members, close friends, or other such individuals.

Though similar, palliative care and hospice differ in the kinds of patients they serve and the purpose of the care. While both seek to provide comfort to the patient by alleviating pain and other symptoms, palliative care is offered at the same time as curative measures and treatment are being administered. Hospice is most commonly sought for patients in the last six months of their lives, for whom curative measures and treatments are no longer effective in slowing or curing their disease.

Palliative Care Hospice Care

What is the Service?

Palliative care is medical care for individuals dealing with a life-threatening illness or condition. The focus of palliative care is relief of symptoms and stress for patients undergoing treatment for serious diseases. Hospice is a form of comprehensive end-of-life care. It is offered to individuals who are terminally ill, whose illnesses are not responding to medical treatments aimed to cure or slow a disease’s progression. The goal of hospice care is to enable a patient to be as comfortable as possible during the last six months of life.

Whom Does it Serve?

Palliative care is for patients battling serious illness, their family members, and caregivers. Hospice is for individuals dealing with terminal illness, their family members, and caregivers.

How Does it Benefit Individuals and Families?

Palliative care provides an additional level of support to severely ill patients and their families. This comes in the form of providing medical information as well as social and emotional support, and decision-making assistance.

Palliative care can be provided for patients of any age, at any stage of an illness, and in a variety of settings: at home or in hospitals, outpatient and specialized clinics, and nursing homes/assisted living facilities. It can be offered as a complement to curative treatment.

The goal of palliative care is to improve the quality of life for patients and families affected by serious illnesses like cancer, kidney disease, congestive heart failure (CHF), amyotrophic lateral sclerosis (ALS), Alzheimer’s, Parkinson’s, and chronic obstructive pulmonary disease (COPD).

Palliative care addresses any symptoms affecting the quality of life of the patient from pain, shortness of breath, constipation, nausea, and loss of appetite, to depression, anxiety, fatigue, and sleep difficulties. Palliative care professionals may educate patients and families on how to manage these symptoms.

Palliative care staff members also assist in the coordination of a patient’s care. They serve as a liaison between patients and their team of doctors and play a role in patient advocacy. They support patients and families in understanding the illness, the treatment options available, and the choices that may need to be made. They spend time talking with and listening to patients and family members and ensuring that they understand the treatment options available. They help patients choose those options that best support their personal goals.

The goal of hospice is to provide comfort care to the individual who is dying. This care is focused entirely on the quality of the person’s life over the course of their remaining days. This entails providing relief from discomfort, such as pain and shortness of breath.

Hospice care can be provided for patients in a variety of settings: at home or in hospitals, long-term care facilities, nursing homes or assisted living facilities, and designated hospice centers.

Four levels of care are offered by hospice. The most common type is routine home care, which includes nursing and home health aide services and nursing.

Continuous home care is utilized by patients in crisis who need around-the-clock care.

When a patient’s pain and symptoms cannot be managed outside of a hospital setting, general inpatient care is arranged.

Respite care provides short-term care to terminal patients in a facility when caregivers need a break from their role.

In addition to meeting the physical, emotional, and spiritual needs of the terminally ill patient, hospice workers support family members through counseling and, in some cases, assistance with household chores and shopping.

Regular visits by hospice professionals are scheduled according to the needs of the patient and family. Support is available by phone 24/7 as well.

What Kinds of Professionals Work in this Field?

Palliative care is administered by a team of multidisciplinary professionals. In addition to palliative care specialist doctors and nurses, other professionals that may serve on a palliative care team include nutritionists, social workers, and chaplains. Palliative care teams work together to coordinate the care of the severely ill person and support and education those caring for their loved one.

Palliative care specialists approach each patient’s care with regards to the following issues: physical symptoms, emotional needs/coping, spiritual beliefs, caregiver and practical needs. They address the physical symptoms a patient is experiencing as well as the emotions that may present due to the illness and other factors. Palliative specialists may support patients and families in exploring spiritual beliefs and values that may be supportive to them through this time. They may also attend to the needs of caregivers with regards to stress and the complexity of issues patients and caregivers may face while caring for their loved one, such as financial or legal matters, questions about insurance, employment issues, advanced directives, and communication with members of the medical team and other family members.

Patients in palliative care may also choose alternative and complementary care in addition to the medical treatment they are undergoing. Such approaches may include massage, aromatherapy, energy work, music therapy, and acupuncture, among others.

Hospice care is administered by a multidisciplinary team of doctors, nurses, social workers, home health aides, spiritual advisors, and trained volunteers. These professionals work together to keep the person who is dying as comfortable as possible and support those caring for their loved one.

Hospice teams create personalized care plans along with patients and caregivers, focusing on comfort, the easing of pain and distressing symptoms. Hospice doctors provide medical care and nurses visit to check vital signs, as well as administer or order medicine, medical equipment, and supplies.

Home health aides provide personal care to the patient such as bathing and dressing, and in some cases to caregivers by cooking and cleaning. Other services available are physical and speech therapy, advice on eating, counseling and spiritual (chaplain) services for patients and loved ones, and the support of a social worker.

Some patients may choose alternative or complementary care methods in addition to the conventional care they are receiving at the end of their lives.

Such approaches may include massage, aromatherapy, energy work, music therapy, and acupuncture, among others.

Educational Preparation

Professionals wishing to work in palliative care must first earn a degree in their area of interest. For example, doctors, nurses, and social workers, first complete the requisite education in their respective field (MD, ADN/BSN/MSN/DNP, or BS/MS/PhD). Then, additional education in the form of continuing education or an advanced degree, certification and/or practical experience in the palliative care specialty area can be sought.

Nurses wishing to specialize in palliative care are required to have either an associate’s degree in nursing (ADN) or a bachelor’s in nursing (BSN) degree and are required to pass the NCLEX-RN exam. Some settings accept the LVN/LPN credential as well.

In this regard, the information for palliative and hospice care are the same. Healthcare professionals that have obtained the necessary education, licensing, and certification in their respective fields may then seek additional education and certification in the hospice specialization.

Sample Academic Programs

The University of Maryland‘s Graduate School offers a 30-credit online master of science in palliative care.

The University of Colorado, Denver has a 36-credit online master of science (MS) in palliative care and a 12-credit interprofessional palliative care certificate.

The University of Colorado and Coursera offer program entitled, Palliative Care: It’s Not Just Hospice Anymore.

Drexel University‘s College of Nursing and Health Professions offers a 12-credit online certificate of advanced study in holistic hospice and palliative care.

Madonna University has a 15-credit on-campus graduate certificate in hospice and palliative studies.

The Stanford eCampus provides free training for healthcare professionals in hospice and palliative medicine.

Other Resources

The California State University Institute for Palliative Care provides online training for all healthcare professionals.

The University of California, San Francisco School of Nursing offers a minor in palliative care for nurses in UCSF’s graduate programs as well as interprofessional continuing education in palliative care for healthcare professionals working with seriously ill patients.

Operational training is offered to palliative care programs through eight Palliative Care Leadership Centers around the United States.

The Center to Advance Palliative Care holds online courses for social workers, nurses, and doctors in both clinical and operational aspects of palliative care.

The Center for Palliative Care at Harvard Medical School offers training for physicians and nurses on clinical practice, teaching, and palliative program development.

eDoctoring offers an online palliative and end-of-life care training through five UC campuses comprising simulated case studies, interactive tutorials, and a virtual library resources for medical students, residents, and physicians.

The National Hospice and Palliative Care foundation offers a hospice manager development program and continuing education for nurses and social workers (14 contact-hours, respectively), and a trauma-informed end-of-life care workgroup.

The Center for Hospice Care of Southeast Connecticut offers education in the form of in-service programs, classes, and seminars for the public, professional caregivers, and skilled nursing facilities.

The Hospice and Palliative Credentialing Center (HPCC) offers five certification exams for nursing assistants, pediatric palliative nurses, registered nurses, advanced practice nurses, and individuals coping with perinatal loss. They also offer credentials in palliative care and hospice for licensed practical/vocational nurses and administrators.

The Hospice and Palliative Nurses Association provides e-learning courses for nurses on a variety of topics in both of these types of care. They also administer the Advanced Certified Hospice and Palliative Nurse (ACHPN®) exam for experienced advanced practice nurses (CNS or NP) with 500 hours of hospice and palliative nursing practice within the past 12 months (1,000 within the past two years).

The International Association for Hospice & Palliative Care has a wealth of resources, programs, projects and training, and travel opportunities for healthcare professionals interested in and involved in both types of care.