What is the difference between hospice care and palliative care?
When most people hear the words “palliative care,” their next thought is hospice. While palliative care is a component of hospice, it is also a separate medical specialty of care that focuses on relieving the pain and distress of serious illnesses for those still seeking treatment.
In other words, some people can and do move on from palliative care.
In June, Cape Cod Healthcare began to reinvigorate their palliative care efforts done through the Visiting Nurse Association of Cape Cod. Meaghan Weymouth, RN, has been assigned to lead the new initiative. She recently explained the subsets of VNA home care and the difference between palliative care and hospice care, which people often confuse as the same thing.
“There’s the certified side, where you have a problem and we fix it or you stabilize and we discharge you because the goals were met,” she said. That option is not necessarily for those with chronic conditions, but it is used for patients who need things like wound care treatment.
“Then you’ve got palliative care,” Weymouth said. “That’s for patients who have a chronic condition. A good amount of the referrals right now are cancer patients. They’re going to chemotherapy and radiation and they need a little extra love and care. So, it’s my job as the palliative nurse to be the in-between when they are home and they are at their doctor’s getting treatment to advocate for them and to be the contact for them to stay out of the hospital and try to do symptom management as best as possible at home.”
When Hospice Comes Into Play
Some palliative care patients stabilize and then they no longer need homecare. Others with a terminal diagnosis transition to hospice care when the time is right. That occurs when further treatment is either no longer an option or no longer desired by the patient.
Once a person goes on hospice, they stop receiving treatments like chemotherapy, radiation or imaging. It is generally for people who have six months or less to live, and the goal is comfort care. At the end of six months, hospice can be recertified if their condition has continued to deteriorate, as has been the case of former President Jimmy Carter, who has been receiving hospice care since February 2023.
Being on hospice care doesn’t mean that the patient is denied treatment if they get an acute illness like pneumonia or a urinary tract infection. Patients can still access treatment if they need it, but most people don’t have to continue returning to the hospital. A lot of patients and their loved ones find this to be a huge relief.
“For both palliative and hospice, it’s switching the mindset to focus on quality of life and making every day the best day it possibly can be for their circumstances,” Weymouth said. “It’s really about having conversations about what the patient wants to do and what their goals are.”
More About Palliative
With palliative care, patients have multi-symptom health issues that need management. Weymouth assesses their condition and then sees what path their disease is taking. Her visits are longer than they would be for certified home nursing care, and there is a lot more education for both the patient and their family. She then helps them come up with a plan that will help manage their care so their life is as meaningful and comfortable as possible.
She also reports back to their physician with her recommendations, which helps patients get a more coordinated approach to their care. For example, if a patient started having numbness or pain in their feet, she would recommend that the doctor prescribe a nerve pain drug, like gabapentin.
If the patient can’t be stabilized and their health continues to decline, Weymouth makes a referral to hospice and requests a hospice informational session to help allay their fears about the next stage.
“When people hear the word 'hospice', they think we are giving up on them and that we’re just throwing in the towel, so I explain to them that’s not true at all. Hospice just has more tools in their bag to treat patients.”
For example, in palliative care, Weymouth is sometimes restricted when it comes to things like accessing medications in the off hours. Hospice patients can get emergency medications to treat their symptoms on the same day. They also have a “comfort kit” of anticipated medications right in their home.
“I do get some palliative care patients who stopped treatment but they are not ready for hospice,” she said. “They think hospice is the final thing and I explain to them that some patients graduate off hospice and that’s okay. They can come back recertified or they might even just discharge completely until they need us again because that can happen also.”
