A serious health issue often brings difficult choices for the patient and their loved ones about treatment, comfort, and quality of life. Two terms that families frequently encounter in such situations are palliative care and hospice care.

These care services can share some common goals, however palliative care and hospice care are used at different points in the illness journey. Knowing the similarities and differences between these two types of care services can help older adults and their loved ones make more informed, confident decisions.

What is palliative care?

Palliative care is a specialized approach that focuses on improving quality of life for people with serious or chronic illnesses. It can begin at any stage of illness, not just near the end of life, and may be provided alongside treatments intended to cure or slow a disease, illness, or injury. The goal is to ease symptoms such as pain, shortness of breath, fatigue, or nausea, while also addressing emotional, social, and spiritual needs.

Services that fall under palliative care are often delivered by a team of providers that may include doctors, nurses, therapists, social workers, and spiritual counselors. These specialized providers work together to coordinate treatment and help patients make decisions aligned with their values while also supporting caregivers.

Palliative care can be provided in numerous settings including hospitals, outpatient clinics, nursing homes, assisted living communities, or in a person’s own home. Insurance and Medicare often cover certain palliative care services, though coverage can vary, so always check on the terms of your specific plan.

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What is hospice care?

Hospice care is often considered a subtype of palliative care specifically for people in the final phase of life, usually when life expectancy is six months or less. At this stage, the focus of care fully shifts from curative treatment to comfort, dignity, and support. Members of the hospice team provide solutions for symptom relief, emotional and spiritual care, and extensive support for families, including bereavement services.

Hospice services can be provided in a person’s home, as well as in nursing facilities, hospitals, or free-standing hospice houses. Levels of hospice care range from routine home visits to full-time inpatient care during a symptom crisis.

Under Medicare Part A’s hospice benefit, most hospice services, including medications and equipment related to the terminal illness, are covered with little or no out-of-pocket costs. Certain criteria do apply, such as receiving care from a Medicare-certified hospice, so always verify your policy’s terms and conditions.

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How are palliative care and hospice care similar?

There are certain similarities between palliative care and hospice care. Both share a philosophy of patient comfort and quality of life. They also are both team-based, holistic approaches that address not only physical symptoms but also emotional, social, and spiritual needs.

Furthermore, both types of care involve patients and their loved ones in decision-making and provide support to caregivers. But it’s important to understand: While all hospice care is palliative, not all palliative care is hospice.

How palliative care and hospice care differ

Despite their overlap, important distinctions exist between palliative care and hospice care. (This chart from the Hospice Foundation can be a helpful visual to understand these key differences.)

Timing

Palliative care can start at any stage of serious illness, whether newly diagnosed or many years into the disease. Palliative care services are even an option while treatments aimed at slowing or curing the condition continue.

In contrast, hospice care is generally reserved for those approaching the end of life. Usually, hospice is for those with a life expectancy of six months or less, as determined by a physician, and is most often started when treatments aimed at curing the disease are no longer effective or desired.

Treatment approach

Another key difference lies in the role of curative or disease-modifying treatments. Palliative care can be offered alongside aggressive treatments such as chemotherapy, dialysis, or surgery. Patients don’t need to give up these interventions to receive palliative care.

Hospice, on the other hand, usually requires that patients stop treatments intended to cure the illness. Instead, the emphasis shifts completely to comfort, dignity, and symptom relief.

Duration

Time limitations also distinguish palliative care from hospice care. Palliative care is not time-limited; it can be provided for months or even years depending on the patient’s needs and illness trajectory. Also, palliative care can be adjusted as the illness evolves. Patients may start, pause, or intensify services as needed.

Hospice, however, is tied to a terminal prognosis. Although patients can remain in hospice longer if their condition declines more slowly than expected, hospice care is specifically designed for those nearing the end of life. Hospice is therefore less flexible, since it represents a clear shift away from curative treatment. That said, a patient may choose to leave hospice at any time if they change their mind and want to resume curative therapies.

Intensity of care

There is another key difference between palliative and hospice care with regard to the levels and intensity of care provided. Palliative care is often consultative, meaning it is integrated into a patient’s broader medical care plan.

Hospice, however, offers several defined levels of care services depending on the patient’s unique needs. These range from routine care-at-home visits to around-the-clock care or inpatient hospice during a symptom crisis or when more intensive support is required.

Insurance coverage and costs

The way each type of care is covered and/or paid for can also be quite different. Palliative care coverage depends on the type of insurance or Medicare plan the patient has, and co-pays or limits may be applied, resulting in potential out-of-pocket expenses.

Hospice care, by contrast, is usually fully covered under Medicare Part A (again, if certain criteria are met) and other insurance plans (but always check on your plan’s specific terms). It also often requires little to no out-of-pocket costs, as it includes medications, equipment, and services related to the terminal illness.

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Making care decisions

Deciding whether to pursue palliative care or hospice care depends on several factors including:

  • The stage and/or severity of illness
  • Treatment goals
  • Personal values

For many patients, palliative care begins when symptoms become difficult to manage with the standard treatment approach. For example, a person with heart failure who retains fluid despite medications, or someone with cancer suffering side effects from chemotherapy, may be referred by their doctor for a consultation with the palliative care team.

Over time, as a disease advances, the same patient may reach a point where further curative treatments or interventions no longer yield benefit, or where the burden of treatment outweighs the benefits. At that juncture, healthcare providers, the patient, and their loved ones may begin conversations about whether initiating hospice care is appropriate.

The decision to begin hospice involves evaluating prognosis, treatment burden, symptom burden, patient preferences, and goals of care, ideally in shared decision-making among the patient, family, and clinicians.

Patients and their loved ones should ask the patient’s healthcare providers about these options early, rather than waiting for a care or symptom crisis. Clarifying what matters most … comfort, independence, staying at home, or avoiding hospitalization … can help guide the right care choice.

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Considerations for palliative or hospice care transitions

As you can see, it is common for patients to “graduate” from palliative care to hospice care, however this will not always be the case. Some people will only use one or the other.  In an ideal scenario, palliative care is introduced early and, if warranted and desired, seamlessly transitions into hospice care when the time comes.

Here are some helpful points to consider when weighing palliative care and/or hospice care transitions for yourself or a loved one.

  • Ask early: Don’t wait until a crisis to ask about palliative care and/or hospice care. Many patients could benefit sooner.
  • Clarify goals: Care decisions should be guided by what matters most to the patient and their loved ones: comfort, staying home, avoiding hospital, and/or maximizing independence.
  • Talk to your physician or specialist: Talk to the patient’s healthcare providers to learn about palliative care options and discuss at what point hospice should be considered.
  • Check insurance/Medicare coverage: Understand exactly what the patient’s Medicare plan, supplemental insurance, and/or Medicaid covers with regard to palliative and/or hospice care (especially medications, home care, and equipment) … and for how long.
  • Be flexible and revisit choices: Bear in mind: If the patient’s condition changes, preferences may change too. Flexibility is a key aspect of both palliative care and hospice care.
  • Caregiver support also matters: Choose care models and providers that include help for caregivers such as respite care, counseling support, and caregiving training.
  • Plan ahead: Advance planning, such as creating a living will and health care proxy, and making end-of-life wishes known, is always easier when you have time, as opposed to during a time of crisis.
  • Evaluate hospice providers. Not all hospice agencies and providers are equal. Ask about staff ratios, responsiveness, crisis care, reputation, and services. And if you have Medicare, verify the provider is Medicare-certified.
  • Understand that entering hospice is not “giving up”: Many find great relief and dignity in shifting to comfort care and focusing on relationships in end-of-life situations.

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Finding the right care solution

In short, palliative care and hospice care both aim to relieve suffering and improve quality of life. While palliative care can begin at any stage and may accompany ongoing treatments, hospice focuses specifically on the final months of life when comfort is the priority.

Both types of care can bring substantial benefit, but each has tradeoffs and ideal timing as well. Knowing these distinctions can empower older adults and their loved ones to seek the right kind of support at the right time. 

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