How you or a loved one want to live the last part of life is not easy to think about. Something to consider, though, is looking at palliative vs. hospice care and learning the differences to decide what is best for you or your loved one.
Palliative care is a holistic approach to care for people with serious illnesses. It offers support that focuses on relieving suffering so patients and their families can have the best quality of life possible.
“The biggest misconception about entering palliative care is that it means you’re dying, so you may as well give up,” said Dr. Katherine Winiarczyk, Marshfield Clinic Health System palliative medicine specialist. “That is not true. Our goal is to focus on how to help you live your best life while you continue to receive aggressive care to cure or treat your illness.”
When considering palliative vs. hospice care, it is important to understand the different parts. For instance, palliative medicine has two different components: inpatient and outpatient.
Inpatient palliative care
This care is for patients who have serious and potentially life-limiting illness. An interdisciplinary team provides this care and includes a physician and nurse practitioner, social worker and chaplain. Care begins at the discretion of the patient and physician and is typically given in a hospital setting.
“Patients in inpatient palliative care often have a drastic change in their care. This may be things like pain management or the current status of their health,” Dr. Winiarczyk said.
Outpatient palliative care
This care takes place outside of the hospital setting. It is led by a physician and nurse practitioner with access to a social worker, and it’s similar to that provided in the hospital.
Patients in outpatient palliative care are typically in a more stable condition and are just struggling to manage symptoms. Specialists may come into the home or patients may come into the hospital for adjustments to medications and to address needs and wishes.
Hospice is a type of care under the umbrella of palliative care. It is for patients with a terminal illness with a prognosis of less than six months to live. Treatment to cure or control disease has stopped. The focus is compassionate comfort care, typically in the home or facilities like assisted living or nursing homes.
Hospital care is no longer an option unless it’s needed to provide better symptom management and comfort due to failure of the plan at home.
Two physicians certify the patient’s life expectancy. A core team – a physician, nurse practitioner, hospice nurse, social worker and chaplain – oversees care, meeting every other week to review patients’ plans. Nurses’ aides help the patient with daily living tasks and volunteers help as needed. A hospice nurse is available 24/7 for problems that arise and makes regular home visits though frequency varies depending on care needs.
Pediatric palliative care
Children and youth under age 18 may benefit from pediatric palliative care as soon as a serious, life-limiting illness is diagnosed. A young patient can start with hospice care but, unlike adults, can continue to be hospitalized for treatment should they wish, even if they have a life expectancy of six months or less.
“We help patients have the best quality of life,” Dr. Winiarczyk said. “Palliative care for children often stems from parents not willing to give up but needing the support that hospice offers.”
“We try to coordinate it all, to make clear to patients and families about care plans and treatment options while weighing risks and benefits. We help them make the best decision aligning with their goals in life as closely as possible.”
One of the most important things that Dr. Winiarczyk would like patients to know is that palliative care and hospice do not have to be scary. People often have a fear of death, but these types of care do not mean the end. There is always more that we can do.
“We work hard to get the word out that palliative care is not a bad thing,” Dr. Winiarczyk said. “There are so many resources available to help patients and their families. Utilizing palliative care and hospice programs does not mean you are giving up, we are just approaching the illness from a new angle.”