Palliative care is extra support for anyone with a serious illness, at any stage, and your parent can get it while still receiving treatment to cure or control the disease. Hospice is a specific kind of palliative care for the last months of life, when the focus shifts fully to comfort and away from cure. They are paid for differently, too: palliative care is billed like other medical care, with the usual copays, while Medicare's hospice benefit covers nearly everything related to the terminal illness.
What palliative care is
The National Institute on Aging describes palliative care as care focused on improving quality of life for people with serious illnesses and for the people caring for them. It can start at diagnosis. It is not only for people who are dying, and asking for it does not mean anyone has given up.
A palliative care team treats pain, nausea, breathlessness, fatigue, anxiety and the stress that comes with a serious illness. According to the National Institute of Nursing Research, the team usually includes doctors, nurses, social workers, spiritual advisors, pharmacists, nutritionists and counselors. It works alongside your parent's regular doctors rather than replacing them, and it helps coordinate care across the hospital, nursing facility and home.
Where palliative care happens
NIA lists hospitals, nursing homes, outpatient palliative care clinics, other specialty clinics and the home. Not every area has every type of program, so ask the doctor or hospital what is available near your parent.
What hospice is
Hospice is palliative care for the final stretch of life. Under Medicare, your parent qualifies when their hospice doctor and regular doctor certify a life expectancy of six months or less if the illness runs its usual course, and your parent chooses comfort care instead of treatment aimed at curing the illness.
The hospice team includes doctors, nurses, aides, social workers, spiritual counselors and trained volunteers. Someone from the hospice is reachable by phone around the clock, and a team member visits regularly. NIA notes that at home, family and friends usually provide most of the day-to-day care, with the hospice team supporting them.
Hospice can be provided at home, in assisted living, in a nursing home, in a hospital or in a hospice facility.
The key differences
- Who it is for. Palliative care: anyone with a serious illness. Hospice: someone whose doctors expect them to live about six months or less.
- Treatment. Palliative care can go alongside treatment meant to cure or control the illness. Under Medicare's hospice benefit, your parent gives up treatment meant to cure the terminal illness.
- How long it lasts. Palliative care lasts as long as it helps. Medicare hospice covers two 90-day periods, then unlimited 60-day periods, as long as a hospice doctor keeps recertifying that your parent is terminally ill.
- How it is paid. Palliative care is billed visit by visit with normal cost-sharing. Hospice is a bundled Medicare benefit with very small copays.
- Extras for the family. Hospice includes respite care for caregivers and grief counseling for the family. Palliative programs vary in what family support they offer.
Can your parent switch from one to the other?
Yes. A parent can get palliative care while treatment continues, then move to hospice if treatment stops helping or becomes too hard to bear. Hospice is not a one-way door either: NIA notes that people can leave hospice and come back later if they still qualify, and Medicare.gov says your parent can stop hospice at any time.
Who pays for each
Paying for palliative care
There is no separate "palliative care benefit" in Medicare. The Center to Advance Palliative Care (CAPC) explains that Medicare and Medicaid don't use the word "palliative," but they pay for the same services. Under Medicare Part B, Medicaid or private insurance, your parent can see a palliative care team in an office, a nursing facility or at home, and their insurance covers it with normal cost-sharing, such as deductibles and copays.
CAPC suggests asking the palliative care team or calling the health plan to learn what is covered now and later. Veterans may be eligible for palliative care through the VA, according to NIA.
Paying for hospice
Medicare Part A pays for hospice from a Medicare-approved hospice. Under Original Medicare, your parent pays:
- $0 for hospice care, with no deductible
- Up to $5 per prescription for outpatient drugs for pain and symptoms
- 5% of the Medicare-approved amount for inpatient respite care
Medicare does not pay room and board, so a parent who lives in assisted living or a nursing home still owes that monthly bill. Medicaid hospice is optional for states, according to Medicaid.gov, so coverage for a parent on Medicaid alone depends on the state. Private insurance coverage depends on the plan.
When to ask about palliative care
You do not need to wait for a crisis. The National Institute of Nursing Research says it is never too early to start, and suggests considering it when your parent has:
- Pain or other symptoms from any serious illness
- Physical or emotional distress that isn't under control
- Trouble understanding the illness and the treatment choices
Palliative care doesn't depend on whether the illness can be cured, NINR notes, so a parent can ask for it during active treatment.
To get it, ask your parent's doctor for a palliative care referral. If the doctor doesn't suggest it, you can request it. NINR notes that most clinicians welcome the extra support, and your parent does not have to give up their current doctor.
When to ask about hospice
Ask about hospice when treatment is no longer working, when your parent decides the side effects aren't worth it, or when the doctor says the illness is likely to progress over the coming months. NIA notes that people sometimes start hospice too late to get its full benefit, so it is worth raising the question earlier rather than later.
One plain question to the doctor can open the door: "Would you be surprised if my mother died in the next six months?" The answer tells you a lot.
Questions to ask the doctor
- Is my parent eligible for palliative care now? For hospice?
- What would each one add to the care they get today?
- Which treatments would continue, and which would stop?
- What will Medicare or their insurance cover?
- Who should we call for help at night or on weekends?
Practical next steps
- Ask for a palliative care consult at your parent's next appointment or hospital stay if they have a serious illness and symptoms are hard to manage.
- Talk about goals early. What matters most to your parent: more time, staying at home, avoiding the hospital, being comfortable? Write it down in an advance directive. Our documents checklist covers what to have on file.
- Compare hospices before you need one. You can find a hospice and check each one's CMS family survey star rating, so the family isn't choosing in a rush.
- If your parent lives in a community, ask how it works with outside palliative and hospice teams. You can search communities and nursing homes to check their inspection records too.
- Get help coordinating from afar. An aging life care manager can attend appointments, push for a palliative referral and keep siblings in the loop. Find a care manager.
This guide is general information, not medical advice. Talk with your parent's doctors about their situation.
