Differentiating Palliative vs. Hospice Care

Primary Objective To effectively manage symptomatic advanced conditions by reducing disease exacerbation, hospitalization and maintain physical functioning
Goal Engage in Life
To provide comfort of pain and symptoms associated with a terminal condition and provide support until death
Goal Comfortable Death
Prognosis Initiate palliative care with a diagnosis of a non-reversable condition (e.g., heart failure, chronic obstructive pulmonary disease, chronic kidney disease etc.)

Debilitated not Terminal/Dying

Admission into hospice requires provider referral with a 6 month or less prognosis
Terminally Ill and Dying
Origin Palliative care originated by medicine with a focus on the clinical aspects of disease and symptom management – research based
Hospice care originated by social work and nursing with a focus on pain relief and comfort until death
Social Work/Nursing
Reimbursement Routine reimbursement from third party payers, Medicare, Medicaid on underlying conditions and associated symptoms. Fee for service
Bill Routine CPT/ ICD-10 Codes
Hospice care Benefit from third party payers, Medicare, and Medicaid. Capitated daily reimbursement based on geographical cost of living
Capitated Daily Fee
Care Limitations No restrictions or limitations on the clinical management of patient needs. Appropriate referrals, diagnostics, and pharmacological and nonpharmacological interventions based on patients’ underlying etiology
No Limitations or Restrictions
Discontinuation of routine medications not covered by hospice benefit. Limited access and utilization of clinic or hospital. Patient receives medication box of opioid, benzodiazepines, anticholinergics etc.
Medication/Care Access Limited
Disease Trajectory Palliative care initiation at onset of an advanced chronic or malignant condition. No prognostication. Focus on symptom management. Palliative interventions intensify as the patient approaches death and appropriate referral to hospice team
Earlier Access > 6 Months
Hospice care initiation occurs at the end-of-life. Average length of stay in US hospice care is 77 days
Limited Care < 6 Months
Multidisciplinary Palliative care recognizes the complex care of the patient and family and utilizes an interdisciplinary team to address these needs:
Utilization of Healthcare Team
Hospice care team is employed at the onset of patient admission into services.
Full Hospice Care Team
Clinical Practice Guidelines Majority of guidelines are for cancer and come from different countries (UK, Canada etc.).

Medical societies and associations offer guidelines on symptom management. CDC 2016 pain management guidelines are currently under revision
International Guidelines/US Medical Associations, CDC

2018 Clinical Practice Guidelines for Quality Palliative Care 4th edition- National Coalition for Hospice and Palliative Care. No clinical management on symptoms. Provides the nurse with comfort and communication guidance
Guidelines Do Not Include Clinical Symptom Management