1 The Difference Between Hospice and Palliative Care Hospice care has evolved over the past several decades and has always incorporated palliative care interventions. However, palliative care has taken on its own identity in American health care and is considered a specialty separate from hospice care. Although these two types of care are closely related, they are not the same. This chapter reviews the similarities and differences between hospice and palliative care. After reading this chapter, you will be able to: ■ Specify how hospice and palliative care differ ■ Identify unique features of hospice care and palliative care ■ Discuss hospice and palliative care as unique but interrelated specialty areas HOSPICE CARE Hospice care is widely recognized as a type of specialized care for terminally ill patients and their families that primarily takes place in the home (Coyle, 2015). By definition, hospice care is aimed at providing symptom management for patients with terminal illnesses and support for their families (Lanken et al., 2008). In hospice settings, the patient and family are considered to be the unit of care. Hospice care can be delivered in the patient’s home, an inpatient hospice unit, a long-term care facility, or other settings. So, actually, the location of care is not what defines hospice care. Rather, according to Coyle (2015), hospice care incorporates the following: ■ The care is specifically tailored to terminally ill patients. ■ Hospice patients no longer receive curative treatments. ■ Hospice patients can receive the Medicare hospice benefit. ■ End-of-life concerns are addressed in a holistic manner. ■ Patients receive skilled palliative care interventions. ■ Care is provided mainly in the home. Fast Facts in a Nutshell Resources for the hospice and palliative nurse include: ■ American Nurses Association ■ End-of-Life Nursing Education Consortium ■ Hospice and Palliative Credentialing Center ■ Hospice and Palliative Nurses Association ■ National Hospice and Palliative Care Organization ■ The City of Hope CHARACTERISTICS OF HOSPICE CARE Hospice care is associated with terminality and there is often fear on the part of patients and families when the term is used. According to Hui et al. (2013), key concepts related to hospice include: ■ Emphasis on symptom management ■ Interprofessional care ■ Caregiver involvement ■ Bereavement services ■ Six-month life expectancy ■ Criteria-based determination of terminality/eligibility for hospice services ■ Community-based care ■ Availability of hospice inpatient services ■ Availability of hospice volunteer and aide services END-OF-LIFE PROTOCOLS Hospice care, because it is specialized for end-of-life needs, involves certain specialized skills that pertain only to end-of-life situations. For example, several organizations have published position statements on end-of-life procedures such as withdrawal of mechanical ventilation (Lanken et al., 2008), the use of opioids at the end of life (Hospice and Palliative Nurses Association, 2004), and automatic implantable cardioverter-defibrillators (National Hospice and Palliative Care Organization, 2008). Protocols such as these underscore the unique skill-set of hospice nurses in ensuring comfort in the last moments of a patient’s life. Several resources for end-of-life protocols and position statements include: ■ The Hastings Center Guidelines (Berlinger, Jennings, & Wolf, 2013) ■ National Hospice and Palliative Care Organization ■ Hospice and Palliative Nurses Association ■ American Nurses Association BEREAVEMENT CARE
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