When a parent has a serious illness, doctors may suggest palliative care or hospice, and families often wonder whether one is giving up. Neither is. Both aim to relieve pain and symptoms, support emotional and spiritual needs, and help the whole family. The real differences in hospice vs. palliative care are when they start, whether treatment continues, and how they are paid for1.
This guide compares the two side by side, explains what Medicare covers, and walks through how families decide. It also covers comfort care, a term you may hear in hospitals, and what changes when your parent lives in assisted living, memory care or a nursing home.
Hospice vs. palliative care at a glance
| Palliative care | Hospice care | |
|---|---|---|
| Who it is for | Anyone with a serious illness, at any stage | People with a terminal illness and a life expectancy of six months or less |
| Curative treatment | Continues alongside | Stops for the terminal illness; comfort care only |
| Who provides it | A palliative team, often based at a hospital or clinic | A Medicare-approved hospice team |
| Where | Hospital, clinic, home or care community | Usually home, assisted living or nursing home; sometimes an inpatient hospice |
| Medicare coverage | Part B and Part A, like other medical care, with usual cost-sharing | Part A hospice benefit; little or no cost for covered services |
| How long | As long as needed | Two 90-day periods, then unlimited 60-day periods with recertification |
Coverage summarized from Medicare.gov. Private insurance and Medicaid rules can differ.
A simple way to remember it: all hospice care is palliative, but not all palliative care is hospice12.
What is palliative care?
Palliative care is specialized medical care for people living with a serious illness such as heart failure, COPD, kidney disease, cancer, Parkinson's or dementia. For lung disease, see end-stage COPD. Its goal is to improve quality of life by treating pain, breathlessness, nausea, fatigue, anxiety and other symptoms, and by helping patients and families make decisions that match their goals1. For long-term pain, see chronic pain in the elderly.
A palliative team usually includes doctors, nurses, social workers and sometimes chaplains, working with your parent's regular doctors. Your parent can keep getting chemotherapy, dialysis, surgery or any other treatment while receiving palliative care2.
How palliative care is paid for
There is no separate Medicare palliative care benefit. Visits from palliative doctors and nurse practitioners are billed under Part B like other doctor visits, and hospital palliative consults fall under the hospital stay. Usual deductibles and coinsurance apply. Medicare Advantage plans, Medicaid and private insurers generally cover palliative services as medical care, sometimes with extra home-based programs.
How to get it
Ask your parent's doctor to arrange a palliative care consult. Many hospitals have an inpatient palliative team; outpatient clinics and home-based palliative programs are growing but are not available everywhere. Veterans can ask their VA care team, since the VA offers palliative care in all its settings3.
What is hospice care?
Hospice is end-of-life care for people whose illness can no longer be cured. The focus moves fully to comfort and quality of life, for the patient and the family4. Our guide to end-of-life signs in the elderly describes what families often see in the final months and days, and our guide to what hospice provides walks through the services, team and costs.
Who qualifies for Medicare hospice
- Terminal illness. The hospice doctor and your parent's regular doctor, if they have one, certify a life expectancy of six months or less if the illness runs its normal course4.
- Comfort care instead of a cure. Your parent accepts palliative care rather than treatment to cure the terminal illness and related conditions.
- A signed election. Your parent, or their legal representative, signs a hospice election statement choosing a hospice provider45.
Six months is an estimate, not a deadline. After the first two 90-day periods, hospice continues in 60-day periods for as long as the hospice doctor recertifies, after a face-to-face visit, that your parent is still terminally ill4.
What the hospice benefit covers
- Visits from nurses, a hospice doctor, aides, social workers and chaplains
- Medicines for pain and symptom control related to the terminal illness
- Medical equipment such as a hospital bed, wheelchair or oxygen, and supplies
- Short-term inpatient care when symptoms cannot be managed at home
- Inpatient respite care so a family caregiver can rest, for up to five days at a time (more on respite care for elderly parents)
- Grief support for the family after death6
Medicare generally pays almost all of the cost of covered hospice care, with a small copay for some prescriptions and a small coinsurance for respite stays4. If your parent is in a Medicare Advantage plan, Original Medicare still pays for hospice6.
Comfort care vs. hospice
Comfort care is a description, not a program. Hospitals use it to mean that treatment now focuses only on comfort, for example in the last days of life. Comfort care can be given in a hospital without hospice enrollment, or it can be delivered through hospice. If a doctor recommends comfort care, ask whether a hospice evaluation makes sense, because hospice brings a team, equipment and family support that a hospital stay does not1.
Where hospice and palliative care happen
Most hospice care happens wherever your parent lives: their own home, a relative's home, an assisted living or memory care community, or a nursing home4. The hospice team visits on a schedule and is on call around the clock. Family members or the care community still provide most day-to-day hands-on care.
Two cost points surprise families:
- Room and board is not covered. Medicare hospice does not pay for rent or the daily rate in a nursing home or assisted living4. Medicaid may cover nursing home room and board for eligible residents who elect hospice.
- Hospice is not 24-hour care at home. Continuous nursing at home is only for short crises. If your parent needs more hands-on help, families combine hospice with private aides or a move.
If your parent is in a nursing home under Medicare's skilled benefit, electing hospice for the same condition usually ends that skilled coverage. Read when Medicare stops paying for a nursing home before deciding, and see home care vs. home health for how other home services differ.
Read moreWhen Medicare Stops Paying for a Nursing Home: What Families Can Do
Palliative care vs. hospice for dementia patients
Dementia is a common reason families ask about hospice vs. palliative care, because the decline is slow and hard to predict. Palliative care can help from the middle stages on, with distress, sleep, appetite and behavior changes, and with advance planning while your parent can still take part1. See DNR vs. POLST for the medical orders that put those wishes in writing.
Hospice usually becomes an option in late-stage dementia, when a person needs help with all daily activities, speaks very little, and has complications such as weight loss, infections or trouble swallowing. Each hospice applies Medicare's eligibility standards, so ask for an evaluation if you are unsure. Our guide to the stages of dementia and care needs describes how needs change, and memory care vs. nursing home covers where late-stage care often happens. Our guide to hospice for dementia explains eligibility in detail.
Common myths about hospice and palliative care
- "Hospice means giving up." Hospice shifts the goal from cure to comfort. Many families say it gave them more good days together, not fewer.
- "Palliative care is only for cancer." It helps people with heart, lung, kidney and neurological diseases, including dementia1. For examples, see kidney failure in the elderly or congestive heart failure in the elderly.
- "Hospice is a place." Hospice is mainly a service that comes to your parent. Inpatient hospice units exist, but most care is at home or in a care community4.
- "You have to be bedbound." Eligibility depends on prognosis, not on being in bed. Some people on hospice still go out to lunch or to church.
- "Hospice hastens death." Hospice does not aim to speed or delay death. Pain medicines are adjusted to relieve symptoms.
- "Once you start hospice, you cannot stop." Your parent can leave hospice at any time and return later if eligible6.
Many families say they wish they had started hospice sooner. Late enrollment, in the last few days of life, leaves little time for the team to manage symptoms and support the family. Asking early does not commit you to anything.
Questions to ask a hospice or palliative program
- How soon can you do an admission visit, and can you start on a weekend?
- How often will a nurse and an aide visit, and who do we call at 2 a.m.?
- How fast does someone come to the home in a crisis?
- Do you work with my parent's assisted living, memory care or nursing home now?
- Which medicines and equipment will you provide, and which will you not?
- Do you offer continuous care at home during a crisis, and inpatient care when needed?
- What respite options do you offer family caregivers?
- What grief support do you offer, and for how long?
For palliative programs, also ask whether they make home visits, how they coordinate with your parent's specialists, and what insurance they bill. If you are still comparing types of help, our overview of types of senior care and Medicare vs. Medicaid for long-term care can help you sort out who pays for what.
How to decide which is right
- Ask the prognosis question. Ask the doctor directly: would you be surprised if my parent died in the next six months? A no answer is a reason to discuss hospice.
- Clarify the goals. Talk with your parent about what matters most: more time, more comfort, staying home, avoiding hospital trips. Advance directives put those wishes in writing7.
- Start palliative care early. If your parent is still pursuing treatment, a palliative consult adds symptom help now and makes a later move to hospice easier.
- Interview hospices. Ask how quickly they can start, how often nurses visit, how they handle a crisis at night, and whether they work with your parent's community. Medicare's Care Compare lists hospice quality data8.
- Remember it can change. Your parent can stop hospice at any time to resume curative treatment, and enroll again later if eligible6.
