Understanding hospice vs palliative care is an important part of preparing for end of life. While these services share a focus on comfort and quality of life, there are some important differences.
In Episode 24 of The Geriatric Dietitian Podcast, we’re beginning a five-part series on nutrition at end of life. In this first episode, I want to set the stage by talking about hospice vs palliative care, and what it means when someone is approaching the end of life.
This series is based on my article, End of Life Nutrition: What Everyone Needs to Know.
Why We Need to Talk About End of Life
Death is not an easy topic to discuss. It’s emotional, unpredictable, and something many people would rather avoid.
During my 13 years working in home care, I had many conversations with patients and families about end of life. One thing I learned is that the more we talk about these difficult subjects, the more we can help reduce confusion, fear, and guilt.
Nutrition at the very end of life is different from nutrition during other stages of life.
When someone is in the final stages of terminal illness and approaching death, eating less is part of the dying process. There is no proof that increasing calories during this stage will improve strength, energy, function, or prolong life.
Understanding this is an important foundation for the conversations we’ll have throughout this series.
Hospice vs Palliative Care
Hospice and palliative care both help people manage symptoms and improve comfort, but they are not the same thing.
What Is Hospice Care?
Hospice is a program of care and support for someone approaching the end of life.
In this episode, I explain how hospice eligibility involves a physician’s certification that a person has a life expectancy of six months or less if the illness follows its expected course.
Hospice focuses on comfort rather than attempting to cure the terminal illness.
One important thing to understand is that no one knows exactly when someone will die. During my time working in geriatrics, I had patients who remained on hospice longer than expected and others who passed away shortly after beginning hospice services.
The six-month estimate is a clinical prediction, not an exact timeline.
What Is Palliative Care?
Palliative care also focuses on comfort, symptom management, and quality of life. However, unlike hospice, palliative care is not limited to people approaching death. It can be provided at any stage of a serious illness, and patients may continue receiving treatments intended to manage or cure their condition.
For someone who isn’t ready for hospice, palliative care may be an important way to receive additional support.
Who Provides Hospice Care?
Hospice care involves professionals who help support patients and their families.
But when I talk about caregivers throughout this series, I’m using a much broader definition. A caregiver might be a spouse, adult child, grandchild, friend, neighbor, paid caregiver, or healthcare professional. Anyone helping care for someone approaching the end of life can be a caregiver.
This is important because end-of-life nutrition affects not only the person who is dying but also the people who love and care for them.
Where Is Hospice Care Provided?
Hospice is not necessarily a place someone goes to receive care. Hospice services can be provided wherever someone lives, including their home, an assisted living community, or a nursing facility. Hospice may also be provided in hospitals or dedicated hospice facilities, depending on the person’s circumstances.
During my time working in home care, I visited people in many different living environments. Everyone’s needs, living situation, and available support are different.
The goal is to provide appropriate care and comfort in the setting that best meets the individual’s needs.
What Does End of Life Mean?
End-of-life care isn’t limited to the final moments before someone dies. It can involve the days, weeks, and even months leading up to death. This is an important distinction because someone can be approaching the end of life without necessarily being in the very final stages of dying.
As death gets closer, a person may transition into what we call actively dying. Recognizing these changes matters because continuing to focus on traditional medical and nutrition goals may no longer provide the greatest benefit.
Hospice care can help manage uncomfortable symptoms and provide physical and emotional support during this time.
Why Hospice and End-of-Life Conversations Matter
I believe we need to have more conversations about death and dying.
Accepting hospice doesn’t mean someone has failed or that their family has stopped caring for them. It means recognizing that their needs have changed and focusing on providing support and comfort.
My hope is that understanding hospice, palliative care, and end-of-life care will help families feel more prepared for what lies ahead.
In the next episode, we’re going to talk about what happens when someone stops eating at end of life and why this can lead to something I call “the food fight.”
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