What Is Palliative Care?

Palliative care and hospice are related approaches to health care for seriously ill people, but they are not identical.

Hospice is an interdisciplinary approach to health care for people who are likely to die within six months. Most hospice care takes place in the patient’s home.  It became part of the Medicare system in the early 1980s, and programs are also usually available for end-of-life care through Medicaid and private insurance.

But hospice generally requires that the patient give up care aimed at curing or at least halting the progression of the disease.  But it can be very hard for patients, families and doctors to know when the time has come to stop aggressive treatment – or to surrender hope for a cure.

That’s one reason palliative care has emerged in the past decade. It takes that interdisciplinary approach – doctors, nurses, social workers and often chaplains – and blends it with curative care for seriously ill people.  While palliative care is for people who are very sick, they don’t have to have a six-month life expectancy.  Some palliative care programs operate in hospitals; others treat people living at home. Growing numbers of community-based hospices also have palliative care services now.

Pediatric palliative care is not available everywhere, although it’s becoming more common at the major children’s hospitals, according to Dr. Joanne Wolfe, director of pediatric palliative care at Children’s Hospital Boston. In addition, hospices nationwide, which traditionally were often unwilling to treat dying children, have also become more open to pediatric care. The new health reform law allows dying children on Medicaid or the state Children’s Health Insurance Program to get hospice or palliative care without halting other treatment.