Ruby, age 96, is in poor health.  She has a litany of problems, ranging from hearing loss to wounds on her legs that just won’t heal.  And yet, Ruby doesn’t have any serious or life-threatening issues to deal with either.

Ruby openly talks about being ready to die, but she dutifully takes her heart medication each morning.

Recently, Ruby has been in a lot of pain.  An x-ray showed that Ruby has fractures in her spine, most likely due to osteoporosis. To fix the problem, she will need vertebroplasy (bone cement inserted into her back).  But in the meantime, the doctor gave her pain medication and recommended palliative care.

But Ruby refuses palliative care, saying “I’m not ready for that.”

Given her age and physical condition, and the fact that she has had home care for a number of years, why would Ruby refuse this type of care that would make her last stage of life less painful?

Most likely, Ruby is not saying she expects to live many more years or denying that she will eventually die.  Instead, she is likely confusing palliative care with hospice care.

What they have in common

Many confuse hospice and palliative care, in part because many organizations offer both and because they are similar forms of care.

Both hospice and palliative care provide:

  • Comfort care
  • Stress reduction
  • Complex symptom relief related to a serious illness
  • Physical and psychosocial relief

However, the two forms differ significantly.

Hospice care
  • Prognosis of 6 months or less
  • Excludes curative treatment
  • Paid for by insurance, Medicare, or Medicaid

Hospice care is care designed to give support to individuals in the final phase of a terminal illness. This level of care focuses on the comfort and quality of life of the individual’s life, rather than attempting to cure the illness.

The goal is to enable patients to be comfortable and free of pain, so that they live each day as fully as possible. Most often, hospice care is recommended when the patient is no longer benefitting from curative treatment.

Palliative care
  • Offered at any stage of the disease
  • Offered in conjunction with curative treatment
  • Paid for by the individual or insurance

Palliative care is medical care for individuals living with a serious illness.  This level of care focuses on symptom relief, with the goal of improving quality of life for patients, as well as their families.

Palliative care is delivered by a trained team of doctors and nurses, who work with the patient’s regular medical team to provide an extra layer of support.  The focus is on the needs of the patient, not on the patient’s prognosis.

Palliative care is appropriate at any age and at any stage of a serious illness, and can be provided at the same time as regular treatments.  It is generally recommended in situations where individuals have limited ability to care for themselves.

If palliative or hospice care has been recommended for your perennial, be sure that you and your perennial understand the purpose of each level of care.

Ruby could benefit from the additional support that palliative care offers, but because she is confusing this service with hospice, she is missing out on this help.

Talk to your family and the medical team about goals of care and whether palliative care or hospice might improve your perennial’s quality of life.