Some words land like a punch. Palliative care. Hospice. When a doctor drops them into conversation, it’s hard to know what to do. You nod, maybe even laugh nervously, all while your brain scrambles to catch up. Both are meant to ease suffering and improve quality of life, but they’re not the same. And knowing the difference can help you make sure your mom or dad gets the right support, at the right time.
We sat down with palliative care nurse practitioner Kristy Mikell, founder of Own Your End to get the breakdown every family caregiver should have.
ICYMI (in case you missed it)
📅 This August is Make‑A‑Will Month, and The Michael J. Fox Foundation offers free guides, on-demand talks (like “Your Estate Plan After a Parkinson’s Diagnosis”), and support to help you protect your wishes and those you care about.
🎉 A couple who met caring for seniors at a living center turned their vows into a reunion including their “200 grandparents” as guests of honor at a second ceremony in the same home where it all began.
🤖 MIT-aligned ianacare continues building a lifeline for caregivers—helping families coordinate meals, rides, caregiving shifts, and supportive networks. Through partnerships with AARP and healthcare providers, they’ve already reached over 50,000 caregivers.
🏠 Beginning this year, Medicare’s GUIDE pilot program is offering up to $2,563 in annual respite funds for caregivers—covering in-home care, overnight respite, or adult day services. It’s a meaningful step toward recognizing and easing the emotional and financial weight of dementia caregiving.
Palliative and Hospice Care
When dad shifts into unfamiliar territory, medical appointments are more frequent and the conversations increasingly more daunting. Somewhere in the swirl, a doctor mentions palliative or hospice care, and you nod along, only to later realize you’re not entirely sure which one dad needs… or when.
Here’s the real talk.
Palliative care is about living better while living with a serious illness, at any age, in any stage. It’s not just for older adults, and it doesn’t mean giving up on treatments that aim to cure. Think of it as an extra layer of support: easing pain, controlling symptoms, keeping care coordinated, and helping you make the big, complicated decisions. The team can include doctors, nurses, social workers, nutritionists, chaplains, people who work alongside dad’s existing providers to make sure his care reflects his goals and values.
Palliative care can start the day of diagnosis and happen in hospitals, nursing homes, clinics, or at home. As palliative care NP, Kristy Mikell points out, Medicare, Medicaid, and many insurance plans may cover it <insert big asterisk> but the details depend on the plan.
Hospice care is often considered palliative care’s final chapter. Typically, it begins when a doctor believes there are six months or less left if the illness runs its natural course, and curative treatments are no longer on the table. But it can last longer if physicians continue to determine its still needed. The goal shifts entirely to comfort, dignity, and emotional support, for both dad and your family. Like palliative care, hospice can happen at home, in assisted living, a nursing home, or a dedicated hospice facility.
Hospice teams are on call 24/7. They include nurses, doctors, social workers, spiritual advisors, and trained volunteers. They cover the medical, emotional, and spiritual needs while the hands-on care at home often still falls to family. However, hospice helps with that too, offering coaching and respite breaks when you need to step away.
Quick look at the key differences:
When it starts: Palliative care can begin any time after diagnosis; hospice typically starts when life expectancy is likely six months or less, however, it can last years.
Treatment goals: Palliative care can include curative treatments; hospice focuses solely on comfort.
Coverage: Hospice is fully covered by Medicare; palliative care coverage depends on your plan.
Caregiver Cheat Sheet: Palliative Care vs. Hospice Care
Specifics | Palliative Care | Hospice Care |
|---|---|---|
When It Starts | Any stage of a serious illness, from diagnosis onward. | When a doctor believes life expectancy is six months or less if the illness follows its usual course. |
Goal | Improve quality of life while continuing curative or life-prolonging treatments. | Comfort, dignity, and symptom relief—no curative treatments. |
Who It’s For | Anyone with a serious illness—regardless of age or prognosis. | Anyone with a serious illness in the final months of life. |
Care Team | Doctors, nurses, social workers, nutritionists, chaplains, plus dad’s existing medical providers. | Doctors, nurses, social workers, spiritual advisors, trained volunteers. |
Where It Happens | Hospitals, nursing homes, outpatient clinics, or at home. | Home, assisted living, nursing home, hospice facility, or hospital. |
Coverage | Medicare, Medicaid, or private insurance—coverage varies by plan. | Fully covered by Medicare; many private insurers also cover. |
Length of Care | As long as needed based on condition and insurance coverage. | As long as dad meets hospice eligibility criteria (can be renewed if prognosis remains six months or less). |
Treatment Approach | Works alongside ongoing treatments for the illness. | Stops curative treatments; focuses solely on comfort care. |
Family Support | Emotional and logistical support, plus guidance with decision-making. | Emotional, spiritual, and practical support; respite care for family caregivers. |
Wondering what to look for and when to bring the topic up with dad’s doc? Talk with his medical team if you’re noticing he lives a “bed-to-chair existence”, is experiencing frequent hospitalizations, falls, weight loss, or has cognitive decline. While not every symptom listed requires palliative or hospice care, they should trigger a conversation with your dad’s care team.
Both types of care are designed to relieve suffering and improve quality of life. Kristy says the mistake some families make? Waiting too long. Palliative care can make the road less overwhelming from the start. Hospice, begun early enough, can give you more time for connection instead of scrambling in crisis mode.
What’s Good
Helpful care-focused finds we’ve identified and researched so you don’t have to.
Perspective comes in many forms, and Being Mortal: Medicine and What Matters in the End by surgeon Dr. Atul Gawande is one of the most profound. Part memoir, part manifesto, the book brilliantly blends his personal journey caring for his aging father with the lessons he’s learned guiding patients through end-of-life decisions.
Tears likely and introspection guaranteed.
