When someone you love is living with a serious illness, hospice and palliative care often come up in the same conversation, sometimes in a hospital hallway, sometimes during a difficult talk with a doctor. Many families assume they mean the same thing. While they’re closely related, they aren’t interchangeable, and understanding the difference can change what kind of support your loved one receives and when.
Palliative care is specialized medical care focused on symptom relief and quality of life for anyone with a serious illness, at any stage. Hospice care is a specific type of palliative care for people nearing the end of life, once treatment meant to cure the illness has stopped. Put simply, all hospice care is palliative, but not all palliative care is hospice.
In this guide, we’ll walk through what each type of care involves, who qualifies, where it’s provided, how Medicare and other health insurance typically cover it, and how to know which is right for your family. We’ll also share how the skilled nursing team at Cardinal Ritter Senior Services supports families through both.
Palliative Care: Support Through Serious Illness
Palliative care focuses on easing the physical symptoms and stress that come with a serious illness, or for those in memory care, assisted or independent living who require additional support with pain, shortness of breath, fatigue, nausea, poor appetite, trouble sleeping, anxiety, and depression. According to the National Institute on Aging, palliative care can begin as early as diagnosis and continue alongside curative treatment like chemotherapy, dialysis, or surgery. Many patients find that better symptom management actually helps them tolerate their treatment.
Palliative care also treats the whole person, not just the diagnosis. A palliative care team typically includes palliative care specialists (doctors and nurses), social workers, nutritionists, and chaplains who work alongside your loved one’s primary care provider and other specialists. Together, the palliative team helps with:
- Pain and symptom management, including medication management as needs change
- Emotional support and mental health care for both the patient and family
- Spiritual care that honors each person’s faith, values, and treatments
- Care coordination so every doctor is working from the same plan
- Advance care planning, including help putting advance directives in place
Who Qualifies for Palliative Care?
Anyone with a serious illness can receive palliative care, at any age and at any stage of their illness. There’s no life expectancy requirement, and no one has to give up curative care to get it. Patients receiving palliative care are often living with conditions like heart failure, cancer, dementia, Parkinson’s disease, chronic obstructive pulmonary disease (COPD), or kidney disease.
If you think your loved one would benefit, ask their primary care doctor or specialist for a referral to palliative care services. You don’t have to wait for the doctor to bring it up first.
Where Palliative Care Is Provided
Palliative care can be provided in hospitals, nursing homes and skilled nursing communities, outpatient palliative care clinics, and at home. Unlike hospice, palliative care isn’t a separate Medicare benefit. Visits are usually billed like other medical care, so Medicare Part B, Medicaid, and private insurance may cover them, with the usual deductibles and co-pays. A quick call to your loved one’s health insurance provider can clarify what’s included.
Hospice Care: Compassionate Comfort and Support
Hospice care focuses on comfort, dignity, and quality of life for people in the final months of life. When curative treatment is no longer working, or when a patient decides its burdens outweigh its benefits, hospice shifts the focus to pain and symptom relief, emotional and spiritual support, and meaningful time with family.
Choosing hospice doesn’t mean stopping all medical care. Hospice patients still receive medications to manage symptoms, and they can keep treating conditions unrelated to their terminal illness, such as high blood pressure. They can also keep their regular doctor involved as their attending physician.
Hospice care services are delivered by an interdisciplinary hospice team that includes physicians, nurses, social workers, home health aides, chaplains, trained volunteers, and other specialists, all overseen by a hospice medical director. Under the Medicare hospice benefit, a hospice program typically covers:
- Visits from hospice physicians, nurses, and social workers
- Durable medical equipment, such as hospital beds, wheelchairs, and walkers, plus medical supplies
- Medications for pain and symptom management
- Home health aide and homemaker services
- Physical, occupational, and speech therapy, plus dietary counseling
- Short-term inpatient care for symptoms that can’t be managed elsewhere
- Respite care, which gives family caregivers a short break
- Grief support for the family for up to a year after a loved one’s death
A member of the hospice team is usually available by phone 24 hours a day, seven days a week, which gives families extra support during the hours when questions tend to feel most urgent.
Who Qualifies for Hospice Care?
According to Medicare.gov, a person qualifies for the Medicare hospice benefit when all three of the following are true:
- Their hospice doctor and their regular doctor (if they have one) certify that they are terminally ill, with a life expectancy of six months or less if the illness runs its usual course
- They accept comfort care instead of care to cure their illness
- They sign a hospice election statement choosing hospice over other Medicare-covered treatment for that illness
A six-month prognosis is a doctor’s best estimate, not a deadline. Medicare covers hospice in two 90-day benefit periods, followed by an unlimited number of 60-day periods, as long as the hospice doctor continues to recertify that the patient is terminally ill. Patients can also leave hospice at any time, whether their condition improves or they decide to pursue treatment again, and return later if they still qualify.
What’s new for 2026: Starting October 1, 2026, Medicare requires every hospice to give each new Medicare patient a written addendum to their election statement listing any items, services, or drugs the hospice won’t cover because they’re unrelated to the terminal illness. Under the Centers for Medicare & Medicaid Services’ FY 2027 hospice rule, the addendum is now mandatory for everyone who elects hospice, not just families who ask for it, so you’ll know up front what isn’t covered.
Where Hospice Care Is Provided
Hospice is an approach to care, not a place. It can be provided at home, in assisted living, in a nursing home or skilled nursing community, in a hospital, or in a dedicated inpatient hospice facility. For a loved one who already lives in a nursing home, hospice comes to them, so they can stay in familiar surroundings with the caregivers they know.
When it comes to cost, Medicare.gov notes that patients pay nothing for covered hospice care from a Medicare-approved provider, aside from a co-pay of up to $5 per prescription for symptom-control drugs and up to 5% of the Medicare-approved amount for inpatient respite care. One important exception: the Medicare benefit doesn’t cover room and board in a nursing home, so that portion is usually paid through Medicaid, long-term care insurance, or private funds.
Hospice vs. Palliative Care: Key Differences
Both types of care share the same heart of easing suffering and improving quality of life. The difference between palliative care and hospice comes down to three things: whether curative treatment continues, when care can begin, and the goals of care. Here’s a side-by-side look:
| Palliative Care | Hospice Care | |
| Who it’s for | Anyone with a serious illness, at any age or stage | People with a terminal illness and a life expectancy of six months or less |
| When it can start | As early as diagnosis | When curative treatment stops and a doctor certifies the six-month prognosis |
| Curative treatment | Can continue alongside palliative care | Stops for the terminal illness (care for unrelated conditions continues) |
| Goals of care | Symptom relief and quality of life, together with treatment | Comfort, dignity, and quality of life alone |
| Where it’s provided | Hospitals, nursing homes, outpatient clinics, home | Home, assisted living, nursing homes, hospitals, inpatient hospital facilities |
| How it’s paid for | Billed like other medical care; Medicare Part B, Medicaid, and other private insurance may cover it, with usual co-pays | Medicare hospice benefit (Part A) covers nearly all related care at little to no cost; Medicaid and many private plans also cover hospice |
Curative Treatment
Under palliative care, patients can receive curative treatment at the same time as comfort-focused care. Under hospice, treatment aimed at curing the terminal illness stops, though medications and care for comfort and unrelated conditions continue.
Timing and Life Expectancy
Palliative care has no timeline restriction and can start the day a serious illness is diagnosed. Hospice generally begins when a doctor believes the patient has six months or less to live if the illness follows its usual course.
Goals of Care
Palliative care supports treatment and quality of life together, helping patients feel well enough to pursue the care they want. Hospice care focuses on comfort alone, prioritizing peace, dignity, and time with loved ones over treatments that are no longer helping.
How to Know Which Type of Care Is Right for Your Family
There’s rarely a single moment when the right choice becomes obvious. Instead, families usually notice a pattern. These questions can help guide a conversation with your loved one and their healthcare team:
- Is current treatment still helping, and does your loved one want to continue it?
- Have hospital stays or emergency room visits become more frequent?
- Are pain, breathlessness, confusion, weight loss, or other symptoms becoming harder to manage?
- What matters most to your loved one right now: more time, more comfort, or staying somewhere familiar?
- Are their wishes documented in advance directives, and does everyone know what they are?
If your loved one is still pursuing treatment but struggling with symptoms, palliative care is often the right first step. If treatment is no longer working or wanted, and their doctor believes time is limited, it may be time to talk about hospice. Many families begin with palliative care and transition to hospice as needs change.
Timing matters, too. The National Institute on Aging notes that people often start hospice too late to benefit fully, and that families of hospice patients report higher satisfaction with end-of-life care. Starting the conversation early gives your family more time to make decisions together, rather than in a crisis. If you’d like help finding providers, the National Alliance for Care at Home offers resources on hospice and palliative care nationwide.
How Cardinal Ritter Supports Both Palliative and Hospice Needs
At Cardinal Ritter Senior Services, hospice and palliative support are part of the care we provide in our St. Louis skilled nursing and rehab community at Mary, Queen and Mother Center. Families from Webster Groves, Shrewsbury, and across the St. Louis area turn to us when a loved one’s care needs begin to change.
Our interdisciplinary care team of nurses, certified nursing assistants, dietitians, rehabilitation therapists, and activities staff provides 24-hour nursing care, medication management, and a person-centered approach that looks after each resident’s physical, emotional, social, and spiritual needs. Routine assessments allow us to adapt care plans as needs evolve, so a resident who arrives for rehab or palliative support can transition to comfort-focused hospice support within a community they already know.
Spiritual care is woven into daily life here. We celebrate Mass six days a week in our chapel, and our pastoral care and social services staff are available to support residents and families alike. We also offer respite stays, giving family caregivers a much-needed break. If you’re new to this level of care, our guide to what skilled nursing is is a helpful place to start.
Common Questions About Hospice and Palliative Care / FAQs
Is hospice only for cancer patients?
No. Hospice serves anyone with a terminal illness and a life expectancy of six months or less, including heart disease, dementia, lung disease, kidney disease, and other serious illnesses, not just cancer.
Does Medicare pay for hospice care?
Yes. Medicare Part A covers hospice care for eligible patients, including most services, symptom-management medications, and medical equipment, with little to no out-of-pocket cost. Patients may owe up to $5 per prescription, and hospice doesn’t cover room and board in a nursing home.
Can you receive palliative care and still get curative treatment?
Yes. Unlike hospice, palliative care can be provided alongside treatments meant to cure or control the underlying illness, at any stage of the disease.
How do I start the conversation about hospice or palliative care?
Start by talking with your loved one’s doctor about their prognosis and goals of care, then ask for a referral or evaluation to determine which type of support fits best. It also helps to review advance directives together so everyone understands your loved one’s wishes.
Talk to Our Cardinal Ritter Team About Hospice and Palliative Care Options
Choosing between hospice and palliative care doesn’t have to feel confusing or overwhelming, and you don’t have to figure it out alone. Our compassionate team understands how personal these decisions are, and we’re here to walk your family through your loved one’s specific options with honesty, dignity, and care.
If you’re exploring hospice and palliative care in St. Louis, call Cardinal Ritter Senior Services at (314)961-8000 or schedule a visit to Mary, Queen and Mother Center. We’ll help you understand what support is available and what next steps make sense for your family.