Hospice care vs palliative care: what is the difference?

In Australia, palliative care is the type of care and hospice is usually a place where that care is given. Palliative care is support that helps someone live as comfortably and fully as possible with a serious, life-limiting illness, and it can be provided at home, in hospital, in a residential aged care home, or in a hospice. A hospice is a specialist inpatient unit staffed by a palliative care team, generally used when symptoms are too complex to manage elsewhere or when someone is in the final stage of life. Hospice care is a setting within palliative care, not an alternative to it.

That is a genuinely different arrangement from the one described in most of what you will find online. A great deal of the internet's writing about hospice is American, where hospice is a separately funded insurance benefit with its own eligibility rules. Australia has no equivalent separate benefit, which is why the two terms behave differently here.

Palliative care: the approach

Palliative care focuses on quality of life for someone with an active, progressive or advanced condition. It covers pain and symptom management, emotional and psychological support, practical and social help, spiritual care for those who want it, and support for family and carers, including after a death.

Two points are worth stating plainly because they are so often misunderstood:

• Palliative care is not only for the last days. It can begin soon after a life-limiting diagnosis and continue for months or years, easing during stable periods and stepping up when symptoms flare.
• It does not mean stopping treatment. It is frequently provided alongside active treatment such as chemotherapy, dialysis or heart failure medication.

Our guide to palliative care covers the approach in more detail, including who is on the team.

Hospice: the place

In Australian usage, hospice most often means a dedicated inpatient palliative care unit. Some are standalone buildings run by not-for-profit or church-based organisations; others are wards or units within a public or private hospital. What they share is a team built around palliative care rather than cure: palliative medicine doctors, specialist nurses, social workers, pastoral care and volunteers, in an environment designed to feel less clinical than a general hospital ward.

People are usually admitted to a hospice for one of three reasons:

1. Complex symptoms that need close monitoring and adjustment, for example pain, breathlessness, nausea or delirium that has not settled at home.
2. End-of-life care, when someone is in the final phase and the family cannot manage at home, or the person prefers not to be at home.
3. A short stay for respite or stabilisation, after which the person goes home again. Not every hospice admission is a one-way trip, and a stay can be a way of getting symptoms under control and then resuming care at home.

That third point surprises people. Being admitted to a hospice does not automatically mean someone will die there.

The Australian system versus the American one

If you have read that hospice requires giving up curative treatment, or that a doctor must certify a specific prognosis, that is describing the United States. There, hospice is a defined insurance benefit with formal eligibility criteria tied to a prognosis and, in most cases, a decision to stop treatment aimed at cure.

Australia does not work that way:

• There is no separate hospice benefit or program to enrol in. Palliative care is part of the health system, funded through state and territory health services, Medicare and, for older people, the aged care system.
• You do not have to stop treatment to receive palliative care or to be admitted to a hospice bed.
• There is no prognosis threshold you must cross before palliative care is appropriate. Referral is based on need, not on a countdown.

Australians reading American advice often delay asking for help because they think they are not "eligible yet." They usually are.

Where else palliative care happens

A hospice is one of four common settings, and many people move between them as needs change.

• At home, coordinated by the GP with community palliative care nurses and allied health. This is where most palliative care in Australia is delivered, and where most people say they would prefer to be.
• In hospital, often with a consulting palliative care team advising the treating doctors.
• In a residential aged care home, where staff can call on visiting specialist palliative care services so a resident does not have to move.
• In a hospice or specialist palliative care unit.

A good care team plans for movement between settings in advance rather than leaving it to a 3am ambulance call. This is one of the practical reasons advance care planning matters; our guide to advance care directives explains how to record someone's wishes while they can still express them.

What it costs

Specialist palliative care through the public system, including public hospice beds and community palliative care nursing, is generally provided at no cost to the patient, though arrangements vary between states and territories. Private hospitals with palliative care units, private specialists and some services run by not-for-profits may involve fees or use private health insurance.

For an older person already in residential aged care, the usual aged care fees continue to apply while palliative care is delivered in place; our guide to aged care fees explains that structure. Because arrangements differ by state and by provider, ask the service directly what, if anything, you will be charged rather than assuming. Financial hardship provisions exist; raise cost as a barrier rather than going without.

How to get started

You do not need a special diagnosis or a referral already in hand to ask about either.

1. Talk to the GP or treating specialist. They can explain what is appropriate and refer on to community or specialist palliative care. In some states you can also contact a local palliative care service directly.
2. For an older person, My Aged Care (1800 200 422) is a second door. You do not need to already be receiving other aged care services to ask.
3. Ask about a hospice bed specifically if symptoms are hard to manage at home, or if the family is not coping. Bed availability is limited in most areas, so raising it early is better than raising it in a crisis.
4. Ask about support for carers too. Palliative care includes the family. Carer Gateway (1800 422 737) and respite care can both help while care continues at home.

To see what is available near you, browse verified palliative care services on Our Mate.

Please speak with a GP, the treating team, or Palliative Care Australia for guidance specific to your situation.

Frequently asked questions

Is hospice care the same as palliative care?

Not quite. Palliative care is the type of care: comfort-focused support for someone with a serious, life-limiting illness. Hospice, in Australian usage, is usually a place where that care is delivered, namely a specialist inpatient palliative care unit. Hospice care is a setting within palliative care rather than a separate program.

Do you have to stop treatment to go into a hospice in Australia?

No. That rule comes from the American hospice insurance benefit and does not apply here. In Australia, palliative care and hospice admission are based on need, and people frequently continue treatment aimed at controlling their illness while receiving palliative support.

Does going into a hospice mean someone is about to die?

Not necessarily. Some hospice admissions are for end-of-life care, but others are short stays to bring difficult symptoms such as pain or breathlessness under control, after which the person returns home. Ask the team what the goal of the admission is, because it is a reasonable and common question.

Is hospice care free in Australia?

Public hospice beds and community palliative care are generally provided at no cost to the patient, though arrangements vary by state and territory. Private hospital palliative care units, private specialists and some not-for-profit services may involve fees or use private health insurance. Ask the service directly what applies to your situation.

How do I arrange hospice or palliative care?

Start with the GP or treating specialist, who can refer to community or specialist palliative care and discuss a hospice bed if one is needed. In some states you can contact a local palliative care service yourself. For an older person, My Aged Care on 1800 200 422 is another door, and you do not need to be receiving other aged care services first.