Dear Laird: My 90-year-old mom is in assisted living. She is happy there but has had more care issues lately, like needing help getting dressed and forgetting how to get back to her room. She is also sleeping more than usual. The activity director told me, “I think your mom needs palliative care.” Does this mean she will die soon and that she needs hospice? Signed, Concerned

Dear Concerned: It’s frightening when you’re told your failing mother may need an unfamiliar treatment or type of care. Although they’re similar, palliative care and hospice care have distinct differences. 

Cicely Saunders, a nurse, social worker and doctor, pioneered the concept of hospice in 1976 to provide pain relief and enhanced quality of life to cancer patients who had run out of options for medical treatment. Hospice encompasses spiritual support, interactive living and family participation to deliver meaningful comfort for those nearing end of life. 

While hospice care has remained largely unchanged since Medicare began covering it in 1983, palliative care has evolved significantly in its utilization and interpretation. 

Balfour Mount, a Canadian physician who’d collaborated with Saunders, wanted to expand comfort care to patients living with a serious illness at any stage, not just end of life. Palliative care is person-centered care that provides patients with comfort measures such as pain relief, relaxation techniques, and spiritual and emotional support, even while they’re actively seeking traditional medical treatments like radiation or surgery. 

Family caregivers provide most forms of palliative care at home for as long as possible. The Caregiver Support Foundation describes palliative family caregiving as keeping your loved one safe and comfortable, and creating moments of joy. 

Palliative work is augmented by professional care. Eventually, we may hire in-home help, then independent living, assisted living and finally memory care. 

Palliative care in medicine is also growing. About 55% of hospitals with more than 100 beds have palliative services. Twenty percent of smaller hospitals do as well. Typically, patients seek medical treatment before palliative care, but I believe both should be relevant throughout. 

Back to your question: It’s important to clarify what the activities director meant by your mom needing palliative care. He or she could mean your mom requires more assistance each day. Hospice is palliative care to a degree; however, many people don’t understand that palliative care is more than hospice.