The two terms are used interchangeably. They refer to different things. The difference determines what a patient can access and when.
Hospice and palliative care are not the same thing. They are used interchangeably in most conversations about serious illness. That confusion is not trivial. It determines what patients access, when they access it, and what they give up to get it.
What Hospice Is
Hospice is a specific benefit, defined under Medicare Part A, for patients with a terminal diagnosis and a prognosis of six months or less if the illness runs its expected course. To access hospice, a patient must agree to stop curative treatment for the terminal condition. The focus shifts entirely to comfort, symptom management, and support through the dying process. Services are typically delivered at home, though inpatient hospice facilities and nursing settings also provide the benefit under specific circumstances.
What Palliative Care Is
Palliative care is broader, and it starts earlier. It is available at any stage of a serious illness — at diagnosis, during active treatment, or as the illness progresses. It does not require a terminal prognosis. It does not require stopping curative treatment. A patient undergoing chemotherapy can receive palliative care simultaneously to address side effects, pain, and the emotional and logistical burden of being seriously ill. The focus is quality of life, symptom management, and informed decision-making.
Kayla Bonkowski is completing her MSW in Sterling Heights, Michigan, with a focus on both. She holds a Cum Laude psychology degree from Rochester College. She notes that for many patients, palliative care is the path that leads to hospice — the support structure during treatment that eventually transitions to end-of-life care when the patient chooses to stop pursuing cure. The two are not competing options. They are different phases of care for people with serious illness.
The Cost of Confusion
The practical implication for families is significant. Families who do not know palliative care exists often wait until their loved one is actively dying before engaging any support. The symptom management, the help navigating the medical system, the emotional and logistical support — all of that could have begun at diagnosis. It did not, because the family understood “serious illness support” to mean hospice, and hospice meant the end.
That misunderstanding has a cost. Patients are sicker during their final months than they need to be. Families are less prepared. Decisions that could have been made deliberately end up being made in crisis.
A Systemic Failure, Not a Patient Failure
Kayla Bonkowski also notes that the confusion between palliative care and hospice is not a communication failure on the part of families. It is a systemic failure. The healthcare system does not do a reliable job of explaining palliative care at the point of serious diagnosis. Families receive information about their treatment options. They rarely receive a clear explanation of what supportive care is available alongside treatment, when it can start, and what it covers. Closing that gap is a social work function — one that can significantly change a family’s experience of a serious illness from the day of diagnosis rather than only in the final weeks.
Part of what a social worker does in both settings is make the care system legible to people navigating it while frightened and overwhelmed. That means explaining the distinction between palliative care and hospice in plain language, early enough that it can change what the family does.
The Conversation That Changes What Comes Next
She will eventually be the person in the room explaining this. Early in someone’s serious illness, before the word hospice has been said, before the prognosis has become terminal. Explaining that there is a form of support specifically designed for this moment — that it does not require giving up on treatment, that it can start now — is one of the most consequential conversations a social worker has. Kayla Bonkowski is preparing to have it clearly.
More from Kayla Bonkowski: What Hospice Social Workers Actually Do All Day and The Grief Nobody Prepares a Family For. Full background at About Kayla Bonkowski.