Palliative Care vs Hospice

This week we will discuss Palliative vs Hospice with Dr. Karl Steinberg.

Palliative Care, Hospice Care, End-of-Life Care, Serious Illness Care, and Advance Care Planning/POLST all represent important elements of care for individuals dealing with serious illness, particularly those facing end-of-life situations. These are related but distinct concepts within the healthcare system.

1. Palliative Care: This is a type of care that is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve the quality of life for both the patient and the family. Palliative care is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment. It's not limited to end-of-life scenarios and can help patients manage symptoms and side effects of disease or its treatment.

2. Hospice Care: This is a specific type of palliative care for patients who are in the final stages of an incurable disease and have chosen to focus on comfort and quality of life rather than treatments aimed at cure. Generally, hospice care is considered when patients have a life expectancy of 6 months or less. It is often provided in the patient's home but can also be provided in hospice centers, hospitals, long-term care facilities, and nursing homes.

3. End-of-Life Care: This refers to the support and medical care given during the time surrounding death. End-of-life care can include a broad range of possible treatments and support, depending on the patient's needs. It might include treating pain and other uncomfortable symptoms, providing emotional and spiritual support, and helping the patient and their family make decisions about care. Both palliative and hospice care can be part of end-of-life care.

4. Serious Illness Care: This is a broad term that includes all types of care that someone with a serious, potentially life-limiting illness may receive. This can include everything from aggressive treatments aimed at curing or controlling the disease to palliative and hospice care aimed at managing symptoms and improving quality of life.

5. Advance Care Planning/POLST (Physician Orders for Life-Sustaining Treatment): Advance Care Planning involves making decisions about the care you would want to receive if you become unable to speak for yourself. These decisions are often documented in an advance directive. A POLST form is a type of advance directive that becomes an actionable medical order when signed by a healthcare provider. The POLST form helps ensure that a patient's wishes regarding life-sustaining treatments are honored by emergency medical personnel, nursing home staff, and healthcare providers.

​All of these concepts share a common goal: to ensure the best possible quality of life for patients facing serious illnesses, while respecting their values, preferences, and goals for care.

About Our Guest

Dr. Karl Steinberg has been a nursing home, hospice, and home health agency medical director and chief medical officer in the San Diego area since 1995. He received his bachelor's in biochemistry from Harvard and studied medicine at The Ohio State University College of Medicine, then completed his family medicine residency at University of California San Diego (UCSD) in 1990. He has board certifications in family medicine and in hospice and palliative medicine, and is certified as a nursing home and hospice medical director in addition to having a certification as a healthcare ethics consultant.

Dr. Steinberg also serves as president of the National POLST Collaborative, and is a past president of AMDA and CALTCM and past chair of the San Diego and California Coalitions for Compassionate Care. He serves on the National Advisory Board for the CSU Shiley Haynes Institute for Palliative Care and is the recipient of the 2022 Doris Howell Award for Excellence in Palliative Care.

Dr. Steinberg is on the Board of Directors of the San Diego County Medical Society and serves as a delegate to the AMA and California Medical Association's House of Delegates. He is also an appointee to the California Insurance Commissioner's Long-Term Care Insurance Task Force.

​Dr. Steinberg enjoys presenting at educational conferences to professional audiences and the public, and also serves as a consultant and testifying expert witness in civil lawsuits and regulatory matters. He hosts two podcasts for AMDA, called JAMDA-on-the-Go and Caring-on-the-Go. Dr. Steinberg is perhaps best known for taking his poodles on nursing home rounds with him.