Post-acute care (PAC) and hospice care are often confused because both services occur after a patient is discharged from an acute care hospital stay. Understanding the specific definitions, goals, and regulatory structures of each is necessary to clarify their distinct roles. This article defines these two models of care to explain why hospice is generally not considered a form of post-acute care, despite their shared position in the healthcare continuum.
What is Post-Acute Care
Post-Acute Care (PAC) is a category of short-term, comprehensive services provided immediately following a hospitalization for a serious illness, injury, or surgery. The fundamental purpose of PAC is to stabilize the patient, provide necessary medical management, and facilitate rehabilitation. This phase acts as a bridge between high-intensity hospital treatment and the patient’s return to independence at home.
The overarching goal of PAC is recovery, aiming to restore the patient’s functional abilities and prevent hospital readmission. Services are highly skilled and often include physical, occupational, and speech therapies to regain strength and daily living skills. PAC is delivered in several distinct settings, including Skilled Nursing Facilities (SNFs), Inpatient Rehabilitation Facilities (IRFs), Long-Term Care Hospitals (LTCHs), or through Home Health Agencies.
The Scope and Goals of Hospice Care
Hospice care is a specialized, holistic program designed for individuals facing a terminal illness, typically when a physician certifies a prognosis of six months or less. The focus shifts away from curative or life-prolonging treatments toward comfort and quality of life, a philosophy known as palliative care. This care model addresses the patient’s physical symptoms, as well as their emotional, social, and spiritual needs.
Hospice services are delivered by an interdisciplinary team, often including physicians, nurses, social workers, spiritual counselors, and home health aides. While hospice can be provided in a dedicated facility, it is most commonly delivered in the patient’s own home or a long-term care setting. The Medicare Hospice Benefit covers costs related to the terminal illness, including medications for pain and symptom management, medical equipment, and respite care for caregivers.
Distinguishing PAC from Hospice Care
The primary distinction between post-acute care and hospice care lies in their fundamental goals and the patient’s prognosis. PAC is inherently rehabilitative, centered on functional improvement and recovery with a clear intent to return the patient to a non-institutional setting. In contrast, hospice is palliative, meaning it focuses on comfort and symptom control when a cure is no longer possible or desired.
Eligibility criteria further highlight this difference. PAC is accessed based on a need for skilled services, such as intensive physical therapy following a medical event. Hospice eligibility is solely determined by a physician-certified terminal prognosis. Because PAC is defined by its short-term, recovery-oriented services, hospice’s non-rehabilitative, end-of-life focus means it is generally categorized as a distinct service outside of the PAC model.
Patient Transition and Continuum of Care
In the healthcare continuum, patients may experience a transition between these two distinct models of care. A patient might first receive PAC, such as a stay in a Skilled Nursing Facility following a surgery or stroke, to regain strength and mobility. This recovery-focused care aims at achieving the maximum possible functional improvement.
If a patient’s underlying condition progresses, they may become eligible for hospice care. The transition occurs when the goal of care formally shifts from intensive rehabilitation to comfort and symptom management. In this scenario, the patient moves from a setting dedicated to recovery (PAC) to one focused on end-of-life support (Hospice).