March 8, 2014

Hospice Care versus Palliative Care

As we age, new terms begin to creep into our vocabulary. My exposure to hospice care came into being when my first wife had cancer with little hope of winning the battle. Almost 12 years ago on March 23, 2002, she lost the battle. If it had not been for the caring folks of our local hospice group, I honestly don't know what I would have done. As people with diabetes, we never know when we may need hospice care or palliative care.

Palliative care was not a term I was familiar with until about ten years later. At the time, I was not sure I liked what I saw being done to a friend with Alzheimer's disease. Since I was not sure that there were other illnesses involved, I was concerned that he was being ignored and a form of euthanasia was being employed. One day I asked the nurse why he was being treated the way he was and I was told he was being given palliative care. I won't go into the expletives that went through my mind about his care, but I was going to do some research.

Hospice care and palliative care can go hand-in-hand, and often do, but it is important to understand the meaning and definition of each. Hospice Care is palliative by its very nature. My friend was receiving neither, but was on an experimental treatment, which his family was not aware of and once they were made aware of this, transferred him out of the care facility to another facility.

When most people think of hospice care, they are thinking about end of life care and this would be correct. One point is important - With Hospice Care, Medicare requires that a physician certify that a patient’s condition is terminal. The physician must certify that a patient’s life expectancy is six months or less. Both Palliative and Hospice Care can be delivered at any location. Hospice is normally considered for people near the end of life. Just because they are on hospice does not mean that once the six months of hospice has passed, they are removed from hospice. Many people have been on hospice more than once and many have been on hospice longer than six months.

The focus of hospice relies on the belief that each of us has the right to die pain-free and with dignity, and that our loved ones will receive the necessary support to allow us to do so. Hospice is a philosophy, not a specific place.

  1. Hospice focuses on caring, not curing and, in most cases; care is provided in the person's home.
  2. Hospice care also is provided in freestanding hospice centers, hospitals, and nursing homes and other long-term care facilities.
  3. Hospice services are available to patients of any age, religion, race, or illness.
  4. Hospice care is covered under Medicare, Medicaid, most private insurance plans, HMOs, and other managed care organizations.
  5. Hospice Care services are more inclusive than Palliative Care services. Hospice Care includes physician services, nursing services, social worker, spiritual care, bereavement care and volunteers.

For a blog on three hospice myths, read this blog.

Palliative care treatments are not limited with palliative care and can range from conservative to aggressive and curative. This can be used at any stage of the illness and need not wait until the advanced stages.

Palliative care focuses on relieving the symptoms that are related to chronic illnesses.
This care is generally provided by a team of specialists, which may include physicians, nonphysician clinicians, social workers, chaplains, pharmacists, and nutritionists. The palliative care team works in conjunction with the primary physician. The team can offer assistance with treatment of pain and other symptoms, assistance with communication of bad news regarding diagnosis and prognosis, support for patients and families in medical decision-making and in navigating the complex medical system, and emotional and spiritual support.

Palliative care in the United States is relatively new starting in 1996 where hospice care started in when the philosophy and principles were introduced in the 1970s. The concept gained acceptance and Medicare began covering its costs in 1982. The first board examination for palliative care under the American Board of Medical Subspecialties (ABMS) was offered in 2008.

Nurses are an integral part of any palliative care treatment. Since palliative care nursing is so complex, the specialty requires training in subjects such as social issues and psychology. Palliative care nurses should have a thorough knowledge of medications used for pain, symptom control, and psychiatric conditions. The nurses work with the patient and bring information to the treating physician, but they also work quite independently.

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