QUALITY OF LIFE-PALLIATIVE AND HOSPICE CARE

Palliative care is meant to make the patient more comfortable. To palliate is to make a disease or its symptoms less severe or unpleasant without removing the cause.

Hospice is a philosophy of care focused on comfort and quality of life, intended to give seriously ill patients and their loved ones meaningful time together when the focus is on the people, not the disease. Palliative care treats people suffering from serious and chronic illnesses, such as cancer, congestive heart failure, COPD, kidney failure, AIDS, Alzheimer’s, Parkinson’s, ALS, etc.

Palliative Care is coordinated by a team headed by clinicians board certified in hospice and palliative medicine. They create a unique plan of care based on the goals of the patient and family. They involve additional appropriate team members: social worker, chaplain and specialists like a registered dietician, music therapist and/or counselor. Working collaboratively with the patient’s medical team, the palliative care team may care for a patient at any time during the course of the illness, during or following curative treatment.

Problems Palliative Care Addresses: Advance directives, anxiety, confusion, constipation, depression, diarrhea, difficulty breathing, family concerns, stress and fear, fatigue, financial matters, legal issues, loss of appetite medical and insurance forms, nausea, pain, questions of faith, sleep problems, transitioning to end-of-life care, weakness, weight loss.

Is Hospice Care Palliative Care? Yes, hospice care is palliative care; it too focuses on comfort and support rather than cure. Palliative care is available to anyone coping with serious illness; hospice is defined as comfort care for patients with a life expectancy of six months or less.

How Long Does Palliative Care Continue? Palliative care can begin at diagnosis and continue alongside curative care. Hospice care begins when curative therapies no longer control the disease; the patient and the patient’s physician agree that curative treatment is no longer effective and/or that the side effects outweigh the benefits.

Who Pays for Palliative Care? Most insurance providers offer palliative care coverage. Medicare and Medicaid (Medi-Cal in California) cover only hospice care, during the last six months of life Hospice is “comfort care,” meaning it aggressively treats pain and other symptoms without trying to cure the illness. It is a whole package of services that is almost always provided at the patient’s home, whether that’s a private residence or a care facility.

Hospice is not about giving up. And it’s not a place, it’s a service. Most hospice companies work closely with the patients’ doctors. They partner with hospitals, nursing homes, insurers and community-based organizations to address the discomfort, fears and high expenses that often accompany an incurable illness. This approach meets the needs of the patients and their families and helps manage care transitions: from hospital to home, from curative to palliative, from chronic to advanced.

Where Does Hospice Care Happen? Hospice care can be provided in the patient’s home, as well as in dedicated inpatient hospice units, hospital beds, nursing homes and assisted living communities/residential care facilities—wherever people can benefit from comfort care. The goal is to support patients and manage their care in the setting they consider home.

Who Pays for Hospice? Hospice is covered by Medicare, Medicaid/Medi-Cal and most private insurance.

When is the right time to ask about hospice? Some neurological diseases cause a slow decline over months or years. It can be difficult to determine when the time is right for hospice. When improvement is unlikely and a decision is made to discontinue the use of a feeding tube or breathing machine, hospice care is likely to benefit the patient and family.

Patients with Parkinson’s: Severe difficulty breathing, severe difficulty swallowing, rapid progression to wheelchair- or bed-bound, barely intelligible-to-unintelligible speech, need for puréed foods, need for major assistance with eating and personal care, or total dependence on others for these activities. The patient’s neurologist or personal physician may recommend hospice when the time is right. But patients and family members often must act as their own advocates to receive the care they need. You or your loved one may request an evaluation to see if hospice is an appropriate option for care.

For more information about hospice and palliative care visit VITAS HOSPICE. Since VITAS accepts Medicare and Medicaid as 100 percent coverage for its hospice services, there are no out-of-pocket expenses for eligible patients or their loved ones.