Palliative Care

It happened, again, the other day. Someone was telling me about her husband’s unrelenting pain. When I suggested he consider palliative care, she replied, “Oh, no, he’s not dying; he’s just in a lot of pain.” And that’s when I knew it was time for another PSA.

Palliative Care is one of the most misunderstood medical options available. I would venture to say most people think palliative care and hospice are synonymous – they are not. Palliative care is a specialty available to anyone with a serious illness, regardless of age or diagnosis. A palliative team consists of a physician, nurse, social worker, and chaplain. The goal of palliative care is to ameliorate a patient’s physical, emotional, and/or spiritual symptoms. Palliative care services are in addition to traditional medical management of an illness. Patients may continue to seek aggressive care such as surgery, chemotherapy, radiation, etc., while receiving palliative care. Medicare, Medicaid, and most private insurers cover palliative care costs.

I think the best way to describe hospice is to explain it is a subset of palliative care. Like palliative care, hospice includes physicians, nurses, social workers, and chaplains. In addition, hospice volunteers are available to provide companionship for patients, and a brief respite for caregivers. Hospice can be provided in a patient’s home, nursing home, outpatient hospice facility, and in some instances, a hospital. In addition to the medical team, hospice provides equipment such as a hospital bed, oxygen, and wheelchairs. Medications related to the terminal diagnosis and for symptom management are also provided by hospice.

Patients with a life expectancy of six months or less are “hospice appropriate,” regardless of their age or diagnosis. The good news is there’s no penalty if you live too long. Patients are re-certified every 90 days. As long as the disease is progressing as expected, and the patient is not pursuing aggressive treatment, hospice continues. Bereavement services are also available for the patient’s family and continue for 13 months. Hospice services are covered 100% by Medicare, Medicaid, and most private insurers.

During my time in palliative care, I heard the same statements repeatedly: “I had no idea something like this existed,” and “I wish I would have known about this sooner.” I continue to advocate for palliative services every chance I get. Often, it takes the patient/family asking their physician about palliative care before it is initiated.

For those considering hospice, I have known many patients who lived longer, and certainly better, foregoing aggressive treatment and focusing on symptom management and quality of life rather than quantity of days. If you would like more information, please reach out to https://www.nhpco.org. If you want to make sure your wishes are honored, complete an Advance Directive, your family will thank you.