Seasons of Life

Support During Serious Illness

Hospice Vs. Palliative Care

When you or a loved one needs specialized care during a serious illness, palliative care can

significantly improve quality of life, easing symptoms and providing support. Hospice care, on the other hand, brings comfort to those experiencing a terminal illness. Both specialties address the challenges and improve the well-being of patient and caregiver. The aims of hospice and palliative care are similar, but there is a difference. Palliative care may begin at diagnosis and occur along with treatment. Hospice is specialized care when recovery is not expected and curative treatment is stopped.

Palliative care is relatively new, becoming a defined medical specialty in 2006. I was not familiar with it until my sister-in-law developed a debilitating illness six years ago. Many fellowships are available in the United States to train doctors, nurse practitioners, and social workers in palliative care. Most large hospitals now have palliative care teams.

Palliative care affirms life and provides relief from pain and distress. It includes psychological and spiritual care, encourages an active life, and offers support to the family of the person who is ill. Palliative care benefits those with illnesses such as cancer, heart disease, lung disease, kidney failure, dementia, AIDS, or ALS. Patients can remain under the care of their regular doctor as they receive treatment. A palliative care team might include doctors, nurses, physician assistants, dietitians, social workers, psychologists, massage therapists, or chaplains. By Linda Barnes

The goal of palliative care is to help patients feel better while they undergo treatment for serious illness. Symptoms caused by the illness or the treatment are eased. The stress, fear, or anxiety that treatment can bring are attended to, and spiritual challenges can be explored. Treatment often causes nausea, loss of appetite, sleeplessness, or pain. Palliative care is an extra layer of support, addressing all of these. Palliative care teams can also help with logistical challenges like understanding medical forms or treatment choices, obtaining financial counseling, and securing housing or transportation during treatment.

Look for palliative care services at hospitals, clinics, home care agencies, cancer centers, or rehabilitation facilities. Though it is often covered by health insurance, including Medicare or Medicaid, check with your provider. A social worker or hospital’s financial counselor may be able to help.

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Hospice care is for people with serious illnesses who do not expect to recover. Usually, a doctor and patient come to agree that curative treatment is no longer effective or desired. Caregivers focus on achieving the best possible quality of life for the patient in the time that remains.

Hospice may involve medications to ease pain, medical equipment, counseling, and other kinds of support. Care can be provided in one’s home, at an assisted living facility or skilled nursing facility, in a hospital, or at a facility dedicated to hospice care. A team might include a doctor, nurse, social worker, and others working together with caregivers and family, giving support where needed.

A member of the hospice team makes regular visits, and someone is available by phone 24/7. Daily care is provided by family or friends, augmented by the hospice team. If the patient prefers to stay at home but no family or friends can help with daily care, in-home care may be obtained. Note that insurance and Medicare do not normally cover this. For Medicare to cover hospice costs, they must be given by an approved provider.

The hospice team coaches family members or others to care for the terminally ill patient’s physical and emotional needs. This can be a heavy load for caregivers. Respite care may be needed to give them a break. Most insurance does not cover respite care, but Medicare will likely cover most of the cost for up to five days.

Deciding on hospice care can be difficult for the patient and also the family, but it is likely to improve quality of life for both. Some feel it to be too final—what if the patient stabilizes or improves? What does “stopping treatment” really mean? A person can stop hospice care at any time. Though treatments meant to cure are discontinued, other measures such as medications to control high blood pressure, oxygen to ease breathing, or diuretics to address fluid retention will continue. The goal is not to prolong life, nor is it to shorten the time remaining.

To enter hospice care, a medical doctor must certify that the patient is terminally ill and is expected to live six months or less. For palliative care, it is the patient’s wish that is determinative. Most professionals advise starting palliative care early in treatment.

How fortunate that we have specialists able to improve quality of life during recovery from a serious illness! When recovery is not possible, it is reassuring to have roundthe-clock specialty support for patients and caregivers.

Sources for this article included: medlineplus.gov, nehospice.org, and americanhospice.org.

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