It's often difficult for us to look the inevitable in the eye. Yes, I speak of death. It comes to us all. As the Roman poet, Horace observed, "Pale Death beats equally at the poor man's gate and at the palaces of kings."
When that end is predictable, it stands to reason that everything that can be done to comfort the dying should be done. This is the goal of care with hospice and palliative care. These two modes of care are different but connected.
Palliative care is for anyone with a serious illness, such as cancer, cardiac disease, Alzheimer's, amyotrophic lateral sclerosis (ALS or Lou Gehrig’s Disease) and multiple sclerosis. It can be utilized at any age, at any stage of an illness and with curative treatments. It is not dependent upon prognosis.
Palliative care focuses on the entire person, not just the illness. The goal is to provide the best quality of life for as long as possible. Typically, a palliative care team identifies sources of pain and discomfort. These may include problems with breathing, fatigue, depression, insomnia and other bodily functions. They establish goals for care, help with decision-making and coordination of care; and address any social, psychological, emotional or spiritual needs the patient may have. Team members often include doctors and nurses with specialties in the field, along with social workers, pharmacists, nutritionists and chaplains.
The team then provides a treatment plan to offer relief. The plan might include medications, along with physical therapies like massage or relaxation techniques. The team also coaches family caregivers on caring for the patient. While most palliative care services are given in hospitals, it is offered also in outpatient clinics, home care and long-term care facilities. A talk with your family member's doctor can determine if palliative care might help.
With many diseases, there comes a time when treatment is futile. When there simply are no more treatment options to cure the disease, hospice becomes an option. With hospice, the focus is on comfort and quality of life.
Hospice focuses on caring, not curing. In most cases, care is provided in the patient's home but may also be provided in hospice centers, nursing homes and other long-term care facilities. Hospice services are available to patients with any terminal illness, of any age, religion or race.
Like palliative care, hospice employs a team approach. This interdisciplinary team develops a care plan that meets each patient's individual needs for pain management and comfort. It normally consists of the patient's personal physician, nurses, hospice aides, social workers, bereavement counselors, clergy and trained volunteers. The U.S. hospice movement was founded by volunteers, and there is a high commitment to volunteer service. Hospice is unique in that it is the only provider whose Medicare Conditions of Participation requires that volunteers make up at least 5 percent of total patient care hours.
Typically, a family member serves as the primary caregiver and assists with decision making for the terminally ill loved one. The hospice team will teach family members and others how to provide care at home, which may involve learning a new task or procedure. Members of the hospice staff are on-call 24 hours a day, seven days a week and make regular visits to evaluate the patient and provide additional care or services.
Decisions about end-of-life care are deeply personal and involve personal values and beliefs. I urge families to talk about what type of care each member may want if facing a life-limiting illness.
Dr. Gialde is in family practice at Oak Grove Medical Clinic and can be reached at 816-690-6566.