What Is the Big Deal About Palliative Care?

When someone mentions palliative care or hospice, most people think of death. I have even been affectionately called "Dr. Death". Quite the contrary, hospice and palliative care are all about LIVING. It's about making each day the best it can be.

You may be like a lot of people and think that Hospice and Palliative Care are the same thing. Or maybe you have an idea about what hospice is but not a clue as to what palliative care entails. Well, you've come to the right place! In the next few paragraphs, I will attempt to answer the most common questions and resolve the most common myths related to hospice and palliative care.

Palliative Care is a medical specialty that focuses on improving quality of life for those patients facing serious illnesses. It concentrates on pain and symptom management while focusing on the patient as a whole and supporting their family. Someone can receive palliative care from the time of diagnosis and continue it while receiving aggressive, curative treatment.

The palliative care team works to relieve symptoms such as pain, shortness of breath, fatigue, constipation, nausea/vomiting, loss of appetite and difficulty sleeping. It helps improve daily life and gives strength for medical treatments. It can also help the patient decide about future treatments.

Hospice is very similar in that it serves to improve quality of life by focusing on pain and symptom management, but it does so in patients facing the final phases of their illnesses. Patients usually have a life expectancy of 6 months or less. The focus is on comfort rather than cure. The philosophy of hospice is to provide support for the patient's physical, emotional, social and spiritual needs.

Most of hospice care is provided in the patient's home by a team lead by a physician, nurses, nurse aides, social worker, chaplain, volunteers and bereavement coordinator. It provides medications for symptoms, medical supplies and equipment, social services, bereavement assistance for the family, respite care and hospitalization if needed.

Some common myths about Hospice and Palliative Care:

1. Hospice is a place.
   TRUTH: Hospice takes place wherever the need is-usually the home but can be in a hospital, nursing home, assisted living facility; about 70% of hospice care takes place in the home.
2. Hospice is only for people with cancer.
   TRUTH: Only half of patients nationwide in hospice have cancer; hospices serve patients with chronic diseases like emphysema, Alzheimer's dementia, heart disease and neuromuscular disease.
3. Hospice care is expensive.
   TRUTH: Hospice patients over age 65 are entitled to hospice care under the Medicare Hospice Benefit. This benefit covers almost all hospice expenses with little (if any) out-of-pocket expenses.
4. Hospice is just for the patient.
   TRUTH: The quality of life for the patient, and also family members and others who are caregivers, is the highest priority.
5. Once a patient elects hospice care, he/she cannot return to traditional medical treatment.
   TRUTH: Patients always have the right to return to traditional medical treatment at any time, for any reason. If a patient's condition improves or the disease goes into remission, he/she can be discharged from a hospice and return to aggressive, curative measures. The patient can then return to hospice at any time.
6. Patients are sedated with medications (mainly Morphine) until they die.
   TRUTH: Medications are carefully monitored by nurses and physicians to find the optimal balance between comfort and alertness to allow patients to get the most out of every day.
7. Patients have to be a DNR to be in hospice.
   TRUTH: Having a DNR (Do Not Resuscitate) is a patient and family CHOICE; a patient has the right to choose to have CPR (cardiopulmonary resuscitation). We offer education to patients and families about choosing to be resuscitated versus choosing to be a DNR and allow them to make that decision.
8. Hospice care means giving up hope.
   TRUTH: It is exactly the opposite in hospice. It is actually redefining hope and shifting the focus. The motto of hospice is "There is something we can do". Hope for patients and families is found in spending the final weeks or months of their life in a dignified and peaceful way.

If you believe hospice or palliative care may be right for yourself or a loved one, discuss it with your primary care physician. He/she can help make that decision with you and refer you to a palliative care physician or a hospice agency.