There are special services available from medical professionals during this time of your life. These services can also be helpful, under certain circumstances, while waiting for completion of a medical treatment such as a transplant or chemotherapy. One example of when these services might be employed is for cirrhosis patients that may have completed their workup for transplant, who still have some severe complications (like Hepatic Encephalopathy [HE] in patients with liver problems) and whose caregivers cannot always be present.
There are two types of care available for this time in your life. One is called "hospice" care and the other is called "palliative"care. There are some subtle differences between these two types of care but both focus on keeping extremely ill patients comfortable, while helping patients, family members, and caregivers be comfortable and cope with the entire process. From the start of a serious or terminal illness, practitioners try to reduce the burden on family caregivers by identifying and providing for patient and family needs, whether physical, emotional, practical or spiritual.
You have probably heard of hospice care before and may have general knowledge of the services it provides. What is confusing about the difference between hospice and palliative care is that hospice provides "palliative care," and that palliative care is both a method of administering "comfort" care and increasingly, an administered system of palliative care offered most prevalently by hospitals.
Care services for the seriously ill, their caregivers, families and loved ones include:
Curative or Life-Prolonging Treatments While hospice care usually requires that patients give up such treatments, palliative care services make no such injunction. Palliative care patients can receive all of the benefits of comfort care while continuing curative treatment of their condition.
Relief of Physical Suffering Palliative care professionals provide highly skilled symptom management for pain, anxiety, constipation, weakness, and many other kinds of discomfort. They also help patients and families deal with side effects of therapies.
Attention to Emotional Needs Palliative care recognizes that emotional and spiritual distress are important sources of suffering. Palliative care teams can offer help with non-physical pain through counseling and spiritual support.
Communication Palliative care teams are made up of not only medical and nursing practitioners, but social workers, clergy, pharmacists, and physical and occupational therapists. Thanks to their interdisciplinary nature, the teams can facilitate frank discussions between all the relevant players about what is needed during a patient's illness, as well as help patients identify their own goals for the dying process.
Guarantee Of 24/7 Access to Help By coordinating communication between doctors, home care nurses, pharmacists, hospital and nursing home staff, palliative care teams ensure that patients and their families can always reach someone quickly with questions. After a hospital stay, palliative care teams can arrange reliable at-home care so that patients and their families don't fall through the cracks. Teams can organize practical help with transportation, at-home equipment, medications and day-to-day decision-making.
Support for the Bereaved Family Palliative care programs don't forget about the family after a patient dies. They recognize that family caregivers need help and support after an illness and make sure that support and counseling services are available to those who need them.
Sounds Good! How Do I Get Palliative Care? While palliative care can be given to any patient in any part of a hospital, doctor's office, or even at home, hospital and nursing home-based palliative care programs are still few and far between. Ask your doctor, nurse or local hospice program if there is a palliative care program available in your hospital or community. And if there isn't one, ask why.
Palliative care programs and hospice care programs differ in the care location, timing, payment and eligibility for services.
Place Hospice: Hospice programs far outnumber palliative care programs. Generally, once enrolled through a referral from the primary care physician, a patient's hospice care program, which is overseen by a team of hospice professionals, is administered in the home. Hospice often relies upon the family caregiver, as well as a visiting hospice nurse. While hospice can provide round-the-clock care in a nursing home, a specially equipped hospice facility, or, on occasion, in a hospital, this is not the norm.
Palliative Care: Palliative care teams are made up of doctors, nurses, and other professional medical caregivers, often at the facility where a patient will first receive treatment. These individuals will administer or oversee most of the ongoing comfort-care patients receive. While palliative care can be administered in the home, it is most common to receive palliative care in an institution such as a hospital, extended care facility or nursing home that is associated with a palliative care team.
Timing Hospice: One must generally be considered to be terminal or within six months of death to be eligible for most hospice programs or to receive hospice benefits from your insurance.
Palliative Care: There are no time restrictions. Patients at can receive palliative care any time, at any stage of illness whether it be terminal or not.
Payment Hospice: Before considering hospice, it is important to check on policy limits for payment. While hospice can be considered an all-inclusive treatment in terms of payment (hospice programs cover almost all expenses) insurance coverage for hospice can vary. Some hospice programs offer subsidized care for the economically disadvantaged, or for patients not covered under their own insurance. Many hospice programs are covered under Medicare.
Palliative Care: Since this service will generally be administered through your hospital or regular medical provider; it is likely that it is covered by your regular medical insurance. It is important to note, however, that each item will be billed separately, just as they are with regular hospital and doctor visits. If you receive outpatient palliative care, prescriptions will be billed separately and are only covered as provided by your regular insurance. In-patient care however, often does cover prescription charges. For more details, check with your insurance company, doctor, or hospital administration.
Treatment Hospice: Most programs concentrate on comfort rather than aggressive disease abatement. By electing to forego extensive life-prolonging treatment, hospice patients can concentrate on getting the most out of the time they have left, without some of the negative side effects that life-prolonging treatments can have. Most hospice patients can achieve a level of comfort that allows them to concentrate on the emotional and practical issues of dying.
Palliative Care: Since there are no time limits on when you can receive palliative care, it acts to fill the gap for patients who want and need comfort at any stage of any disease, whether terminal or chronic. In a palliative care program, there is no expectation that life-prolonging therapies will be avoided.
It is important to note that there will be exceptions to the general treatment precepts outlined. There are some hospice programs that will provide life-prolonging treatments, and there are some palliative care programs that concentrate mostly on end-of-life care. Consult your physician or care-administrator for the best service for you.