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'Palliative care': A term you need to know!

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The Centers for Disease Control and Prevention (CDC) estimates that nearly 50 percent of U.S. adults are living with a chronic condition, a number that is up from less than 40 percent 10 years ago.  According to the CDC, Medicare beneficiaries with chronic conditions such as congestive heart failure, stroke, arthritis, diabetes, cancer and Alzheimer’s represent a disproportionate share of Medicare fee-for-service expenditures.  One study found that the percentage of individuals 45 and over with two or more of nine selected chronic conditions continues to grow and that providing care for 78 million Baby Boomers, many of them with chronic conditions will financially strain the U.S. healthcare system.  One likely answer is palliative care.

Palliative and hospice care are often seen as the same thing and therefore viewed as synonymous with end-of-life care.  However, while  palliative care and hospice both provide care to relieve suffering and use a holistic, multidisciplinary approach that incorporates physicians, social workers, chaplains, and many other specialists working together with the patient and the patient’s family, where they differ is that hospice care requires two physicians to certify that a patient has less than 6 months to live.  Palliative care, on the other hand, is designed to relieve a patient’s suffering and improve quality of life through a serious, but not necessarily life threatening illness.

Palliative care was approved as a medical specialty in 2008 and is one of the fastest growing fields in medicine.  According to the Center to Advance Palliative Care, nearly 60 percent of U.S. hospitals with 50 or more beds have a palliative care program.  Hospitals have jumped at having palliative care teams because study after study has found that hospital palliative care teams are associated with significant cost savings (about $1700 per admission for live discharges and $5000 for patients who died).  That’s largely because a palliative care team helps link the various teams involved with a patient’s care to make better use of resources.  But the benefits aren’t merely about the cost savings, from the patient’s side of things, palliative care helps them to have a better understanding of their illness and helps them to make timely and informed decisions.

Patients at end-of-life also benefit from palliative care in that it provides ways to improve a patient’s quality of life much earlier in the process.  A study that looked at 461 cancer patients found that palliative care increased patient satisfaction and improved quality of life.  For low income patients, palliative care could relieve the strain on emergency rooms if it included transportation (now provided by ambulances) to regular doctor appointments (rather than the ER).  For those patients with advanced illness, about half of whom would prefer to die at home, home palliative services had a 2-fold increase in dying at home as compared with usual care and the severity of symptoms they experienced was less than experienced with usual care according to the Journal of American Medical Association.

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