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Understanding palliative and hospice care

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Palliative and hospice care share many similarities. Both offer patients a change or supplement to traditional care options by attempting to combine counseling, symptom management and even equipment needs under one umbrella.  Both approaches are directed at patients suffering from chronic conditions such as cancer or heart disease.  Both attempt to provide patients with a balance between medical care and comfort to address a common problem with critically ill patients—sometimes the cure is worse than the disease.  This is especially true when the so-called cure isn’t really a cure but a short postponement.

If the two treatments are similar, then what makes them different? 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.

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.

Patients can receive palliative care at any stage in the disease’s progress, not just its final stage.  Hospice is palliative care but with a difference.  The patient is presumed to be at his or her end-of-life and the focus is on providing the patient with a comfortable end by managing terminal symptoms and providing support for the patient as well as the patient’s family. Hospice is available to anyone diagnosed with a terminal disease within six months of his or her expected death. One aim of hospice is to lower visits to intensive care, hospitalization and other expensive treatment by focusing on comfort rather than aggressive end-of-life treatment. Hospice care generally can include medical equipment and supplies, therapy, grief and loss counseling for the patient and the patient’s family, short-term respite care and social work services among other things.  Those services are provided at home rather than in an institutional setting.

According to the 2012 report “Hospice Care in America,” the median length of hospice service in 2011 was 19.1 days, significantly less than the time care is offered for. Yet the one regret most people have about hospice care is that they didn’t get it sooner. One reason people put off requesting hospice care is that for many Americans including many doctors, asking for hospice care is akin to giving up. So hospice care around the country is trying to rebrand itself with a focus not on death and dying but on what it can do to improve the quality of living for the patient and the patient’s family. Some hospice programs are even beginning to offer care in addition to curative services so the choice doesn’t have to be made between working to be cured and wanting to be comfortable and at home.

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.

Much of the emphasis that people place on the difference between hospice care and palliative care is that palliative care doesn’t have an expiration date.  The patient isn’t expected to die soon.  In fact, the patient may be expected to live for quite some time.  Ideally, hospice care and palliative care would work in conjunction with each other.  A patient would begin palliative treatment for a disease like dementia or cancer.  Palliative care could help provide the patient with a higher quality of care and that care could work at being in alignment with the patient’s own desires.

Palliative care teams include doctors, nurses and other professionals that provide the care in a facility such as a hospital, extended care facility or nursing home associated with palliative care, although it can be provided at home. While hospice programs far outnumber palliative care programs, palliative care is one of the fastest growing trends in health care according to the Center to Advance Palliative Care (CAPC), an industry trade group. Over 1700 hospitals with more than 50 beds have a palliative care team. Palliative care often leads to better health outcomes allowing the patient’s primary doctor to treat the underlying disease while the rest of the team’s efforts concentrate on improving the patient’s quality of life. One goal of palliative care not shared by hospice care is to provide the patient with a better understanding of their medical choices.

As the Baby Boomers age, the number of Americans with chronic disease is expected to double over the next 25 years.  CAPC expects palliative care to become a significant part of their care. For instance, by 2020, the United States aims to include palliative care as a part of every cancer patients care plan. In the future, palliative care will be an essential component of care for frail and medically compromised elderly patients.

Palliative and Hospice Comparison Chart

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