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Hospice vs Palliative care

 
 
Reply Fri 8 Apr, 2011 09:34 am
In the United States hospice and palliative care represent two different aspects of care with similar philosophy, but with different payment systems and location of services. Palliative care services are most often provided in acute care hospitals organized around an interdisciplinary consultation service with or without an acute inpatient palliative care ward. Palliative care may also be provided in the dying person's home as a "bridge" program between traditional US home care services and hospice care or provided in long-term care facilities. In contrast over 80% of hospice care in the US is provided in a patient's home with the remainder provided to patients residing in long-term care facilities or in free standing hospice residential facilities. In the UK hospice is seen as one part of the specialty of palliative care and no differentiation is made between 'hospice' and 'palliative care'.

In most countries hospice and palliative care is provided by an interdisciplinary team consisting of physicians, registered nurses, nursing assistants, social workers, hospice chaplains, pharmacists, physiotherapists, occupational therapists, complementary therapists, volunteers, and, most important, the family. The team's focus is to optimize the patient's comfort. Additional members of the team are likely to include certified nursing assistants or home health care aides, volunteers from the community (largely untrained but some being skilled medical personnel), and housekeepers. In the United States, the physician subspecialty of Hospice and Palliative Medicine was established in 2006,[9] to provide expertise in the care of patients with life-limiting, advanced disease and catastrophic injury; the relief of distressing symptoms; the coordination of interdisciplinary patient and family-centered care in diverse settings; the use of specialized care systems including hospice; the management of the imminently dying patient; and legal and ethical decision making in end-of-life care.[10]

Medications used for palliative patients are used differently than standard medications, based on established practices with varying degrees of evidence. Examples include the use of antipsychotic medications to treat nausea, anticonvulsants to treat pain, and morphine to treat dyspnea. Routes of administration may differ from acute or chronic care, as many patients lose the ability to swallow. A common alternative route of administration is subcutaneous, as it is less traumatic and less difficult to maintain than intravenous medications. Other routes of administration include sublingual, subcutaneous, intramuscular and transdermal. Medications are often managed at home by family or nursing support.[11]

In the UK palliative care services offer inpatient care, home care, day care, and outpatient services, and work in close partnership with mainstream services. Hospices often house a full range of services and professionals for both pediatric and adult patients.

In the US palliative care services can be offered to any patient without restriction to disease or prognosis. Hospice care under the Medicare Hospice Benefit, however, requires that two physicians certify that a patient has less than six months to live if the disease follows its usual course. This does not mean, though, that if a patient is still living after six months in hospice he or she will be discharged from the service. Such restrictions do not exist in other countries such as the UK.

Caregivers, both family and volunteers, are crucial to the palliative care system. Caregivers and patients often form lasting friendships over the course of care. As a consequence caregivers may find themselves under severe emotional and physical strain. Opportunities for caregiver respite are some of the services hospices provide to promote caregiver well-being. Respite may last a few hours up to several days (the latter being done usually by placing the patient in a nursing home or in-patient hospice unit for several days).

Because palliative care sees an increasingly wide range of conditions in patients at varying stages of their illness it follows that palliative care teams offer a range of care. This may range from managing the physical symptoms in patients receiving treatment for cancer, to treating depression in patients with advanced disease, to the care of patients in their last days and hours. Much of the work involves helping patients with complex or severe physical, psychological, social, and spiritual problems. In the UK over half of patients are improved sufficiently to return home. Most hospice organizations offer bereavement counselling to the patient's partner or family should he die.

In the US board certification for physicians in palliative care was through the American Board of Hospice and Palliative Medicine; recently this was changed to be done through any of 11 different specialty boards through an ABMS-approved procedure. More than 50 fellowship programs provide 1–2 years of specialty training following a primary residency. In the UK palliative care has been a full specialty of medicine since 1989 and training is governed by the same regulations through the Royal College of Physicians as with any other medical specialty.[12]

Funding for hospice and palliative care services varies. In the UK and many other countries all palliative care is offered free to the patient and their family, either through the National Health Service (as in the UK) or through charities working in partnership with the local health services. Palliative care services in the US are paid by philanthropy, fee-for service mechanisms, or from direct hospital support while hospice care is provided as Medicare benefit; similar hospice benefits are offered by Medicaid and most private health insurers. Under the Medicare Hospice Benefit (MHB) a patient signs off their Medicare Part A (hospital payment) and enrolls in the MHB with direct care provided by a Medicare certified hospice agency. Under terms of the MHB the Hospice agency is responsible for the Plan of Care and may not bill the patient for services. The hospice agency, together with the patient's primary physician, is responsible for determining the Plan of Care. All costs related to the terminal illness are paid from a per diem rate (~US $126/day) that the hospice agency receives from Medicare - this includes all drugs and equipment, nursing, social service, chaplain visits, and other services deemed appropriate by the hospice agency; Medicare does not pay for custodial care. Patients may elect to withdraw from the MHB and return to Medicare Part A and later re-enroll in hospice.

The first pan-European centre devoted to improving patient palliative care and end of life care was established in Trondheim, Norway in 2009. The centre is based at NTNU’s Faculty of Medicine and at St. Olavs Hospital/Trondheim University Hospital, and coordinate researchers across Europe, specifically Scotland, England, Italy, Denmark, Germany and Switzerland, along with the USA, Canada and Australia.
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Type: Discussion • Score: 35 • Views: 35,555 • Replies: 403

 
mags314772
 
  1  
Reply Fri 8 Apr, 2011 03:45 pm
@dyslexia,
Sounds like you've done a good deal of research on this since your posting earlier in the week
dyslexia
 
  1  
Reply Fri 8 Apr, 2011 03:52 pm
@mags314772,
I've had to. not much accurate information available, I found the questions/conversation at yesterdays meeting very interesting even though I was the target.
dyslexia
 
  4  
Reply Fri 8 Apr, 2011 04:04 pm
@dyslexia,
interesting ie, both Diane and I have (as I'm sure many people do) legal documents by attorney, signed and registered with the courts for DO NOT RESUSCITATE, however should Diane wake up or come home and find me dead/dying and she phones 911, in New Mexico (and perhaps other states) 911 para-medics are required to attempt up to and including bone-cracking resuscitation even if I had the documents stapled to my forehead, they have no choice. Diane would have to not call 911 and instead call the Hospice phone number instead. I had no idea.
ossobuco
 
  1  
Reply Fri 8 Apr, 2011 04:21 pm
@dyslexia,
That is really strange but apparently true, eek.
0 Replies
 
George
 
  1  
Reply Fri 8 Apr, 2011 04:27 pm
@dyslexia,
Thanks, Dys. I didn't know that.

I just looked this up on the Mass.gov site and found:

The Comfort Care/Do Not Resuscitate (CC/DNR) form is the only means for
ambulance services, EMTS and paramedics to verify that a patient has a valid
DNR. If EMTs are not shown a properly executed CC/DNR form for the patient,
EMTs are required to resuscitate per their Protocols. If they are shown a
properly executed CC/DNR form for the patient, EMTs will provide only
palliative care to the patient during transport.


Gonna have to fill one of those out.
0 Replies
 
dyslexia
 
  4  
Reply Fri 8 Apr, 2011 05:53 pm
I was intending to use this as a new-replacement thread for my discarded "hospice" thread and intended to post a synopsis of my hospice meeting yesterday but I think I'll just post a few salient points.
1. I can have whatever pain meds I want (no thanks, I'm stupid enough already, I'll let you know).
2. some questions/discussion about my "spirituality/soul" to which I'm sure they found my answers perplexing.
dadpad
 
  4  
Reply Fri 8 Apr, 2011 06:06 pm
Dys I'm finding this thread very interesting as I'm sure Mumpad will too if she can leverage me off the computer.


Quote:
1. I can have whatever pain meds I want

I'm thinking A2k dealer.
0 Replies
 
CalamityJane
 
  1  
Reply Fri 8 Apr, 2011 07:43 pm
@dyslexia,
I don't have anything to add except that you both have my support and any
help you should need, I am here for you! Getting older and being ill sure isn't for sissies!

On paper I am prepared for everything, even down to what should happen
with my ashes, but reality might look different and one does need to do a
lot of homework in order to protect oneself.
0 Replies
 
dyslexia
 
  1  
Reply Fri 8 Apr, 2011 08:07 pm
another though most peeps don't know about, think about if you want water or not in the final stages, a drink of water can postpone natural death by hours/days; painful hours/days.
dlowan
 
  1  
Reply Fri 8 Apr, 2011 08:18 pm
@dyslexia,
I'd be very interested to her more, should you decide to change your mind and want to post a synopsis.
dyslexia
 
  3  
Reply Fri 8 Apr, 2011 08:24 pm
@dlowan,
well frankly quite a bit of it was "spiritual/soul" stuff. ie "what do you think happens with your soul when you die?" and my answer was ---"depending on if I had some bourbon or not I regard the universe to be bigger than I am with not changes with my death, but with bourbon I might regard myself being on equal status with the universe"---
another "soul" question as in do you have a "soul" and my answer was ---Yes I do,it's right here where you can see it, it's in my eyes, when my eyes are closed, so is my soul."
They seemed puzzled by my answers.
dyslexia
 
  1  
Reply Fri 8 Apr, 2011 08:26 pm
@dyslexia,
actually, at least for today, I'm feeling more stress from the protocol/process/documentation than the actual prospect of death.
George
 
  2  
Reply Fri 8 Apr, 2011 08:29 pm
@dyslexia,
dyslexia wrote:
. . . They seemed puzzled by my answers.

Can't imagine why.
0 Replies
 
dyslexia
 
  1  
Reply Fri 8 Apr, 2011 08:29 pm
@dlowan,
they also seemed quite interested in my having a comfortable "recliner" chair, to which I responded that I did but I didn't find it all that comfortable and preferred my regular chair with ottoman. weird stuff innit?
dlowan
 
  1  
Reply Fri 8 Apr, 2011 08:32 pm
@dyslexia,
dyslexia wrote:

well frankly quite a bit of it was "spiritual/soul" stuff. ie "what do you think happens with your soul when you die?" and my answer was ---"depending on if I had some bourbon or not I regard the universe to be bigger than I am with not changes with my death, but with bourbon I might regard myself being on equal status with the universe"---
another "soul" question as in do you have a "soul" and my answer was ---Yes I do,it's right here where you can see it, it's in my eyes, when my eyes are closed, so is my soul."
They seemed puzzled by my answers.



Well, if I'd been one of them, that'd have been the most fun I'd had at work for some time!
0 Replies
 
dlowan
 
  1  
Reply Fri 8 Apr, 2011 08:35 pm
@dyslexia,
dyslexia wrote:

actually, at least for today, I'm feeling more stress from the protocol/process/documentation than the actual prospect of death.


Hope you have some damn fine bourbon around.

0 Replies
 
dlowan
 
  2  
Reply Fri 8 Apr, 2011 08:38 pm
@dyslexia,
dyslexia wrote:

they also seemed quite interested in my having a comfortable "recliner" chair, to which I responded that I did but I didn't find it all that comfortable and preferred my regular chair with ottoman. weird stuff innit?


Hmmm...I wonder if if that 's because of the design of the recliner or just that that is how your body is designed?

0 Replies
 
dlowan
 
  2  
Reply Fri 8 Apr, 2011 09:35 pm
May I ask what, specifically, worries you about the prospect of death, Dys?
dyslexia
 
  4  
Reply Fri 8 Apr, 2011 09:39 pm
@dlowan,
in order;Lady Diane-Sally dog-Dante cat-garden.
 

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