Karen McPhail, RN, MSN
Comfort Care In the News
We are sad to hear of the loss of 92 year old, former first lady, Barbara Bush. She was truly a remarkable woman of substance, poise, and knowledge. Two of her quotes have impacted me and my life in a significant way:
"At the end of your life, you will never regret not having passed one more test, not winning one more verdict or not closing one more deal. You will regret time not spent with a husband, a friend, a child, or a parent."
"Never lose sight of the fact that the most important yardstick of your success will be how you treat other people - your family, friends, and coworkers, and even strangers you meet along the way."
Prior to her passing she brought the subject of comfort care into the news and back into debate. In my practice, there is no debate, comfort care whether hospice or palliative care is a vital and beneficial care option for many individuals. This type of care provides support and assistance in a variety of ways, but sadly many people do not use these care services or understand what they are really for. This is especially concerning for those with chronic conditions and cognitive impairments who need or could benefit from more frequent medication adjustments, support, and monitoring to provide for better quality. I commend Barbara Bush and the Bush family for supporting her decision and allowing her to pass on her terms. People do not want to hear the words comfort care or hospice, but living and dying are both a part of life.
So what exactly is palliative care and hospice care?
Perhaps providing additional information will help more people to understand this subject better and make informed decisions. Let me begin by explaining about how they are similar...
Both types of care provide individualized, specialized care for people with serious life limiting illness or conditions. Palliative care is a component of hospice care that can be used while an individual is undergoing treatment for a condition.
The biggest difference between these programs is that palliative care can be done in conjunction with treatment for a life limiting medical condition, while hospice care is only reserved for individuals who are terminally ill and with less than 6 months to live. However, under hospice care the patient and family can provide input and make decisions on many aspects of care.
The focus for these programs is on providing a team approach to supportive services and relief from the anxiety, stress, and symptoms of a serious illness. The primary goal is always to improve overall quality of life for both the patient and their loved one's.
Care is coordinated and provided by a highly trained and specialized team of doctors, nurses, social workers, clergy, music therapists, and others who work together and collaborate with individuals and health care providers to provide patient centered, wholistic, individualized services and supportive care. People are given access to more personalized / specialized services that would otherwise not be readily available.
For both hospice and palliative care programs the team members will spend a great deal of time collecting information, listening, talking about current needs, and shaping a plan for moving forward. Listening is a big part of this process! They take a broad approach to care and provide support and education in many areas. They will ensure that an individuals wishes are heard, valued, and carried forward.
In terms of costs and covered benefits for both programs:
Hospice care is covered by the Medicare and Medicaid Hospice Benefit.
In addition, the majority of insurance companies cover hospice services. Veteran’s benefits may also cover services with a minimal cost or at 100% coverage.
Palliative care is paid for by Medicare, Medicaid and most private insurances if the patient meets specific set criteria. There may be out of pocket expenses for some depending upon their clinical situation.
The hospice organization consulted can clarify coverage aspects for the above.
More about palliative care, which often requires more clarification...
Many people do not access or ask about palliative care as they do not understand how it works and when it can be used. Palliative care can be received by patients at any time and at any stage of illness whether it is terminal in nature or not.
Palliative care can be used in treating people suffering from a variety of conditions such as dementia, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), kidney disease, liver disease, transplant patients, diabetes, Parkinson’s disease, Amyotrophic Lateral Sclerosis (ALS), cancers, MS, and many more. Mrs. Bush suffered from CHF and COPD. I find that palliative care (and hospice care) can be beneficial for those with cognitive impairments and dementia. However, it is sadly under utilized and something that I am working on educating those in the field about and spreading awareness of.
This type of care assists in managing a variety of chronic symptoms such as: pain, behavioral issues, anxiety, depression, breathing difficulties, chronic fatigue, nausea, loss of appetite, sleep difficulties, and many other areas that may be effecting function and overall quality of life.
Palliative care is about providing quality of life enhancing and supportive services to assist in moving forward with living life and coping.
These supportive services allow effected individuals and family members to have better control over their care situation, better access to care and supportive services, and overall more effective coordination of care. Everyone is brought together to work on behalf of the patient to bring about positive change.
For those with a chronic condition life is difficult, there is no end to the stress, and demands on their mind and body. The process is overwhelming and at times almost impossible to manage. Palliative care with its broad and wholistic approach can help to provide support, lessen stress, and bring a sense of control and peace to the individual and family members.
If you would like to learn more about palliative care please contact a care advisor or your physician. Remember that palliative care is simply an added layer of support and comfort to move forward and live life to the fullest.