PALLIATIVE CARE OR HOSPICE CARE?by Tricia Degan
Since the term palliative care was introduced in the United States in the early 1990s, more and more providers are offering "comfort care" to patients with serious chronic conditions that often cause pain and other symptoms. Palliative care is specialized medical care that focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness - whatever the diagnosis. Palliative care is provided by a team of doctors, nurses, and other specialists who work together with a patient's other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in an illness and can be provided along with curative treatment. However, palliative care is not hospice care.
Hospice care is considered by many to be the pre-cursor to the concept of palliative care. Hospice providers are the pioneers in employing palliative care as the basis for pain management and dignified care at end of life. Dr. Cecily Saunders, a British physician, began the modern hospice movement during the 1960's by establishing St. Christopher's Hospice near London. St. Christopher's organized a team approach to professional caregiving, and was the first program to use modern pain management techniques to compassionately care for the dying. The first hospice in the United States was established in New Haven, Connecticut in 1974. Hospice care is also provided by a team of doctors, nurses and other specialists; but it also includes hospice aides, homemakers and volunteers who provide a variety of services.
Palliative care and hospice care share many similarities; however there are two main differences between the two:
1. Palliative care is appropriate at any stage in a serious illness whereas hospice care is appropriate for individuals when the prognosis is approximately six months or less to live. Patients who live longer than 6 months can often continue on hospice. If their illness takes a turn for the better, patients can stop receiving hospice care.
2. Palliative care can be provided while a person is also pursuing curative treatment; hospice care is provided to individuals who are no longer pursuing curative treatment and quality of life during the time they have left with family and friends is paramount.
There are other differences to think about when considering palliative care and hospice care. 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. Hospice care is provided primarily in the home, but it is appropriate wherever the patient lives - whether in their own home, a caregiver's home, nursing home, assisted living facility, or a hospice residence. Hospice care can also be provided in the hospital.
Additionally, hospice care considers the entire family as the unit of care and provides supports and resources for caregivers who are often overwhelmed. Hospice continues to serve family members even after the loss of their loved one by providing bereavement services. The goal is to be there for those who are left behind as they move through their own personal grieving process.
Patients with serious illness will see benefits in choosing a palliative care model while pursing curative, often aggressive treatment. However, it is important to know when the transition to hospice care may be the best choice should those treatments not be effective, or are no longer tolerable or desired. Many patients wait too long before choosing hospice and suffer symptoms that may have been eased with a hospice plan of care provided by specialists who care for the dying.
Because hospice providers are specialists in palliative care, many now offer palliative services to individuals still pursuing curative treatment, recognizing that if a transition to hospice care is in the best interest of the patient that it can be seamless and immediate. It is important to ask your "comfort care" provider if this is an option - and to ask for hospice by name. Patients need hospice care, because of the positive impact it has for end-of-life care as well as its impact for caregivers. Quality of life is improved, many patients actually live longer than those who don't receive hospice care, and caregivers have also seen tangible benefits even long after the death of their loved one.
If you or someone you love is struggling to cope with a serious illness, call your local hospice provider. In Niagara County, call Niagara Hospice at 439-4417. More information can also be found on the organization website at www.NiagaraHospice.org.