Palliative vs. Hospice…how do I choose?

At Elite, we are often asked about the difference between palliative and hospice. The biggest misconception is that palliative is “hospice light”, and this just isn’t true. Palliative is designed to help you live your best life while you are still pursuing curative treatments. That means, our goal is to help you live the life and participate in the activities by minimizing symptoms and side effects of the medical interventions you need. 

Palliative Care

Definition:
  • Palliative care is a holistic approach aimed at improving the quality of life for patients facing serious illnesses.
  • It is not limited to end-of-life situations and can be provided at any stage of an illness.
Goals of Palliative Care:
  • The primary goal is to manage symptoms and improve overall well-being.
  • A multidisciplinary team collaborates to address physical, emotional, and spiritual needs. At Elite, our team is led by a nurse practitioner, a medical assistant, a social worker, a chaplain, and a nurse. We meet together regularly to support your individual situation.
Applicability:
  • Palliative care is suitable for patients at any age and any stage of a serious illness, including those undergoing curative treatment.

Hospice Care

Definition:
  • Hospice care is a specialized form of care focused on providing comfort and support for those nearing the end of life.
  • Hospice care is typically considered when curative treatments are no longer effective or desired.
Goals of Hospice Care:
  • The primary goal of hospice is to enhance the quality of life in the final months, weeks, or days.
  • Hospice professionals are focusing on pain management, emotional support, and facilitating a peaceful and dignified death.
Applicability:
  • Hospice care is generally for patients with a life expectancy of six months or less.
  • While many believe that hospice means giving up on treatment, the goal of the program is actually a shift in focus towards comfort and quality of life.

Key Differences

Timing:
  • Palliative care can be integrated at any stage
  • Hospice care is typically considered towards the end of life.
Goals and Focus:
  • Palliative care is focused on improving overall quality of life
  • Hospice care is focused on end-of-life comfort.
Treatment Intent:
  • Palliative care is designed to be provided alongside curative treatments
  • Hospice care is more about comfort measures and discontinuing aggressive treatments.

How are Hospice and Palliative Care provided?

All hospice is palliative, but not all palliative is hospice.

Both programs are designed to provide you comfort and target quality of life.

The programs do this task in different ways, because of when and how the programs are accessed.

Hospice is a Medicare-designed program that is implemented when an individual is no longer pursuing curative treatments and has a prognosis of less than 6 months of life if the disease process were to run its course. Hospice provides equipment, medications, and a team of support – nursing, chaplain, social worker, and an aide. Additional services can be added such as massage therapy, physical therapy, occupational therapy, and speech therapy.

Palliative is not defined by Medicare and will vary based on the provider. Most palliative programs support interventions to aid in quality of life while pursuing curative treatments. The goal for palliative is to focus on the patient and their health goals during treatment. The patient is financially responsible for all care and equipment needs. The palliative team is comprised of a practitioner (for Elite, this is a nurse practitioner), a nurse, a medical assistant, a chaplain, and a social worker.

Elite provides both hospice and palliative care services to the communities of the Lewis-Clark valley, Moscow area, and Orofino area. We may request to schedule a meeting with you, called a Goals of Care, to support your goals and needs. This conversation also helps to identify the right program for you based on what you are currently pursuing with your doctor.

If you would like additional information, please email us at info@EliteHHH.com. We would be happy to address any questions you may have about our programs, these services, and your healthcare goals.

How do I choose a Hospice Agency? Part 2

The Centers for Medicare & Medicaid Services (CMS) has created the hospice coverage program to support patients who have a terminal illness and their families through the dying process and 13 months afterwards. The guarantee supports patients receiving care from a certified hospice agency, collaboration from two providers to certify the patient’s prognosis, and the patient election of services. While the hope is for all patients to experience the comfort and care that is provided through hospice, patients and families always have a choice.

A common misconception is that hospice is only for palliative services, i.e., pain management via morphine. This is an oversimplification of the skilled services the hospice team provides and limits the level of intervention that is actually provided. Services that can support quality of life include the medical oversight from the agency provider, the skilled nursing care, the medical equipment and supplies provided, the medications that address pain and other symptoms, the care services of the certified aide, the counseling services of the social worker, the spiritual guidance of the chaplain, and the consultative training and support of physical, occupational, speech, and dietary therapies. Finally, the ongoing service provision after the patient has died cannot be discounted.

Facilities and providers that claim “hospice-like” services will often charge for the medical consultation, charge for the medications provided, and often do not address the psycho-social-emotional-spiritual aspects of the dying process. Patients on hospice are supported with a comprehensive plan that addresses how they would like to pass away, their funeral arrangements, their household arrangements, and the collaboration with their family members for key decisions beyond their healthcare. This is included in the hospice benefit. The Medicare benefit covers all of these services.

Patients are entitled to hospice. They have paid their whole life for the service, and they deserve the full benefit.

Questions you may want to explore with a potential hospice company are:

1)How will the hospice team manage my pain or other symptoms that arise? Your nurse and medical provider will review your symptoms and implement different interventions, including medications, therapies (e.g., massage), or strategies.

2) Can I take my current medications? Some patients choose to continue existing medications. All medications are discussed with your hospice team to identify side effects and symptoms that may alleviate or contribute to your comfort.

3) What if my symptoms become uncontrollable at home? Can I go to the hospital? Hospice involves different levels of care. While our goal is to manage all of your symptoms in the comfort of your home, if we are unable to do this, we will increase your care potentially involving an inpatient stay.

4)How will the hospice team keep me and my family informed about my condition? You will have ongoing communication with your hospice team, primarily through your nurse case manager.

5) Will my family and I be involved in making care decisions? Yours and your family’s concerns for care are integral in the team dynamic. Your concerns and questions are critical to developing a care decision that meets the need.

6)How do I communicate any questions or concerns I have about my care? You have access to all of your care team members. These individuals are available to you to support issues or concerns that arise.

7)Can I still see my regular doctor if I am on hospice? If you choose the agency’s medical director, your care will be deferred to the new provider in collaboration with you and the care team. You may elect to use your primary care provider to oversee your hospice benefit if you prefer to retain your provider.

8)How will the hospice team prepare me and my family for what to expect? Your team involves trained professionals who recognize signs and phases of the dying process. Part of hospice is to provide education and support as things change. This is why you will have regular visits with the nurse who will assess and provide education and training. This visit with your nurse may introduce, or exit, members of your care team based on your individual needs.

9)Can we speak with other caregivers to learn of their experience with hospice? We can connect you with individuals who have gone through the hospice process. Many times, these individuals are volunteers with our agency who want to give the support they received back to individuals who are now going through the process.

10) What support services are offered by the hospice? One of the levels of hospice involves respite care. There are also coordinated services for caregivers to provide regular opportunities to refresh. Your case manager will work with you and the social worker to identify and coordinate the appropriate supports.

11) What if we cannot take care of our loved one at home? Your social worker is a critical member at addressing your psycho-social-emotional needs. If you find that you are unable to care for your loved one at home, your social worker will work with you to identify options for placement, increased hired help, or other supports.

12) How will the hospice team support us emotionally through the grieving process? Bereavement is offered for up to 13 months. By design, your hospice benefit is meant to support your loved ones after you pass away through important dates, such as birthdays, anniversaries, and your death. These services are part of hospice and help family members after you have transitioned.

These questions are some of the more common questions we address regularly. You may have others, and those should be talked about before you start hospice. It is a big decision, and for many family members, a decision that helps shape how someone passes.

Hospice and Palliative Care

Are they different? YES

Hospice is a Medicare program. Medicare has designed and created this program.

Palliative is not a designated service. Elite has created its program, so this will look different from agency to agency.

Here is a fun way to understand how these two services are different!

Hospice and Palliative Care Month

November is the month where we get the privilege to highlight the unique realm of healthcare that is focused strictly on quality of life.

The Hospice Foundation of America provides resources to assist in selecting the best hospice provider for you.

Here are some key ideas to consider when selecting a hospice provider

https://hospicefoundation.org/Videos/video-player?id=85

What does a day on hospice look like? According to the Hospice Foundation of America, hospice is…

  • Medical care for people with an anticipated life expectancy of 6 months or less, when cure isn’t an option, and the focus shifts to symptom management and quality of life. 
  • An interdisciplinary team of professionals trained to address physical, psychosocial, and spiritual needs of the person; the team also supports family members and other intimate unpaid caregivers.  
  • Specialty care that is person-centered, stressing coordination of care, clarification of goals of care, and communication.
  • Provided primarily where a person lives, whether that is a private residence, nursing home, or community living arrangement, allowing the patient to be with important objects, memories, and family.
  • Care that includes periodic visits to the patient and family caregivers by hospice team members. Hospice providers are available 24 hours a day, 7 days a week to respond if patient or caregiver concerns arise.
  • The only medical care that includes bereavement care, which is available during the illness and for more than a year after the death for the family/intimate network.

For more information, check out Hospice Foundation Of America – What is Hospice?

This is an unbiased website about what to look for and consider when selecting a hospice provider.

As a local provider, we hope you will choose us to support you and your loved ones in this critical decision. We know every story is different and every experience is unique. Our goal is to tailor your experience to you and your wishes. If you have questions, you can always call or email us.

What really matters

How we approach healthcare matters.

As healthcare professionals, our job is to reframe how we look at people’s health and treat our patients with their goals in mind. We are intentional in our approaches to put our patient’s goals as an integral component of their care plan. Our challenge is often to reframe how we provide this care, because it breaks from expectations. And, it is constantly evolving.

One of the areas of reframing is in how we look at the end of life, and this is why we do hospice.

Hospice is designed to provide comfort and care for the end-of-life. But, this also means looking at what is meaningful in the first place for our patient. It also means bringing in people that facilitate what is meaningful and how that changes as the individual is on our service.

Hospice is provided for cancer, dementia, cardiac disease, pulmonary disease, renal disease, liver disease, HIV/AIDS, neurological disease, and strokes/coma. It is a service that is provided by a nurse, a chaplain, and a social worker. That’s the basic.

We add in massage therapy, nurses aides, volunteers, physical therapists, occupational therapists, and speech language pathologists.

Patient-directed care means that you lead the process. It also means that you help reframe what it looks like for you.

Pain is a disease

September is Pain Awareness Month.

Understanding chronic pain is critical to how we support our patients on our service.

Join us in our learning:

Pain Awareness Month – International Association for the Study of Pain (IASP) (iasp-pain.org)

September is Pain Awareness Month: Complexity and Progress in Pain Research | National Institute of Neurological Disorders and Stroke (nih.gov)

Pain Awareness Month 2023 – U.S. Pain Foundation (uspainfoundation.org)

What is Psoriasis?

Psoriasis is an immune-mediated disease* (a disease with an unclear cause that is characterized by inflammation caused by dysfunction of the immune system) that causes inflammation in the body. There may be visible signs of inflammation such as raised plaques (plaques may look different for different skin types) and scales on the skin. 

This occurs because the overactive immune system speeds up skin cell growth. Normal skin cells completely grow and shed (fall off) in a month. With psoriasis, skin cells do this in only three or four days. Instead of shedding, the skin cells pile up on the surface of the skin. Some people report that psoriasis plaques itch, burn, and sting. Plaques and scales may appear on any part of the body, although they are commonly found on the elbows, knees, and scalp.

Inflammation caused by psoriasis can impact other organs and tissues in the body. People with psoriasis may also experience other health conditions. One in three people with psoriasis may also develop psoriatic arthritis. Signs of PsA include swelling, stiffness and pain in the joints and areas surrounding the joints. PsA often goes undiagnosed, particularly in its milder forms. However, it’s important to treat PsA early on to help avoid permanent joint damage.

Symptoms often start between ages 15 and 25, but can start at any age. Menwomen, and children of all skin colors can get psoriasis.

From https://www.psoriasis.org/about-psoriasis/

Learn More at…

Aging as an adventure

Aging can have a negative connotation in our culture.

One of the goals we have at Elite is to promote healthy aging. We are intentional in our community work to preserve people’s wishes for independence, their voice in their healthcare plans, and building rehabilitation around their needs. Through home health, palliative care, and hospice, we value and respect aging. Our goal is to join you on your journey.

For information on the best aging strategies, check out:
Dishman, Eric. “Inventing wellness systems for aging in place.” Computer 37.5 (2004): 34-41.

Mitzner, Tracy L., et al. “Self-management of wellness and illness in an aging population.” Reviews of human factors and ergonomics 8.1 (2013): 277-333.

Coughlin, Joseph F., and James Pope. “Innovations in health, wellness, and aging-in-place.” IEEE Engineering in Medicine and Biology Magazine 27.4 (2008): 47-52.

If you are open to a new perspective, check out…

What if your life continued after your death?

Not all cultures look at death in the same way.

Different cultures perspective of death changes the way individuals perceive and process death, and people’s approach to the death and dying process can be very different based on their cultural perspective of life and death.

If you are interested in some interesting articles, check out:

Roberson, Karen, Turenza Smith, and Wanda Davidson. “Understanding Death Rituals.” International Journal of Childbirth Education 33.3 (2018).

Lobar, Sandra L., JoAnne M. Youngblut, and Dorothy Brooten. “Cross-cultural beliefs, ceremonies, and rituals surrounding death of a loved one.” Pediatric nursing 32.1 (2006): 44-50.