What Is Palliative Care?
If you asked people “What is palliative care?,” most would probably say it means the care you get when you are terminally ill and going into hospice. Although the two are connected, they are not the same.
Palliative care, which is also known as “comfort care,” helps seriously ill people handle the pain, symptoms and stresses of their conditions to promote the best quality of life possible for them and their families. Those who opt for palliative care tend to spend less time in intensive care units and typically don’t go to the emergency room or back into the hospital once they’ve been sent home.
This specialized medical support can take place in the hospital or a skilled nursing facility, at home and, yes, in a hospice setting. Here’s what you need to know about palliative care.
What’s the difference between hospice care and palliative care?
There’s a saying in the healthcare industry: “All hospice is palliative care, but not all palliative care is hospice.” As noted above, palliative care can happen in hospice but it can take place in other locations.
Palliative care applies to several different types of health issues:
- Diseases that are being actively treated, such as cancer
- Incurable conditions, such as congestive heart failure or chronic obstructive pulmonary disease
- End-of-life situations, whether that takes place at home, in the hospital or at a skilled nursing center
Palliative care doesn’t replace primary medical care, but it can be a big part of treatment—what the National Hospice and Palliative Care Organization calls “an adjunct to curative care.” Unlike hospice care, which is typically for those diagnosed as having six months or less to live, palliative care has no time limits.
In some cases, those who technically qualify for hospice but are not ready to make that decision will opt for palliative care.
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Elements of palliative care
If you or a loved one wants palliative care, the first appointment with a palliative care team can happen in the hospital or in the early stages of treatment at some other facility. The team will work with medical providers to coordinate care and can address the following issues:
Symptom management: Pain is the symptom most people immediately think of, but palliative care also can address symptoms such as nausea or anxiety.
Care techniques: Palliative care specialists will offer advice on improving overall daily comfort, such as breathing techniques, visualization, and massage or other “healing touch” therapies.
Referrals (if applicable): If need be, the palliative care team can provide referrals to other doctors, such as pain management specialists, who can help improve care.
Help with paperwork: Insurance forms can be overwhelming. So can dealing with the workplace, if the patient or spouse is still employed. A palliative care team member can help patients and their families with work and insurance issues.
Advance care planning: A palliative care team can help patients determine what sort of end-of-life medical care they do or do not want and put those wishes in an advance directive.The team also can help with selecting a healthcare power of attorney.
Advice and support: Serious illness takes a huge toll both on patients and their loved ones, especially those who act as caregivers. All are encouraged to speak with a palliative care chaplain, social worker or other team member. For example, sometimes patients worry about their condition’s impact on their family, while the family members are afraid they won’t be able to provide the right support for patients. A palliative care team has seen it all and is well-equipped to provide advice or offer referrals to community resources.
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Does palliative care mean giving up?
No. It means asking for help to maintain the best possible quality of life during treatment. It also means learning about all treatment options to make informed decisions about care, including whether and when to decline further treatment.
Some conditions, such as cancer, may be curable. Again, palliative care is part of the treatment along with chemotherapy or radiation. In some cases, however, patients may decide to decline aggressive cancer treatment, in favor of palliative care only.
Other health issues, such as end-stage liver disease, will ultimately prove fatal. These patients can receive palliative care throughout their illnesses and in hospice, if they choose that route.
How to get palliative care
A doctor or hospital personnel will likely bring up palliative care as an option for those diagnosed with serious conditions. This can be true even if the condition is not likely to be fatal right away.
For example, people can live for years with congestive heart failure. At some point, however, treatment may no longer work. Palliative care can help ensure the most comfortable quality of life for end-stage illnesses and support families during this difficult time.
Choosing palliative care in advance
A disabling stroke could happen without warning. Other conditions, such as undiagnosed brain cancer or rapidly progressing dementia, might also leave someone incapacitated. That’s why it’s important for people to make their wishes known about the kind of care they want to receive by making an advance directive and naming a healthcare power of attorney.
An advance directive is a document that allows people to spell out what sort of care they do or don’t want, such as artificially provided nutrition and hydration, mechanical ventilation, life-prolonging care, and organ or whole-body donation.
It’s important for people to make these decisions while they are healthy and still capable of making choices for themselves. Those who don’t put their wishes in writing force family members and caregivers to guess—and maybe argue about what care they might have wanted. This can lead to bad feelings and possibly even lawsuits.
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Who pays for palliative care?
Medicare Part A covers many types of palliative care in a hospital or a skilled nursing facility (short-term stays), as well as part-time skilled home health aide visits or rehabilitation services. It also covers palliative care in hospice cases.
Medicare Part B will cover many outpatient palliative care needs, such as doctor’s appointments, durable medical equipment, rehabilitation therapy and mental health counseling.
Medicare Part C, also known as Medicare Advantage, includes all services covered by Medicare Parts A and B. One kind of Part C coverage, the “special needs plan,” may be of interest to those with chronic medical issues.
It’s important to note that patients with end-stage renal disease typically cannot get Medicare Advantage.
Will Medicare cover all palliative therapies?
No. To qualify, the therapy or service must meet the following criteria:
- Not be statutorily excluded by Medicare
- Have a defined benefit category
- Be reasonable and necessary for the diagnosis or treatment of an illness or injury
In other words, not every service or therapy that improves your quality of life will be covered. It must comply with Medicare coverage regulations.
Note: Some Medicare Advantage plans will cover certain home-based palliative care services that aren’t covered by Medicare Part A, according to a spokesperson for the Centers for Medicare & Medicaid Services. Talk to your insurance provider, or contact an insurance brokerage that specializes in Medicare, such as Boomer Benefits.
The bottom line
Dealing with serious conditions or fatal diagnoses is terrifying both for patients and their families. Palliative care services address both the symptoms and the stress of the patient’s condition. It also helps family and friends cope with their grief and their fears so they can best support their loved ones and enjoy the best possible quality of life.
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