Professionals from many different disciplines work with volunteers (both untrained and skilled), health care aides, nursing assistants, housekeepers and family members to provide a full range of hospice and palliative care services to patients. These experts, who include registered nurses, social workers, physicians, occupational therapists, physiotherapists, and complimentary therapists, make up the palliative care team.
To become board certified in palliative care in the United States, physicians must go through the American Board of Hospice and Palliative Medicine and undergo an additional one to two years of specialty training after primary residency. Since it has been a full specialty since 1989 in the United Kingdom, training for palliative care is regulated by the Royal College of Physicians, which regulates all medical specialties.
Who gets palliative treatments?
Palliative care services can be provided to any individual regardless of their disease and expected prognosis. To qualify for hospice care covered under the Medicare Hospice Benefit, a patient must be at end of life and have two physicians attest that he or she is expected to have less than six month to live based on medical examination. Patients who outlive the physician’s prognosis do not get ousted from the program, however.
In the United States, both non-hospice palliative care and hospice care share the same goals of relieving suffering, treating pain and symptoms, psychological and spiritual care, helping the patient live an active lifestyle, and supporting the individual’s family. Besides eligibility requirements, the main differences between the two systems are location of services and payment systems.
Palliative care services are usually offered in different locations, including acute care hospitals that provide interdisciplinary consultations, the patient’s home, or long-term care facilities. On the hand, the majority of hospice care takes place in the patient’s home.
In the US, the payment systems for non-hospice and hospice palliative care are very different. Due to the number of employees needed for a palliative care team and the total amount of time spent on each patient, hospitals have a hard time obtaining adequate financial support for their programs. Hospitals officials focus on cost-saving strategies rather than revenue-generating strategies to support them.
Palliative care can be financially supported by any of several sources, including direct hospital contributions, philanthropy, and fee-for-service methods.
What sets hospice care apart from other Medicare benefits is that it covers all pharmaceuticals, medical equipment, twenty-four hours per day/ seven days per week access to care and support for loved ones after the patient passes away. Patients who enroll in Medicare Hospice Benefit (MHB) receive care by Medicare-approved hospice agencies. The hospice agencies receive money from Medicare, which they use to pay for illness related costs and do not charge the patient any money. Individuals must sign off their Medicare A benefit to get MHB, but they have the choice to reverse their decisions.
The UK and many other countries that do not have a distinction between hospice and non-hospice care offer their citizens free palliative care through government health programs or through charities that help raise money.
The Role of Caregivers
Caregivers, both family and non-family, play an important part in the palliative care process. Because they often spend a large amount of time with the patient and have or develop strong bonds, caregivers are also vulnerable to severe emotional and physical strain. Palliative care programs promote caregiver well-being by providing them respite by way of placing the patient in a hospice facility or nursing home for a few days.
The concept of addressing patients’ total suffering, treating both physical and psychological distress, was developed by Dame Cicely Saunders, and the palliative movement has carried on her way of thinking over the years. While some members of the care teams have become very skilled at treating physical symptoms through prescribing certain pharmaceuticals, others have developed advanced methods that focus on the psychological, social, and spiritual factors which can be equally if not more important than the physical ones.
Patients often express their fears about the future, loss of their self-reliance, family concerns, and thoughts of feeling like a burden to their loved ones.
Scientific study supports the importance of palliative care
A 2002 study by researchers at the UC Davis School of Medicine and Medical Center showed that interventions geared toward improving patients’ physical, emotional, social and functional well-being can enhance traditional cancer treatments.
At the annual meeting of the American Society of Clinical Oncology, UC Davis’s professor and chair of internal medicine, Frederick J. Meyers, criticized the past mindset of past doctors who told terminally-ill patients that could either undergo clinical treatment or go home and focus on quality of life. He stressed that patients should have the right to both.
Meyers and his colleagues devised a study that consisted of two groups of cancer patients enrolled in investigational chemotherapy treatments.
Both groups received the comparable chemotherapy treatments. However, to test their theory, the researchers provided only one group with palliative care, sending a nurse and social worker to their homes regularly.
Both groups were assessed on a monthly basis for quality-of-life, and after the seven-month study concluded, the patients who received palliative care scored higher in quality-of-life measurements, and they were also more likely to finish their chemotherapy treatments.
New guidelines seek to improve palliative care at end of life
In January 2008, The American College of Physicians released guidelines aimed at improving the recognition and palliative care of pain, dyspnea, and depression. The guidelines were based on insights created from sorting through thousands of medical titles and narrowing them down to the most useful data.
The strong recommendations included regularly assessing end-of-life patients for pain, dyspnea, and depression, using therapies that have been proven to be effective to manage each symptom, and planning palliative care in advance for all patients with serious illnesses.