Chronic pain is nothing new to many Americans suff ering from illnesses. According to the institute of Medicine, “chronic pain affects an estimated 116 million American adults—more than the total affected by heart disease, cancer, and diabetes combined and costs the nation up to $635 billion each year in medical treatment and lost productivity.”
In addition to impacting people’s finances and physical comfort, chronic pain can affect their daily functioning, personal relationships, emotional health and spiritual well-being. Thankfully, there is a growing medical field that can provide holistic care for anyone in any stage of any serious illness.
Of Palliative Care & Hospice Care
By Katherine Ladny Mitchell
Palliative Care And Hospice Care: What’s The Difference?
Coming from the Latin word for cloak, pallium, palliative care is a patient-centered, multi-dimensional approach to “cloaking” undesirable symptoms through comfort-focused treatments and personal care, according to Stephen Connor, author of Hospice and Palliative Care: The Essential Guide. Palliative care seeks to improve the quality of life for those coping with chronic pain or undesirable side-effects from medical treatments, regardless of life expectancy or stage of illness. A palliative care team usually offers services in a hospital setting and works in tandem with a primary doctor. “The focus is on less technology, and more on hands-on [approaches],”says Dr. Bob Goldmann, Medical Director of Palliative Care Services at Hospice of Chattanooga. “There is a definite emphasis on in-depth quality time spent with patients.”
Hospice is a particular type of palliative care that provides physical comfort, spiritual encouragement, relational healing and emotional support for terminally ill patients and their families. According to The Family Handbook of Hospice Care the goal of hospice is “to help people complete life’s journey with hope, comfort, dignity and companionship.” Unlike general palliative care, hospice care is often provided in the home to those with a shortened life expectancy. A hospice team helps relieve and assist the primary caregiver—usually a family member—to provide comfort and support. “We want to be proactive, to anticipate—to get the right care at the right time for that individual person,” says Dr. Goldmann. There are several similarities between palliative and hospice care. They both utilize teams of experts such as doctors, nurses, home health aides, counselors, pastors, social workers, massage therapists and dietary consultants to create a personalized treatment plan to minimize suffering and support patients and their families. Both hospice and palliative care seek to alleviate undesirable physical symptoms such as pain, nausea, and fatigue, as well as improve normal functions including breathing, sleeping and eating.
Both hospice and palliative care also focus on relieving the non-physical aspects of illness such as stress, depression and anxiety. “Palliative care is as much about what is happening to the person apart from their medical condition as it is to their medical condition itself,” says Dr. Goldmann. One study has shown that such holistic care may even increase life expectancy. According to Stanford Medicine, a 2010 study by the New England Journal of Medicine showed that patients who receive palliative care alongside normal cancer care actually live longer.
When Should You Choose Palliative Care, Hospice Care?
In general, hospice care is only given to patients expected to live about six months or less. Hospice care helps patients feel as comfortable and functional as possible as they journey toward life’s end. The Mayo Clinic states, “the focus of hospice care isn’t to cure or treat the underlying disease…[but] to provide the highest quality of life possible for whatever time remains.”
Unlike hospice care, palliative care may be sought at any stage of illness, regardless of whether it’s chronic or terminal. Palliative care can help people cope with the symptoms of cancer, heart disease, respiratory disease, Alzheimer’s, multiple sclerosis, HIV or other serious conditions, as well as with uncomfortable side effects from their treatments. “If someone has had a major medical setback,” says Dr. Goldmann, “that’s a good time to start a conversation about palliative care. If someone is having hospitalizations or asking, ‘Do I have to keep feeling like this?’ it might be time to evaluate.”
In fact, getting palliative care early may help reduce overall anxiety, as a team can help with medical decisions, navigate a complex medical system, and prevent certain uncomfortable symptoms or situations as they work alongside a patient’s doctors and curative treatments.
What Should You Expect?
Should a patient opt for palliative care, he or she can expect to work alongside a multidisciplinary team to control undesirable symptoms of chronic disease or other medical side effects from treatments. First and foremost, a palliative care team will help a patient identify his or her goals, both for treatment and for life in general. “There is an initial consultation,” explains Dr. Goldmann. “We ask, ‘What do you want to get out of this? What concerns do you have in terms of your care? What has been diffi cult for you?’ ‘Tell us your story.’” Palliative care workers can also assist with patients’ medical decisions, educate family members regarding a patient’s condition, and give personalized care so patients can live their daily lives well.
To receive palliative care, a patient may need to request a referral from his or her doctor. Medical coverage, duration of benefits and treatment timelines may vary according to a person’s insurance company and personal needs. A member of the care team can walk a patient through the financial process. Many services may be billed separately from a patient’s primary medical treatments. Palliative care is most often offered in a hospital setting, but can also be available in nursing homes, assisted living homes and private residences.
Conversely, hospice care is widely covered by many private insurance plans and both Medicare and Medicaid. Hospice care is often administered in a patient’s home, although some hospitals, nursing homes and hospice facilities may also offer it.
Similar to the palliative care team, the hospice care team also includes various multidisciplinary professionals. A primary doctor usually oversees medication and the overall treatment plan, while nurses, home health aides and volunteers help meet day to day needs such as transportation, caregiver relief, medication administration and hygiene maintenance. Bereavement counselors and clergy can provide spiritual and emotional encouragement, relieve stress, reduce depression and assist patients in healing any broken relationships with family, friends and God. “100 percent of us are going to die,” notes Dr. Goldmann. “But how we do that is important.”
With all the benefits of palliative and hospice care, it’s no wonder that demand for such services is growing. According to Stanford Medicine, 63 percent of hospitals with 50 beds or more offered palliative care services in 2010. This is up from only 25 percent in 2000. If you suffer from chronic pain or have been diagnosed with a terminal illness, palliative and hospice care can help provide the highest quality of life for each step of your journey.
Katherine Ladny Mitchell is a full-time homemaker and part-time writer who lives with her husband, Jason, and their three children in North Chattanooga. She graduated from Covenant College with a degree in Sociology and is a member of the Chattanooga Writers’ Guild.