At the center of hospice, palliative and end of life care is
the belief that each of us has the right to excellent pain and symptom
management and to have our physical, emotional and spiritual concerns
addressed. We have right to die pain-free and with dignity,
and our families should receive the necessary support to 
allow us to do
so.
The term ‘end of life care’ is an overarching concept includes four ways to address important needs in our life. Picture an umbrella. Its arching shelter is ‘end of life care,’ and gathered under it are advance care planning, palliative care, hospice care, and bereavement care.
Advance
care planning is a need all of us will have at some
point in our adult lives – whether we are healthy or not, and with or
without the responsibility of caring for someone else. In
particular, members of the ‘sandwich’ or caregiver generation (those
born between 1950 and 1975) will turn to advance care planning as they
consider care for parents, children and themselves. As you
develop an advance care plan, you will explore your options for care,
reflect on those options and your values, talk with your loved ones,
and finally, record your wishes. Your plan may change over
time, as your situation or wishes change.
Click here for more
information on Advance Care Planning.
Considered to be the model for quality, compassionate care for people facing a life-limiting illness or injury, hospice and palliative care involve a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient's needs and wishes. Support is provided to the patient's loved ones as well.
Hospice focuses on caring not curing, and, in most cases, care is provided in the patient's home. Hospice care also is provided in freestanding hospice centers, hospitals, and nursing homes and other long-term care facilities. Hospice services are available to patients of any age, religion, race, or illness. Hospice care is covered under Medicare, Medicaid, most private insurance plans, HMOs, and other managed care organizations.
Palliative
care extends the principles of hospice care to a broader
population that could benefit from receiving this type of care earlier
in their illness or disease process. No specific therapy is excluded
from consideration. An individual’s needs must be continually assessed
and treatment options should be explored and evaluated in the context
of the individual’s values and symptoms. Palliative care, ideally,
would segue into hospice care as the illness progresses.
Both palliative and hospice care are philosophies, or concepts of care. Neither is limited to a location or practice, and both address the many ways illness can affect a person’s life. Both are available to people of all ages and illnesses.
Bereavement care is the final component of ‘end of life care.’ Bereavement counseling is offered to survivors by the hospice team (and other sources) for up to a year after the death of their loved one.
How does hospice care work?
Typically, a family member serves as the primary caregiver and, when appropriate, helps make decisions for the terminally ill individual. Members of the hospice staff make regular visits to assess the patient and provide additional care or other services. Hospice staff is on-call 24 hours a day, seven days a week.
The hospice team develops a care plan that meets each patient's individual needs for pain management and symptom control. The team usually consists of:
- The patient' s personal physician;
- Hospice physician (or medical director);
- Nurses;
- Home health aides;
- Social workers;
- Clergy or other counselors;
- Trained volunteers; and
- Speech, physical, and occupational therapists, if needed.
What services are provided?
Among its major responsibilities, the interdisciplinary hospice team:
- Manages the patient’s pain and symptoms;
- Assists the patient with the emotional and psychosocial and
spiritual aspects of dying;
- Provides needed drugs, medical supplies, and equipment;
- Coaches the family on how to care for the patient;
- Delivers special services like speech and physical therapy when needed;
- Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home, or the caregiver needs respite time; and
- Provides bereavement care and counseling to surviving family and friends.