The following blog is a discussion and differentiation of palliative care and hospice care.
November is National Hospice and Palliative Care Month. With the holidays on the horizon, it is a great time of year to focus on our family and friends. When considering palliative care and hospice care, naturally many of us immediately think of death and dying. Discussing death and dying feels burdensome at any time of year, but especially during the holiday season. However, I would like to shine an entirely different light on what palliative care and hospice embody.
It is imperative to first discuss the difference between palliative care and hospice as these concepts are often intertwined. Palliative care ultimately focuses on symptom management in those with serious, but not necessarily terminal, illnesses. Palliative care uses an interdisciplinary and holistic approach to symptom management. Interdisciplinary means using multiple teams to help reach the goal of managing symptoms. This may include doctors, nurses, psychologists, social workers, chaplains, therapists and other resources. A holistic approach means the focus is on the entire person as a whole and not just the disease. This can include not only medical support, but also psychological, spiritual, and social support. Palliative care can be incorporated into the care of those receiving curative treatments or into the care of those who are solely focusing on comfort and are no longer wanting aggressive treatments. For example, a young adult going through cancer treatment who may live another 40+ years may receive palliative care. An elderly patient who is preparing for end of life may also receive palliative care. Hospice care includes palliative care measures, but you do not need to be enrolled in hospice to receive palliative care. The focus of palliative care is improving the quality of life.
Now that we have a better understanding of palliative care, we can differentiate it with hospice care. Our health care system often is saturated with interventionism that tends to inadvertently teach resistance to mortality. Hospice care is a bridge that can allow people to forgo aggressive treatments and ultimately focus on comfort. Like palliative care, hospice care continues to focus on symptom management and quality of life, but hospice care is for those that have a life expectancy of approximately six months. This six-month life expectancy is not set in stone. It is not rare that a patient will receive hospice services for longer than six months or that a patient’s condition improves to the extent that they no longer qualify for hospice. The focus in hospice is no longer on curing disease with aggressive measures, but rather solely providing the maximum comfort for each person. I like to think of hospice care as a focus on quality of life rather than a focus on quantity of life. Hospice can be provided in multiple settings including patients’ homes, assisted livings, or nursing homes. Hospice care allows people to maximize their quality of life for the rest of their life, however long that may be. This service provides care to those preparing for end-of-life to ensure the rest of their days are filled with the comfort and dignity that all humanity deserves.
With the holiday season approaching, rather than avoiding these discussions, let’s try to change our way of thinking. Instead of focusing on dying, let’s focus on living. Whether it is you or a loved one experiencing a serious health challenge, it may be helpful to consider these questions: How do you want to live? How does your loved one want to live the rest of their life? What do you value most in your life? What makes you or your loved one feel the happiest, the most comfortable, the safest? What treatments would you want or not want to pursue to help you achieve your goals of care? Exploring these topics can help you and your loved ones pave a path to live the rest of your lives the way you choose. If these topics lead to good discussion, it may be important to talk with your primary care provider about documenting an advanced care plan so you or your loved one’s wishes are in writing. Honoring Choices MN offers many resources including this Advanced Care Planning video. These resources can help prepare you for discussions with both your loved ones and medical provider.
Life is full of uncertainties. If you or someone you know is experiencing a strenuous health journey, opening up this discussion may prove to be more beneficial than burdensome. If you could help yourself or someone you love live with the utmost dignity, comfort, and peacefulness, would you do it? This is your life; how do you want to live it?
Erin K. Dahn
Erin Dahn, NP-C, is a Lakeview Clinic nurse practitioner specializing in the geriatric population. She works at various long-term care facilities with a home base of Lakeview Clinic – Waconia. Her special interests include palliative care and management of chronic diseases including hypertension, heart failure, diabetes, and dementia.