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Much attention has been focused on the importance of making end-of-life (EOL) care decisions before one is in a crisis situation. Some older adults, however, are ambivalent about what they want at the end of life and may change their minds about treatment options when actually threatened by an illness that can cause death (Caron, Griffith, and Arcand, 2005; Cherlin et al., 2005). An option that allows for realistic EOL supportive care without rescinding all efforts at treatment is palliative care. Palliative care is focused on symptom management and relieving suffering and improving quality of life of individuals rather than focusing on cure and lengthening of life. Avoidance of unnecessary, and potentially harmful, tests is initiated, and care is focused on comfort. Palliative care is a philosophy of care that is provided simultaneously with all other appropriate medical management of the patient.

Hospice differs from palliative care. Hospice is a comprehensive care system for patients with limited life expectancy who are living at home or in institutional settings. Hospice is a Medicare benefit that was established in 1982. To be eligible for hospice, the patient's primary health-care clinician must certify that the patient has a remaining life expectancy of approximately 6 months or less, and the patient must elect hospice and agree to accept care from an identified hospice team. The patient's primary health-care clinician may elect to continue to provide care for the patient and work with the hospice team. Services provided through hospice are shown in Table 18–1. Hospice services also include coverage of necessary supplies such as a bedside commode or medications.

Table 18–1. Hospice Services

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