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 ||Download (.pdf)
Table 18–1. Hospice Services
Registered nurses coordinate the care for every patient, provide direct patient care, and check symptoms and medication. Patient and family education is an important part of every visit. The nurse is the link between the patient and his or her family and the physician. The nurse can also help evaluate the patient's condition.
The social worker provides advice and counseling to the patient and all family members during the crisis period. The social worker assists other care team members in understanding the family dynamics and acts as an advocate for the patient and the family in making use of community resources.
The patient's physician approves the plan of care and works with the hospice team. In a full hospice program, a hospice medical director is available to the attending physician, the patient, and the hospice care team as a consultant and a resource.
Clergy and other counselors are available to visit and provide spiritual support to the terminally ill at home. Programs also use churches and congregations to aid the patient and family as requested.
Home health care/homemaker
Home care aides provide personal care for the patient, such as bathing, shampooing, shaving, and nail care, and ...