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Home Health Care & Palliative Care

Pamela Fishman of the Natick (MA) Visiting Nurse Association has been a social worker for more than 20 years, working in various settings that involve child welfare, teen parenting, and domestic violence, in addition to hospice and palliative care.
View Pamela's full Bio
Q:

How long is maximum time that a hospice can keep a patient on service? 


Goldy from NY
A:

In order for a person to be eligible for hospice care their medical doctor has assessed that given that person's diagnosis, with the expectation that the disease will run it's anticipated course, that the patient's prognosis is 6 months or less. However many people may receive hospice care well beyond that six month time frame. To continue to be eligible for hospice care the patient continues to exhibit signs/symptoms of overall declining health and disease progression - for example, increasing fatigue; pain issues; weight loss; functional decline. If a patient's health is improving then they may be discharged from hospice services - sometimes referred to as "graduating" from hospice. A patient can always resume hospice services again in the future should their health decline. Hospice care is intended to provide services to the patient through the dying process and expected death. 

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Q:

My Mom is 88 years old with diabetes and arthritis. She is barely mobile and suffers severe aches and pains. Her mind is beginning to go. She's been to hospital twice in 2011 with pneumonia and UTI the first time and now UTI again. She says she is very tired and wishes she could just be put to rest. When is she a candidate for palliative care? I don't know if she is dying. I don't know how to prepare. Please advise.
 


Darlene from CA
A:

Palliative care is comfort care provided to enhance a person's quality of life by treating their pain and symptoms associated with their illness. Based upon what you have described your mother would benefit from the services palliative care can provide. Your mother seems to be suffering physically and emotionally. Her physical pain caused by her chronic, debilitating illnesses needs to be assessed and managed. Untreated pain is contributing to your mother's diminished quality of life. Palliative care nurses are specialists in pain management. With successful pain management your mother's mobility, overall mood and outlook may improve. As we know, life threatening or life altering illnesses do not just affect us physically, but also emotionally and spiritually. Many of the patients I work with who have similar circumstances as your mother also express their wish to die. They may be depressed regarding the multiple losses they face—loss of their health, their independence, mobility, day-to-day activities as well as loss of a spouse, family members, and friends. Although it may be difficult for you, you can support your mother by allowing her to talk about her feelings of "being put to rest" - validating these feelings with understanding that many people her age living with chronic illness also feel that way. Utilize this time as an opportunity to leave nothing unsaid—time for expressions of love, forgiveness and gratitude. It is also important to have discussions with your mother about her wishes- the medical treatments she would want and not want; whether or not she wants to go to the hospital; where she would like to die; funeral planning. These discussions can be difficult but are necessary to ensure that your mother's wishes will be met. A palliative care social worker can provide both you and your mother with supportive services including emotional support, education, and the resources you need to cope with your mother's illnesses.

 

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Q: What is palliative care?
A:

Palliative care is sometimes called “comfort care,” and it’s really relieving pain and other symptoms like nausea, shortness of breath, fatigue and loss of appetite for people who are living with a chronic illness or long-term medical issue. Sometimes, even side effects from other treatments, such as chemotherapy, can be treated using palliative care. People with cancer, multiple sclerosis, ALS or Lou Gehrig’s disease can really benefit from care that takes their whole life situation into consideration. For these folks, who have been living with their disease for a number of years, their disease does not define them. It’s part of them, yes, and how they and their families live with the symptoms and treatment has a huge impact on their lives. What really separates palliative care from more standard health care is the support it offers in collaboration with the more medical or clinical treatments. Social workers can really enhance what the doctors, nurses and rehabilitation therapists are doing by working with people on the “rest of their life.” Are there services out there they can take advantage of? How will their families deal with their disease as it progresses? If they are facing the end of life, what steps to they need to take, legally and emotionally? By addressing a person’s psychological, emotional and spiritual well-being, along with their physical symptoms, palliative care helps them to gain the strength to carry on with daily life and to maintain a positive outlook.

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Q:

Can I get palliative care at home?


A:

Yes. Although palliative care has traditionally been offered in the hospital or through a hospice “bridge program,” more providers are now offering it. With more and more people able to stay home, even as they undergo chemotherapy treatments, live with debilitating pain or face the end of life, it makes sense to offer palliative care in that setting. It’s where most people want to be and where they are most comfortable. With the number of Americans living with chronic illness expected to double to 180 million over the next 25 years, we have to expect that specialized health care, like palliative care, will be available more readily than it has been. Home health care providers have been giving palliative care for years on an informal basis. Now that palliative care is a recognized medical specialty and certification is available to nurses, the benefits of this “comfort care” are being more closely woven into medical care and effectively delivered in the home.

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