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A Model Of Care

Advances In Palliative Care At Home

Having served the communities of MetroWest Boston for over 100 years, the nurses and clinicians of the Natick Visiting Nurse Association have always sought to help people live longer and sustain a high quality of life while remaining independent in their own homes, for as long as possible. But for patients battling advanced illness, this goal can become particularly challenging. To provide a solution, the Natick VNA created "ComfortCare," a new approach to palliative care provided to patients in their homes. The program is dedicated to enhancing the quality of life for patients suffering from serious, chronic or terminal conditions accompanied by intense pain.

"To palliate: to make comfortable by treating the symptoms and pain from serious illness."— National Hospice and Palliative Care Organization.

"Providing palliative care is essentially healing at a higher level, and something we've been providing to patients in need for quite some time," said Judith Boyko, CEO of the Natick VNA, which provides services to patients in more than 20 towns. "Now by formalizing our efforts, we are even better able to help our patients and their families and provide them with more options for care. Many of these patients have developed strong, trusting relationships with our staff members over the years, and prefer to stay with them at a time when they're feeling more vulnerable."

Understanding Palliative Care

Palliative care focuses on pain control and relief from related symptoms—particularly for individuals who want to maintain the highest possible quality of life despite diagnoses such as terminal cancer, end-stage chronic congestive heart failure or lung disease, ALS (Lou Gehrig's disease) or multiple sclerosis. In addition to improving the quality of life, palliative care may actually extend it. In a Massachusetts General Hospital study of 151 Boston-area patients with lung cancer, those who received early palliative care lived longer, achieved better symptom management and were less depressed and anxious than patients getting standard care.

"With this specialized program, the Natick VNA is now delivering the cutting edge in palliative care services," said Carol Curtiss, MSN, RN- BC, health education consultant, faculty member at Tufts University School of Medicine Pain Research, Education and Policy (PREP) and a nationally recognized speaker on pain and symptom management. "Palliative care may be offered any time during a serious illness. The Natick VNA is unique among local organizations as the first home care agency to establish a formal program of palliative care available to patients in their homes. This program offers comprehensive care and allows patients to maintain already established relationships with their visiting nurses and other staff whom they know and trust."

The Natick VNA's new program enables patients to remain at home while being taken care of by an interdisciplinary team of nurses certified in pain management and hospice and palliative care, as well as rehabilitation therapists, social workers, home health aides among others. All have extensive experience caring for patients with chronic disease.

Working closely with patients' primary physicians, the Natick VNA's palliative care team offers support to patients and their loved ones to control pain, manage medications and relieve other symptoms such as breathing problems, restlessness or nausea. The team works together to make each patient more comfortable, and meets weekly to discuss each individual's healthcare needs. Cold laser therapy, massage and the services of a personal chef are some of the other therapies that can be made available to patients.

In addition to quality of life and symptom/pain management, the Natick VNA program addresses caregiver wellbeing and bereavement. Social workers are available to patients and their loved ones to discuss such issues as anticipatory grief, end of life planning, the dying process, alternative therapies, and to make connections with clergy upon request. A specially trained social worker experienced in bereavement also visits families periodically after the death of a loved one to help them adjust to their new life situations. To learn more about the Natick VNA's Palliative Care Program, go to

A Palliative Care Primer

Palliative care is meant to improve the quality of life for patients dealing with serious, chronic or terminal illnesses. It can address a patient's psychological, emotional, and spiritual well-being, as well as physical symptoms. The primary focus of palliative care is managing pain and providing relief from related symptoms, such as shortness of breath, fatigue, constipation, nausea, loss of appetite or difficulty swallowing or sleeping. It helps patients gain the strength to carry on with daily life and to maintain a positive outlook. It also improves their ability to tolerate medical treatments.

Palliative care is well-suited for patients who want to manage symptoms associated with active treatment for disease, such as chemotherapy and radiation, and other effects of chronic illness. This enables patients to maintain their independence and a higher quality of life.

The Difference Between Palliative Care And Hospice Care

The goal of palliative care is to manage pain and relieve other symptoms. Though most closely associated with serious illnesses at an advanced stage, palliative care can also be given along with curative treatments.

The goal of hospice is to prepare the patient and his/her family for death. It's generally appropriate for someone with a terminal illness and life expectancy of six months or less.

Often, patients view palliative care, administered at home, as a "bridge" to hospice care. Though facing a serious illness, their focus is on experiencing life as fully as they can.

The Benefits Of Palliative Care

Comfort: High-quality palliative care can make the difference between a comfortable existence and one that involves suffering. There is often no need for patients to suffer from shortness of breath, uncontrolled pain or nausea. Palliative care also can help a patient's loved ones begin to deal with the issues of grief and bereavement.

Coordination: Involvement of palliative caregivers and coordination of care is not always the norm when it comes to treating patients with advanced disease. A complex case may be managed by clinicians in specialties ranging from cardiology to endocrinology and pulmonology, but no one specialist may be focused meaningfully on the patient's level of comfort or distress or consider whether family caregivers could also benefit from support.

Choice: Palliative care also gives patients a choice at a crucial juncture in their lives. Those electing palliative care have often established long-standing relationships with visiting nurses and find it more comfortable to continue working with caregivers that they know and trust, especially in a home environment.

The Palliative Care Team

A palliative care team can include nurses, rehabilitation therapists, social workers, home health aides and more. This multidisciplinary team creates and implements a plan of care based not only on a patient's diagnosis but on the challenges he/she may be struggling with, from anxiety about the difficulty of caring for other loved ones while ill to a family caregiver's stress or depression.

Care Provided

Working in partnership with a patient's primary care physician, the palliative care team provides:

  • Close, clear communication
  • Expert management of pain and relief of symptoms
  • Help navigating the healthcare system
  • Guidance with difficult and complex treatment choices
  • Emotional and spiritual support for patients and their families
  • Help preparing for death
  • Bereavement support

Credentials Of Palliative Care Nurses

The National Board for Certification of Hospice and Palliative Nurses (NBCHPN®) CHDP certification validates a nurse's competence and knowledge in the specialized area of Hospice and Palliative Care. This certification is highly valued. The certification examination for Hospice and Palliative Care Nurses is offered by the American Board of Nursing Specialties.

Other Facts

  • Palliative medicine officially became a medical subspecialty in 2006 (American Board of Medical Specialties).
  • Approximately 90 million Americans are living with serious and life-threatening illness, and this number is expected to more than double over the next 25 years with the aging of the baby boomers.
  • By 2020, the number of people living with at least one chronic illness will increase to 157 million. Today, seven out of ten Americans die from chronic disease.
  • Approximately 6,000,000 people in the United States could benefit from palliative care.