Transitioning from palliative care to hospice is never easy. It’s normal for patients to feel confused, scared and even angry as they undergo a major shift to end-of-life care. Those who serve as support systems, such as family members and caregivers, can help ease the transition process by taking the time to educate themselves. Understanding the differences between palliative and hospice care, knowing when to initiate the transition and choosing the right hospice team will help patients and loved ones feel as comfortable as possible when that time comes.
Palliative Care vs Hospice Care
The first step to understanding the transition from palliative care to hospice is recognizing the difference between these two care types. Palliative care patients typically consist of people with serious illnesses, such as cancer, heart failure and Parkinson’s disease. These patients often deal with daily problems, such as fatigue, painful swelling and consistent coughing. The purpose of palliative care is to increase the quality of life for ill patients through pain relief and symptom management, easing their discomfort as much as possible. It’s also sometimes provided for those with cognitive defects, such as dementia patients.
Palliative care comes with a comprehensive care team that includes nurse practitioners, therapists, social workers and a primary care physician. By working together, these caregivers can assess all possible patient needs to help families make important health care decisions. Palliative care is not meant to cure illness; however, it’s often paired with curative treatments that aim to eliminate the illness entirely. Ideally, patients are eventually treated and can be taken off palliative care. However, in cases where patients are elderly or develop terminal illnesses, hospice care must be considered.
Similar to palliative care services, hospice services strive to make patients feel better through comfort care. However, unlike palliative care, it’s not coupled with curative treatments. This is typically either because the illness is no longer treatable or because the treatment has painful side effects that the patient doesn’t want to experience. At this point, the sole focus of patient care is to foster an enjoyable, empathetic environment that allows the patient to live out their final months in peace and dignity.
One of the most important care decisions is determining when a patient is ready to transition from palliative care to hospice. Making this decision too late means patients suffer longer than necessary. It’s important to put aside any personal desires you may have, look at the situation objectively and make a decision that results in the best possible outcome for the patient.
Most patients transition from palliative care to hospice when they have a life expectancy of less than six months. However, hospice patients who are no longer interested in curative treatments and are prepared for end-of-life care can express this desire to their caregivers. Most health care professionals will take the wishes of patients into account when making this pivotal decision.
In some cases, the patient themselves may not be capable of making their own health care decisions. In this case, the decision is entirely up to either the caregivers or family members. Typically, a palliative care team will recommend hospice when it is deemed necessary; however, a referral isn’t required. If you notice symptoms of deterioration or suffering, such as increased falls, difficulty completing daily tasks, heightened pain or cognitive dysfunction, you can choose to begin hospice transitioning for your loved one.
When making a decision for your loved one, it’s advisable to consult your care team beforehand and have a discussion with them about the next steps. During this conversation, care providers will assess the patient, determine their eligibility for hospice and help you make the best possible decision. You should also communicate with the patient as much as possible and try to keep them aware of what’s happening. Changing the care environment can be daunting, and they’ll need an empathetic shoulder to lean on.
Hospice Patient Options
Once you’ve determined that a loved one is ready for hospice care, the next step is deciding on the setting. Many individuals choose to remain in the hospital, which provides both convenience and safety by letting patients access health care professionals when necessary. However, hospital rooms are not always the most comfortable or enjoyable environment, and they don’t offer the nostalgia or warmth many hospice patients seek. Thus, more and more patients are opting for home health options instead.
Through home care, patients can receive hospice services in the comfort of their own living rooms or bedrooms. The first step is to assemble a comprehensive hospice team that can travel to the patient’s home and meet any potential needs. This team usually consists of home health aides, nurses, doctors and social care workers. Family members may also be trained to join the team. Space is then cleared in the home for any necessary equipment, and a hospice team member is sent to check in several times a week. However, it’s recommended that someone else lives in the home in case of an emergency.
Those who want a comfortable, homelike environment and the assurance of professional caregivers may choose to receive hospice care in a long-term care facility, such as a nursing home or hospice provider. Hospice facilities offer all the equipment and staff members necessary to execute proper care. Moreover, they create an encouraging, warm environment that hospitals typically lack. Most hospice facilities will provide patients with either a private room or a shared space and will allow family members to visit on a regular basis. Many hospice programs are also Medicare-approved.
Making the Transition
No matter what setting you choose, it’s important to handle the process delicately. Both palliative and hospice care patients depend on the support and empathy of their loved ones to help them get through this difficult process. Understanding how the transition works, listening to the needs and wants of patients and communicating openly every step of the way will help you make the right decision and ensure the transition goes smoothly.