Palliative Care

What is Palliative Care?

Palliative (PAL-ee-uh-tiv) care, also known as palliative medicine, supportive care, and symptom management, is a service that improves the quality of life for patients and families facing serious illness, through prevention and relief of suffering. Palliative care is used during any stage of a serious illness and offers treatment of pain, as well as support for physical, emotional, and spiritual well being. Those who are receiving palliative can STILL seek curative treatment.

What does palliative care do?

Palliative care focuses on relieving symptoms like:

Pain
Shortness of breath
Nausea
Loss of appetite
Difficulty sleeping
Depression
Anxiety

Palliative care can assist in help knowing what to expect, what resources are available, as well as providing guidance regarding difficult medical decisions. Your palliative care team will make sure you understand all of your treatment options and choices. In addition to treating your symptoms, the palliative care team spends as much time as necessary communicating with both you and your family providing an extra layer of support. All palliative care programs will differ, but many companies provide:

Home visits from a nurse practitioner, social worker, and chaplain.
24/7 on-call triage telephone service
Coordination with the patient’s primary physician.

Who can benefit from a palliative care program consultation?

Anyone with any serious or chronic illness. Remember, people receiving palliative can STILL seek curative treatment. Some examples of illness include:

Alzheimer’s disease
Parkinson’s
Cancer
Congestive heart failure (CHF)
Kidney failure
Chronic obstructive pulmonary disease (COPD)
Severe arthritis
Amyotrophic Lateral Sclerosis (ALS) or Lou Gehrig’s disease

Who is part of the palliative care team?

Often, palliative care is made up of a multidisciplinary team to coordinate care. This care team may consist of doctors, nurses, registered dieticians, pharmacists, and social workers. Many teams include psychologists and a chaplain as well. Palliative care teams may also make recommendations to primary care physicians about the management of pain and other symptoms. You do not give up your primary care physician to receive palliative care.

Where is palliative care given?

Palliative Care can be received in a hospital, outpatient clinic, or in the home.

How do you find a palliative care team?

Patients should ask their doctor for the names of palliative care and symptom management specialists in the community. A local hospice may be able to offer referrals. Area hospitals or medical centers can also provide information. In addition, The National Hospice and Palliative Care Organization’s Web site has a list of providers at http://www.nhpco.org.

Palliative Care Criteria

Available in an inpatient hospital setting as a “consult service”
As an outpatient, a consult must be written from a physician (i.e. primary care physician, pulmonologist, cardiologist, oncologist, etc.)

Can the patient benefit from any of the following?

Aggressive symptom management
Help with complex decisions or education on a newly diagnosed terminal illness
Assistance in setting appropriate goals or transitioning to other levels of care
Advance care planning
Physical, emotional, and spiritual support

General Referral Criteria

Family distress impairing surrogate decision maker
Marked decrease in functional status/ADLs in the last 60 days
Hospital readmissions of two or more in past 3 months
A patient that remains a full code despite poor prognosis
BMI less than 19
Difficulty controlling physical symptoms (i.e. pain control or vomiting)
Someone considering a PEG tube placement
Considering mechanical ventilation for any neuromuscular condition
Stroke with residual deficits
Advance cardiac disease (LVEF <25%)
Lung Disease (oxygen dependent)
Dementia (difficulty with speech, ambulation, or aspiration)
End Stage Renal Disease
End Stage Liver Disease or cirrhosis
Multi-organ failure
Metastatic cancer progressing despite systemic treatments
Anoxic Encephalopathy
Two or more ICU admissions within the same hospitalization
Prolonged or failed attempt to wean from ventilator

Comparison: Hospice vs Palliative Care

Questions	Hospice	Palliative
Who can receive care?	Individuals of any age, who have been diagnosed with a disease or illness and have physician certification of a prognosis of 6 months or less if the disease continues its normal course.	Individuals with pain or other symptoms such as nausea, loss of appetite, difficulty sleeping, shortness of breath, fatigue and/or anxiety resulting from a serious illness
What services are provided?	Doctor services, nursing care, medical equipment (walkers, wheelchairs, etc.), medical supplies (bandages, catheters, etc.), prescription drugs for pain control and symptom relief, hospice aide and homemaker services, physical and occupational therapy, speech-language pathology services, social work services, dietary counseling, grief and loss counseling for patient and family, short-term inpatient care (for pain and symptom management), short-term respite care.	Consultative services from a team of palliative physicians, nurses, and social workers, pharmacists, and registered dieticians. Assessment of treatments and medications to improve quality of life by managing pain and symptoms of the illness. Assistance with community resources and emotional support to make difficult medical decisions.
How are services paid for?	Medicare (Part A), Medicaid (coverage will vary by state), Most private insurance.	Medicare (Part B), Medicaid (coverage will vary by state), Most private insurance.
Will insurance (Medicare, Medicaid, or Private Insurance) pay for Home Health Services?	No, you cannot receive skilled home health services at the same time as hospice.	Yes, you have skilled home health services at the same time as Palliative care.
Can I have Private Duty caregivers?	Yes	Yes

How is Palliative Care Paid for?

Original Medicare
Medicare Advantage Plan
Commercial Health plans
Medicaid
VA Medical Benefits
- Palliative Care is part of the VHA Standard Medical Benefits Package, all enrolled Veterans are eligible IF they meet the clinical need for the service. Copays may be charged for Palliative Care

Reference: https://www.cancer.gov/about-cancer/advanced-cancer/care-choices/palliative-care-fact-sheet#q1