by Jason P. Smith
Palliative care expert Diane Meier, M.D., recently spoke at Exempla Lutheran Medical Center on the importance of palliative care, a new approach to care for the terminally ill. Stemming from the ideals of hospice care, palliative care incorporates the best of both worlds for many patients – hospice-type care without having to abandon aggressive treatment.
"The hospice movement, which started as kind of a grassroots movement in England, started much the same way in America during the 1960s as palliative care has, according to Meier. "Hospice was an effort to provide quality care to the dying, who were not thought to be well served. The success of hospice was such that the federal government decided to create a Medicare benefit to actually pay for it, so it became available to everyone who had Medicare in the United States."
Meier, who is the director of both the Center to Advance Palliative Care and the Lilian and Benjamin Hertzberg Palliative Care Institute and a professor of medical ethics and adult development, said the growth of hospice has taken a long time, but has seen substantial growth nationally.
"It has been a 20-year process, and over those 20 years there’s been a very rapid growth in the number of hospices in the United States," she said.
According to Meier, the snags in the system are some of the rules the federal government established for patient eligibility when it comes to hospice care. One rule is that the patient has to be terminally ill and within six months of death, and the other is that the patient has to agree to give up Medicare coverage for life prolonging treatment.
"The problem with those two criteria is, one: we don’t know who’s within six months of death, and second, most people do not want to give up life prolonging treatment, particularly since nowadays life prolonging treatment is quite effective," Meier said.
"So, unfortunately, hospice, which is a wonderful program, finds itself treating people closer and closer to their death. Now, the median stay for someone in hospice is just 17-21 days, meaning for most of the course of their illness, they are not getting the care they could be getting."
It is this dilemma that has lead to the current palliative care movement, according to Meier. This movement started in the mid-90s.
The movement is grounded in the recognition that what hospice does and what it provides is needed by everybody, Meier said. "Whether people meet the hospice criteria or not, that hospice care is needed when people are diagnosed and when people are hoping for a cure – families need it and patients need it because it’s good care."
Palliative care refers to the special care given to patients with a serious illness and the families of those patients. Nurses, physicians, social workers, chaplains and others all work together to decrease physical, emotional and spiritual suffering. The main focus of palliative care is to make the patient and the patient’s family more comfortable, whether it’s through communication, emotional support or the physical environment in which the patient is receiving care.
Hospice and palliative care have several similarities, but palliative care may begin much earlier than the last six months of a patient’s life. Patients may receive palliative care while in the hospital or in a home care program, and can transition to a hospice program at a later date.
One of the biggest differences between palliative care and hospice is that patients do not have to stop treating their illnesses in order to receive special care. Palliative care is meant to work in step with treatment, with one complementing the other.
Another issue facing hospitals in the next several years is that of an aging patient population. By the year 2030, the number of people in the U.S. older than 85 is expected to double to 8.5 million, according to Meier. Some believe palliative care will help hospitals care for patients effectively with cost-effective, quality care.
According to Meier, much of what has happened in the health care industry over the last several years has frustrated many nurses, but palliative care can help rekindle that desire to help people and give medical professionals an outlet to do more patient-oriented care.
"It is a great privilege to be able to work and help people," she said. "What palliative care does is say not only can you help people, but we can give you tools. I think palliative care is a means of addressing many ills in the health care industry. My prediction is that five years from now, 50 percent of hospitals will have a palliative care program and 10 years from now it will be mandated by the Joint Commission."