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In a 2011 national poll sponsored by the National Journal and the Regence Foundation, 71 percent of respondents said they believe it is more important to enhance the quality of life for seriously ill patients even if it means a shorter life. The same poll reported that while 86 percent were somewhat or very familiar with the term "hospice," only one in four had the same understanding of the term "palliative care."As part of its core values and mission-based healthcare services, Holy Cross Hospital in Fort Lauderdale has a palliative care program. Palliative care provides comprehensive medical care that includes enhancing the quality of life for the patient and family, optimizing function, helping with decision making and providing opportunities for personal growth. Palliative care is provided throughout an illness, along with curative treatment regardless of the prognosis or life expectancy.
The team consisting of a palliative care doctor, nurse, social worker and chaplain/pastoral care associate works in concert with the primary care physician, consultants, nurses and ancillary staff including dietician, pharmacists and therapists.
Palliative care may be right for anyone suffering from any chronic, debilitating or life threatening illness such as congestive heart failure, chronic obstructive pulmonary disease, kidney failure, cancers, chronic arthritis, HIV/AIDS and dementia including Alzheimer’s and Parkinson’s, among others. It may also be appropriate for anyone suffering from pain or distressing symptoms due to their illness or treatment.
Patient situations that might indicate the introduction of palliative care may include:
• Pain or distressing symptoms lasting more than 24 hours
• Uncontrolled or complex psychosocial or spiritual issues
• Multiple emergency department visits in one month, hospitalizations, or prolonged length of hospital stay, greater than five days, without evidence of progress
• Being in an ICU without evidence of progress
• Patient/family or staff needing assistance with making complex decisions and determination of goals of care
• A new diagnosis of life threatening or serious medical illness
• Assist with education on discharge and long term care planning
• Assist with advance care planning
• Offer support to the family in adjusting to and coping with patient’s illness
• Grief/bereavement support and counseling
The palliative care team provides a comprehensive medical, social, and psychological assessment of the patient and assists with identifying and coordinating appropriate care settings to meet patient needs. The team assists in managing symptoms of suffering such as pain, dyspnea, anxiety, delirium and spiritual distress to name a few.
The palliative care team cares for patients by providing extra time for communication and providing spiritual and social support related to a patient’s illness. It provides information and support to help patients understand their serious medical illnesses, options for medical care and how to set realistic goals of care. Assistance is also provided with discharge, long-term care planning and advance care planning. Of equal importance, palliative care supports patients’ decisions related to social, ethical and spiritual concerns.
Many insurance plans including Medicare and Medicaid cover palliative care. A study entitled Palliative Care Consultation Teams Cut Hospital Costs For Medicaid Beneficiaries published in the March 2011 issue of Health Affairs analyzed data from four New York state hospitals to determine the effect on hospital costs of palliative care team consultations for patients. It reported that, on average, patients who received palliative care incurred $6,900 less in hospital costs during a given admission than a matched group of patients who received usual care. These reductions included $4,098 in hospital costs per admission for patients discharged alive, and $7,563 for patients who died in the hospital.
With census projections estimating that by 2030 one in five Americans will be at least 65 years old, the use of palliative care will increase to meet the medical and spiritual needs of this rapidly growing patient population.
