Palliative care and palliative care can optimize quality of life

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When a person has a serious life-limiting illness, their health care needs often begin to pile up. From managing symptoms to navigating the healthcare system, to understanding the meaning of life and everything in between, extra support can improve quality of life. Loved ones may also need help understanding medical treatment, managing caregiver stress, and planning for the future.

Hospice and palliative care teams can provide this additional support.

What is palliative care?

Palliative care is a specialized form of medical care designed to improve the quality of life for people with a serious illness that limits the life expectancy or quality of life. This type of care is accessible to a patient of any age and at any stage of the disease.

“Palliative means relieving suffering, and that’s our role, helping patients through the challenges of serious illness and relieving their suffering and the burden of that illness,” said Kelsey Terland, MD, of Samaritan Palliative Care. . “When we think of suffering, we often think of pain first, and symptom management is certainly one of our goals, but palliative care is broader than that. It’s really about taking care of the whole person – body, soul and spirit. Palliative care may be accompanied by disease-focused treatments, such as chemotherapy, to provide additional support.

Palliative care teams are made up of experts in different fields – doctors, nurses, social workers and chaplains, among others – who come together to support a patient and their family during a serious illness.

Support for Disease Burdens

While anyone with a condition that affects their quality or length of life would qualify for palliative care, some conditions tend to have heavier symptoms, such as cancer, heart disease, lung disease, or dementia. for example. For these conditions, having an extra layer of support from medical experts can benefit the patient.

“Our team takes the time to ensure that a patient and their family fully understand their diagnosis and prognosis. Team members can help them find out about available resources. We spend time exploring who each person is and what is most important to them to better understand their medical care goals,” said Dr. Terland.

Palliative care serves patients in the hospital as well as in the community.

“When a patient is hospitalized, hospital staff work to treat the acute problem that brought the patient to the hospital with the goal of bringing them home. As a team of consultants, palliative care takes the 10,000 foot view of someone with a critical illness. We are able to spend time with a patient to hear their hopes and concerns,” Dr. Terland explained.

Community palliative care within Samaritan Health Services is currently only available to patients with symptomatic heart failure living in Linn County.

Because everyone’s needs are different, each palliative care plan is tailored to the individual.

“Sometimes a patient may tell me that he intends to do everything he can to fight the disease or prolong his life, and another may tell me that he is tired and finished pursuing its treatment – ​​people’s goals for their care differ, and we tailor their medical treatment accordingly at every step of the process,” said Dr. Terland.

Palliative Care Calendar

The time to seek palliative support also differs for everyone. But there are some general guidelines, Dr. Terland noted.

“When disease burdens begin to accumulate and quality of life is affected, when people feel they need a transition in their care but don’t know how to make it, or when a patient has increasing symptoms and needs more support. to manage these symptoms — these are some of the areas where palliative care can be helpful,” explained Dr. Terland.

Most often, palliative care will be requested by the patient’s doctor, cardiologist or oncologist, for example. But a patient or family member can request a palliative care referral from any of their medical providers.

Once a patient is cared for by the palliative care team, the support may last for short periods while someone is hospitalized, or for months or years in an outpatient setting.

If a patient is on the verge of no longer undergoing aggressive medical treatment and is approaching the end of their life, they can move on to another form of palliative care called hospice.

What is the Hospice?

“Like palliative care, hospice also focuses on managing symptoms and optimizing quality of life,” said Emily Looney, MD, medical director of Samaritan Evergreen Hospice. “However, hospice is only designed for people who are likely in the last six months of life and for whom aggressive medical treatments are no longer desired or helpful.

“People are choosing to switch to hospice so that medical care and team support reaches them at home and they can avoid hospitalizations, regular office visits and lab draws,” Dr. Looney said. .

People often have the misconception that hospice is a place. Although Samaritan has a 12-bed hospice in Albany that accepts patients for acute care, most hospice care is provided in the patient’s home, however defined – at a friend’s house, at a home retirement home or other facility or in the patient’s private residence.

“Hospice is an interdisciplinary visiting team that helps manage a patient’s symptoms, optimize comfort, and address the psychosocial concerns of end-of-life patients and their families,” said Dr. Looney.

This team includes nurses, doctors, and nurse practitioners to adjust medications and meet other health care needs; attendants for bathing and other personal care; social workers to coordinate care and resources, provide counseling and intervene in crisis situations; and chaplains to provide non-denominational spiritual support. Bereavement counselors are also available to relatives after a patient’s death.

Make every day the best it can be

“The goal of hospice is to make every day the best it can be,” Dr. Looney said.

“For many people, this means prioritizing physical comfort to ensure pain, shortness of breath and anxiety are proactively addressed,” she said. “Often too, palliative care will help patients conserve energy so they can spend time with family, take a special trip, or focus on meaningful activities such as life review. Each patient’s palliative care plan is different, depending on their individual goals.

“Hospice does not hasten or delay death,” Dr. Looney said.

“Involving hospice is not giving up, but rather changing the goals and priorities of a patient’s medical care,” she said.

When is palliative care appropriate?

Although it can be difficult to predict where a person is in their journey with a disease, Dr. Looney noted that there are several signs that a person is nearing the end of their life and could benefit from a hospice support.

“If a person is having trouble managing their symptoms and illness without frequent visits to the hospital, doctor’s office, or emergency department, this may indicate medical frailty indicating that they are nearing the end of their life. “, she said. “Functional decline – spending more time sitting or lying in bed – and distressing symptoms such as pain and shortness of breath with minimal activity – can also be a good indicator of life expectancy. Weight loss sustained, recurrent infections and falls are other signs that a patient may be eligible for hospice.

More time spent with the patient

Getting to know a patient and their goals of care requires more time than an average doctor’s office visit allows, which is especially different in palliative care and hospice.

“In palliative care, I would typically ask a patient to tell me about their hopes and concerns about their illness,” Dr. Terland said. “I was asking, ‘What are the things that, if you couldn’t do them anymore, would change the way you want your care?’ Or, ‘What are the things you’re willing to go through in hopes of having more time?’ This conversation takes time, and their responses help shape our care plan.

The same goes for palliative care, Dr. Looney said.

“Typical visits by a nurse to a patient’s home can last two hours, up to several times a week,” she said. “Some patients and families want privacy and would prefer minimal contact with hospice staff if their care plan is stable, but others want the opportunity to get to know their support team and that the team get to know them.”

Additionally, the palliative care team is available 24/7 to respond to emergencies and counsel patients and family members on symptom management.

Palliative care and hospice costs

Coverage for palliative care varies between medical insurance plans. Many private insurers, as well as Medicare and Medicaid, cover palliative care, although there may be conditions, co-payments and deductibles, so be sure to speak with your insurer for details.

“When a person chooses hospice and no longer pursues curative treatment, hospice is 100% covered by Medicare and many other insurers,” Dr. Looney said.

This coverage includes drugs treating symptoms and treating diseases causing a limited life expectancy; medical equipment such as hospital beds, wheelchairs and oxygen; personal care supplies and professional staff costs.

Always consult an insurance professional to ensure that your plan covers your particular case.

Help for your unique situation

No matter where a person is on their journey with a serious illness, the experience can be lonely, painful and frightening. But Samaritan’s hospice and palliative care teams can help ease those burdens by providing the support and resources people need in times of medical crisis.

To learn more about Samaritan Palliative Care services, call 541-812-5020. To learn more about Samaritan Evergreen Hospice, call 541-812-4662.

Medical Director Kelsey Terland, MD, oversees Samaritan Palliative Care, a multidisciplinary team that supports patients with critical illnesses. You can reach her at 541-812-5020. Medical Director Emily Looney, MD, oversees Samaritan Evergreen Hospice and also sees Family Medicine patients on a limited basis at Samaritan Family Medicine – Geary Street. Contact her at 541-812-4662.

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