Hospice Care Versus Palliative Care - page 2

Hospice care is defined as support and care for terminally ill persons to help them achieve maximum comfort and the greatest satisfaction possible with remaining life. Its services are designed to... Read More

  1. Visit  NurseDirtyBird profile page
    3
    Part of me wants to balk at the accusations levelled against LTC facilities, like "Nuh uh, we don't do that." But yeah, you guys are right. LTC facilities are horrible places for hospice care. I try, as an LTC floor nurse, to do my best with my hospice patients, but in that environment, the squeaky wheel is always the one that gets the most grease. Hospice patients that come through my facility are often obtunded, bed bound, and unable to make their needs known. They are most often placed on the rehab unit (as they are considered short-stay), where fully A&O patients are able to verbalize their needs and have them met. It's so easy for me to get incredibly busy with my 21 other (vocal) patients before I realize that my hospice patient's morphine is overdue and they're probably very uncomfortable.
    I also frequently see that hospice care is started a day late and a dollar short. The shortest time a patient stayed on my floor was a man who showed up around 3pm, got his PCA started by the the hospice nurse, and was gone by 8pm. The amount of pain that man was in was ridiculous, and if only his family would have accepted the prognosis, he would have been saved the suffering. I see it so often. I've had family members refuse to sign a POLST because they think it means we're just going to let their (mother/father/sibling/spouse) die. No amount of explaining that you can choose full treatment, and always change your mind will get them to sign. Their denial is so great, they don't even want to think about the possibility that their loved one could be in a situation that they may not survive. This denial and fear surrounding death is a social ill. People are so afraid of it, they refuse to think about it or discuss it until the very VERY last minute, and by then it's too late.
    And don't get me started on the horrible things people say to dying family members! Gah!
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  3. Visit  tewdles profile page
    2
    There are many misconceptions and misunderstandings of what "hospice care" means. Palliative care is the portion of hospice care that can be shared with patients no matter their life expectancy.

    No matter where the patient lives, the hospice care will only be as good as the people running it expect and plan for it to be.
    VickyRN and cherryames1949 like this.
  4. Visit  leoiib profile page
    0
    Just curious...you all know hospice care is a type of palliative care, right?

    I do not understand why you are comparing a whole apple with a sliced apple.

    The whole idea of palliative care is to treat the symptom of a disease that might or might not be treatable. The main idea of hospice is to treat the symptom of an otherwise untreatable disease to promote comfort during the end of life. That is still palliation, but with hospice, the patients are at the end of life or are given a period of time to live.
  5. Visit  toomuchbaloney profile page
    0
    Which came first, palliative care (as a specialty) or hospice?
  6. Visit  leoiib profile page
    0
    I do not know. But as far as i know, hospice care is a branch of palliative care...not the other way around. Not all palliative care is hospice but most hospice care is palliative.

    Example? People with dementia under hospice care...normally, hospice nurses and MDs will recommend taking Namenda off the med list. What is the point? They are at the end of life and namenda will no longer treat it...instead, we try to palliate the obvious signs that might affect their comfort.

    But for those with dementia that are not given a time frame to die in 6 months...yeah, give them namenda...thats palliating a disease.
    Last edit by leoiib on Feb 17
  7. Visit  toomuchbaloney profile page
    1
    Quote from leoiib
    I do not know. But as far as i know, hospice care is a branch of palliative care...not the other way around. Not all palliative care is hospice but most hospice care is palliative.

    Example? People with dementia under hospice care...normally, hospice nurses and MDs will recommend taking Namenda off the med list. What is the point? They are at the end of life and namenda will no longer treat it...instead, we try to palliate the obvious signs that might affect their comfort.

    But for those with dementia that are not given a time frame to die in 6 months...yeah, give them namenda...thats palliating a disease.
    The reality is that hospice has been around for much longer than Palliative care as a discipline and specialty. Palliative care was born out of the hospice moveme, hospice did not branch FROM palliative care. At this time they are "sister" specialties, sharing a philosophy of comfort as a goal.


    Most gerontologists and Hospice Medical Directors and PharmDs I have worked with have advocated for discontinuing the Namenda if the patient has suffered a significant enough decline in cognitive and physical status to qualify for a hospice EOB. This is especially true if the dementia patient is experiencing anxiety or difficulty taking oral meds at time of EOB. Additionally, if the Namenda is not providing obvious relief from symptoms many hospice programs are not interested in spending their pharmacy dollars in that way.
    chopwood carrywater likes this.
  8. Visit  leoiib profile page
    0
    You are quite right about hospice not branching out from p
  9. Visit  MunoRN profile page
    0
    The speciality of "palliative care" actually predates hospice, it just hasn't always been called "palliative care". Palliative care refers to speciality of treating a patient's response to a disease process, rather than treating the disease itself, which is also describes the specialty of "Nursing". A palliative care Physician is basically just someone who practices classic Nursing but with a medical license.
  10. Visit  Libby1987 profile page
    0
    Damn, I thought a hospice patient was at a higher level of care as an inpatient but they just have more liberal prns.

    I also thought with a LTC hospice bed that family would still participate as caregivers in the ways that they physically were able, but still remain at the bedside.
  11. Visit  toomuchbaloney profile page
    0
    Quote from MunoRN
    The speciality of "palliative care" actually predates hospice, it just hasn't always been called "palliative care". Palliative care refers to speciality of treating a patient's response to a disease process, rather than treating the disease itself, which is also describes the specialty of "Nursing". A palliative care Physician is basically just someone who practices classic Nursing but with a medical license.
    The philosophy of palliative care may predate hospice but the specialty itself does not. That is in large part semantics but is nonetheless true.
  12. Visit  toomuchbaloney profile page
    1
    Quote from Libby1987
    Damn, I thought a hospice patient was at a higher level of care as an inpatient but they just have more liberal prns.

    I also thought with a LTC hospice bed that family would still participate as caregivers in the ways that they physically were able, but still remain at the bedside.
    A hospice patient on General Inpatient level of care (GIP) are at a higher level of care. The POC must reflect the higher standard in order to meet the criteria for billing at a higher rate.
    The presence of a hospice patient in a LTC is not a guarantee that the patient is a GIP level of care, however. Most of the time the hospice care occurs in the LTC simply because that is where the patient resides full time. Similarly, not all LTC are capable of providing the nursing supervision necessary to qualify as a GIP level facility.

    Dependent upon the policy of the LTC, the family may well participate in the ongoing physical and emotional care of the hospice patient.
    chopwood carrywater likes this.


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