many Americans die in facilities such as hospitals or nursing homes that receive care that does not conform to their wishes. It is important for older adults to plan ahead and let their caregivers, doctors, or family members know ahead of time about their end-of-life preferences. For example, if an older person wants to die at home, receiving end-of-life care for pain and other symptoms, and makes it known to health care providers and family, they are less likely to die in a hospital than receive unwanted treatments.
If the person is no longer able to make health care decisions for themselves, a caregiver or family member may need to make those decisions. Caregivers should consider several factors when choosing end-of-life care, including the older person’s desire to seek life-prolonging treatments, how long he or she has left to live, and the preferred setting for care.
what is palliative care?
Palliative care is specialized medical care for people living with a serious illness, such as cancer or heart failure. palliative care patients may receive medical care for their symptoms, or palliative care, along with treatment intended to cure their serious illness. palliative care is intended to improve a person’s current care by focusing on quality of life for them and their families.
who can benefit from palliative care?
Palliative care is a resource for anyone living with a serious illness, such as heart failure, chronic obstructive pulmonary disease, cancer, dementia, Parkinson’s disease, and many others. Palliative care can be helpful at any stage of the disease and is best provided soon after a person is diagnosed.
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In addition to improving quality of life and helping with symptoms, palliative care can help patients understand their medical treatment options. Organized services available through palliative care can be helpful for any older person who has a lot of general discomfort and disability very late in life.
who makes up the palliative care team?
A palliative care team is made up of several different professionals who work with the patient, family, and the patient’s other doctors to provide medical, social, emotional, and practical support. The team is made up of palliative care doctors and nurses, and includes others such as social workers, nutritionists and chaplains. a person’s equipment may vary depending on their needs and level of care. To begin palliative care, a person’s health care provider may refer them to a palliative care specialist. if he or she doesn’t suggest it, the person can ask for a referral to a health care provider.
where is palliative care provided?
Hospice care can be provided in hospitals, nursing homes, outpatient hospice clinics, and some other specialized clinics, or at home. Medicare, Medicaid, and insurance policies may cover hospice care. Veterans may be eligible for hospice care through the Department of Veterans Affairs. private health insurance may pay for some services. health insurance providers can answer questions about what they will cover.
visit the website of the national hospice and palliative care organization to find hospice care near you.
adriana developed anemia while being treated for breast cancer. a palliative care specialist suggested that she get a blood transfusion to control the anemia and relieve some of the fatigue she was feeling. controlling her symptoms helped adriana continue her curative chemotherapy treatment. treating her anemia is part of palliative care.
In palliative care, a person does not have to forego treatment that could cure a serious illness. palliative care can be provided alongside curative treatment and can begin at the time of diagnosis. Over time, if the doctor or palliative care team believes that ongoing treatment is no longer helping, there are two possibilities. hospice care could be moved to hospice care if the doctor thinks the person is likely to die within six months (see What does the six-month hospice requirement mean?). Or, the palliative care team could continue to help with a greater emphasis on comfort care.
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for more information, see nia’s palliative care frequently asked questions article.
what is hospice care?
Increasingly, people are choosing hospice care at the end of life. Hospice care focuses on the care, comfort, and quality of life of a seriously ill person nearing the end of life.
At some point, a serious illness may not be curable or a patient may decide not to undergo certain treatments. hospice is designed for this situation. The patient entering hospice care understands that her illness is not responding to medical attempts to cure it or to slow the progress of the illness.
Like palliative care, hospice provides comprehensive comfort care as well as support for the family, but, in palliative care, attempts to cure the person’s illness are interrupted. hospice is provided to a terminally ill person whose doctor believes they have six months or less to live if the illness runs its natural course.
It is important for a patient to discuss hospice care options with their physician. Sometimes people don’t start hospice care early enough to take full advantage of the help it offers. perhaps they wait too long to start hospice and are too close to death. Or, some people are not eligible for hospice care soon enough to receive their full benefit. Starting hospice early can provide months of meaningful care and quality time with loved ones.
where is hospice care provided and by whom?
Hospice is a focus of care, so it’s not tied to a specific place. it can be offered in two types of settings: at home or in a facility such as a nursing home, hospital, or even a separate hospice facility.
Read more about where end-of-life care can be provided.
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Hospice care brings together a team of people with special skills, including nurses, doctors, social workers, spiritual advisors, and trained volunteers. everyone works together with the person who is dying, the caregiver and/or the family to provide the necessary medical, emotional and spiritual support.
A member of the hospice team visits you regularly, and someone is usually always available by phone, 24 hours a day, seven days a week. hospice may be covered by medicare and other insurance companies. check if the insurance will cover the particular situation of the person.
the story of pain
Choosing hospice doesn’t have to be a permanent decision. For example, Dolores was 82 years old when he learned that his kidneys were failing. She thought she had lived a long and good life and didn’t want to go on dialysis, so she began hospice care. a week later, she learned that her granddaughter was pregnant. After speaking with her husband, Dolores changed her mind about using hospice and left to start dialysis, hoping to one day have her first great-grandchild. Shortly after the baby was born, doctors said that Dolores’s blood pressure was too low. At that time, she decided to re-enroll in hospice.
It is important to remember that stopping treatment intended to cure a disease does not mean stopping all treatment. a good example is an elderly person with cancer. If the doctor determines that the cancer is not responding to chemotherapy and the patient decides to enter hospice care, the chemotherapy will be stopped. other medical care may continue as long as it is helpful. For example, if the person has high blood pressure, they will still receive medication for that.
for more information on hospice and palliative care
This content is provided by the NIH National Institute on Aging (NIA). nia scientists and other experts review this content to make sure it’s accurate and up-to-date.
revised content: May 14, 2021