What are the differences between hospice care and palliative care? Any caregiver who sees the quality of life ebbing away in their parent, child or whomever they are caring for, begins to think about comfort. Comfort is about being pain-free so that one can sleep, eat, and perform necessary bodily functions. Comfort is what both hospice and palliative care provide.
Comfort is pretty hardcore basic. But at the end of a long illness, or as one is approaching an involved cancer treatment regime—comfort is paramount.
This is also true of the elderly. In this group of people very often much has already been lost. The elderly experience diminished senses: sight or hearing, taste or smell; and sometimes all of these including touch.
Often the elderly are experiencing progressive dementia. The synapses of the brain no longer fire as they should; memory is lost and with memory the ability to read a book or a newspaper, watch a film and in severe cases even carry on a conversation. If you cannot remember what was just said, you cannot converse in a meaningful way.
For those with dementia and Alzheimer’s disease reality comes and goes. Sometimes your aunt or uncle or parent makes sense. But often they speak of a reality that is made up of dreams, fantasies or the belief that they are still living their past lives. My 95-year-old mother tells me she is working part time, going to the theatre and singing in the choir. She is no longer able to do any of those things. She is living in a senior facility. She cannot walk and is confined to a wheel chair most of the day. When those snatches of her past, which are more ingrained in her mind than her recent life, rise to the surface, she goes there to live. It’s familiar, comforting.
Comfort is what she needs and deserves. And mercy. Understanding.
So how do we comfort ill children, aging parents, spouses who are facing cancer treatment? With palliative care.
This system grew out of the need to provide a quality of day-to-day living that is pain-free. Whether a person is dealing with a chronic illness or about to have chemotherapy, palliative care creates goals so that a person will experience the treatment or live with the disease free of pain. Her or she will experience a life of comfort and hopefully a sense of peace. Palliative care does not preclude other care to possibly cure the cancer or push back the progression of the chronic disease.
Hospice is also palliative care, but it is set within a particular time frame. Sometimes doctors must sign paperwork stating that the client has been judged to be at the end of life. Pain relief and comfort are provided as well as emotional and spiritual help. Both hospice and palliative care are founded on principles that affirm life and acknowledge that death is a normal process, a part of the life spectrum and should be talked about and dealt with—not shunned and avoided.
Palliative care provides relief from pain and physical symptoms that create daily stress in a person’s life. Its purpose is neither to hasten nor to postpone death. Palliative care providers work with clients to integrate spiritual and psychological help and to create a support system so that patients can life as actively as is possible for them. Palliative care provides holistic comfort and thus improves the quality of life of the client and his or her family.
This past week I had to decide whether to place my mother on hospice or to allow her the Medicare benefit of rehabilitation after she had surgery on a fractured hip. Because she completed a 3-day hospital stay, she is allowed 1-20 days of skilled nursing paid for by Medicare. Because of her age, I could also ask to have hospice care only. On the hospice plan, no physical therapy would be done. I consulted with her physician and because my mother has rebounded before, my family and I chose Medicare. This was not an easy decision to make.
Comfort will always be my main concern as I work with my mother’s facility, doing whatever I possibly can to care for her in her last years, months, and days of her life.