For people with chronic illnesses, having a supportive care team provides access to expertise in symptom management. For example, cancer patients ideally receive aggressive treatments early on, targeting affected areas of the body. But, this treatment often comes with a barrage of distressing symptoms, such as pain, shortness of breath, difficulty sleeping, nausea, anxiety, and fatigue. This is where palliative care comes in.
According to Kimberly A. Curseen, M.D., director of Supportive and Palliative Care Outpatient Services at Emory Healthcare, director and primary provider for the Supportive Oncology Clinic at Winship Cancer Institute, and associate professor at Emory University School of Medicine, palliative care is focused on providing relief from the symptoms and stress of a serious illness — whatever the diagnosis may be.
“Whether the goal is to cure, slow, or simply manage the disease, equally early and aggressive management of the symptoms that arise becomes an essential part of treating the whole patient and maintaining their quality of life,” she says. “The goal is to improve quality of life for both the patient and their family. This care can help with emotional and spiritual problems as well as physical problems.”
Services provided by palliative care
The goal of palliative care is to prevent and alleviate suffering and help people improve or maintain their quality of life by providing the following:
- Pain and symptom relief
- Guidance in making complex medical decisions
- Emotional and spiritual support
- Assistance in navigating the health care system
Palliative care is delivered by an interdisciplinary team of medical professionals that works closely with a patient’s current doctor(s). The medical team collaborates to develop an individualized care plan that prioritizes symptom management and personalized treatment goals. This team is composed of doctors, registered nurses, and other specialists. Professionals like massage therapists, dietitians, physical therapists, pharmacists, mental health professionals, and chaplains may be added to a patient’s care team as well.
“The purpose of this diverse group of experts is to help the patient and their family members understand the disease as well as all available treatment options and facilitate communication and collaboration amongst all the patient’s health care providers,” explains Curseen.
Patients receive palliative care services for as long as they might need. While care can be ongoing, assistance services can also be suspended once a senior’s health improves and there’s no longer a need for this kind of care.
Palliative care at home
Your loved one’s palliative care team can provide care in the hospital, in long-term care facilities, at clinics, and, in some programs, through home visits. Providing patients with in-home care allows them to be more comfortable while receiving assistance.
In-home palliative care also assists family caregivers by having knowledgeable professionals available to help with decision-making and offer care advice. With this guidance, patients can receive the support they need to age in place as they’d like.
Palliative care at home allows seniors with serious medical conditions access to the support and care they need to recover and heal in a familiar space they prefer.
How to pay for palliative care
As with other hospital and medical services, Medicare, Medicaid, and most private health insurance plans will cover all or part of palliative care services that a doctor deems medically necessary. The extent of coverage depends on an individual’s unique needs and their current insurance plan.
“A prior authorization may be required before an initial visit,” Curseen says, “so be sure to check with the insurance company [or the Centers for Medicare and Medicaid Services] for help with specific questions related to payment options. A social worker may be able to help find solutions regarding the financial aspects of this care as well.”
If you can’t find much information about palliative care on Medicare.gov or Medicaid.gov, don’t fret. The Center to Advance Palliative Care notes that neither Medicare nor Medicaid uses the term “palliative” to describe these services, but such services are covered under both public insurance programs. If there is a specific palliative care service that you’re seeking additional information about, try using the Your Medicare Coverage tool to search for it by name.
How palliative care differs from hospice
Palliative care, also known as supportive care, may seem straightforward, but it’s not widely known or understood, particularly due to its relationship with hospice care.
Hospice care is provided to patients at the end of life, while palliative care is appropriate at any age and at any stage in a serious illness. Unlike hospice, palliative care can be provided in conjunction with curative treatment.
“Palliation can be provided at first diagnosis or late into the disease process because access is based on the needs of the individual,” Curseen notes.
Hospice provides many of the same services but is a specialized type of palliative care for individuals who have received a terminal diagnosis and are approaching the end of life. When doctors estimate that a patient has a life expectancy of six months or less if their illness follows its natural course, then they are considered a potential candidate for hospice care.
It’s also easy to confuse home health care services with palliative care. Home health care services provide seniors with skilled nursing care in their homes that may not be focused on their overall comfort or symptom remediation.
Who benefits from palliative care?
Although palliative care can be beneficial to patients with countless chronic illnesses, it’s commonly associated with cancer treatment. According to the American Cancer Society, “studies have shown that patients who have palliative care visits while in the hospital spend less time in intensive care units and are less likely to visit the emergency room or to be re-admitted to the hospital after they go home. Studies have also shown that people with chronic illnesses, like cancer, who get palliative care have less severe symptoms.”
Several recent studies have found that palliative care improves patient quality of life and reduces the amount of time patients spend in acute care settings. Curseen cites one study published in the New England Journal of Medicine which shows that patients with metastatic nonsmall cell lung cancer (NSCLC) who received outpatient palliative care early following diagnosis not only had an improved quality of life but also lived longer than patients who didn’t receive this intervention.
However, Curseen urges the public to remember that these benefits are not limited to patients with cancer.
“Those with illnesses such as dementia, Parkinson’s disease, chronic obstructive pulmonary disease (COPD), heart failure, and ALS have experienced benefits like symptom reduction and lower hospitalization rates as well,” she says.
Raising awareness of palliative care
“It is important to spread the message that this type of care is available, since there are many people who are struggling with pain and other symptoms but unaware that their life can be improved while they are undergoing treatment,” Curseen says.
If your loved one has a serious illness and the symptoms are interfering with day-to-day life, talk to their primary care doctor about palliative care options. This may include a referral to a palliative doctor or a palliative specialist at a local hospital. For many people, improving even one serious symptom, such as severe nausea, can make a marked difference in their overall quality of life. It can’t hurt to consult with a health care provider about all available options.
Caregivers can also connect with one another and find advice on care services and resources, by joining the Caregiver Forum, an online support group.
Reviewed by home health care executive Michael Ferraina.
Sources:
What is Palliative Care? (https://palliativedoctors.org/palliative/care)