In Every Life
Posted on November 1, 2011 by bob in In Every Life
The inter-professional hospice care movement began in 1967 in London to provide services to support persons of all ages and their families during the last period of life, through the dying and bereavement processes, in accord with unique situations and personal values.
This model of care came to the United States in the 1970s, and in the 1980s was approved for Medicare cost reimbursement.
Traditionally, a physician certified that life expectancy was 6 months or less, and the person receiving care selected to have supportive care rather than curative or life-prolonging treatments. In 2007, the U. S. had approximately 4,700 hospice programs.
The hospice model evolved to a broader, more inclusive palliative model of care in response to desires of many people with prolonged progressive and potentially debilitating diseases to obtain family-centered care that emphasized quality-of-life concerns, especially as techniques to manage (not cure) chronic illnesses developed.
The scope of palliative care is greater than end-of-life care, blending both curative and hospice approaches across the illness trajectory.
Palliative care is based in a “whole-person” philosophy, and can occur across the lifespan and across health care settings (clinic, hospital, home, assisted, long-term care or respite facilities, in urban or rural areas).
The person and family/significant others are the recipients of care that includes:
– careful symptom management (nutrition, fatigue, pain, mobility, elimination, etc.)
– care for emotional and spiritual needs of the person/family
– promoting ethical and legal decision-making
– incorporating cultural values and attitudes of the person/family
– advocating for personal wishes through genuine relationships and respect
– therapeutic communication
– inter-professional collaboration (nurse, physician, social worker, chaplain, therapist, or others)
– the ability to convey hope and meaning in the face of death
– follow-up care to support those experiencing loss, grief, and bereavement
The World Health Organization, in response to worldwide acceptance of the care model, defined palliative care as “an approach to care which improves quality of life of persons and families facing life-threatening illness, through the prevention, assessment and treatment of pain and other physical, psychological and spiritual problems.”
An “Open Access” approach, with the goal of providing quality symptom management concurrently with curative measures, provides opportunity to transition seamlessly to hospice services as frailty increases. There is a growing number of palliative care programs within institutions, or offered as consultation services through hospice programs.
Although costs have constrained many open access programs, the vision for future care is to incorporate counseling, nutrition, fatigue and pain control services along with rehabilitation, rather than have distinct separation and reimbursement between diagnosis and treatment, and end-of-life care (The National Comprehensive Cancer Network @ http://www.neen.org/professionals/physician_gls/PDF/palliative.pdf).
The National Consensus Project for Quality Palliative Care (March, 2009) identified guidelines for clinical practice in eight domains that can be accessed at http://www.nationalconsensusproject.org. The City of Hope Pain/Palliative Care Resource Center provides other resources available at http://prc.coh.org.
If you are interested in more information about palliative care, discuss it with your health care provider.
Arlene Morris, RN, Ed.D.
Arlene H. Morris, RN, Ed.D. is a Distinguished Teaching Associate Professor in the Auburn Montgomery School of Nursing, where she enjoys teaching content regarding gerontology and professional nursing issues. E-mail
her at amorris@aum.edu.
