“Everybody will die, but very few people want to be reminded of that fact.” Lemony Snicket, The Austere Academy

June 1, 2017

As the population ages and baby boomers begin their golden years, much more attention is being placed on death and dying. The later part of our lives has been given very little emphasis in the past. The goal is to improve the quality of living during this period and to ensure the dignity of death. Medicine has realized the importance of this period of life and in 2006 developed an entire specialty of Hospice and Palliative Care. These are physicians trained to care for patients who have chronic disease and are in the end of life period.

Palliative Care is medical care for patients with life-limiting chronic medical problems. Quality of life is the main objective with care focused on relieving suffering from debilitating symptoms.

Palliative Care can be initiated by the primary care physician when the patient, family, and physician agree that the plan of care needs to be focused more on quality of life and symptom relief rather than toward prevention or cure. This may include patients with cancer, dementia, chronic lung disease, end stage heart disease such a congestive heart failure, chronic renal failure, and other chronic or debilitating conditions. Palliative Care can be given by the patient’s primary care physician and the physician can utilize others to assist with care such as home health, physical therapy, social workers, or other allied health professionals. There are also Palliative Care specialists as well as Palliative Care providers available. Palliative Care can be initiated at any time if felt appropriate by the physician and patient.

Hospice is an extension of Palliative Care but begins when it is felt that a patient may be within their last six months of life. This is not a set time but only an estimation. The question I ask colleagues, patients, and family members is, “Would you be surprised if this patient was with the Lord in six months?”  Hospice is a team approach with the focus on caring, not curing. Care is provided by a team composed of the Hospice Medical Director, the primary care physician, hospice-trained nurses and nursing aides, a chaplain, pharmacist, and hospice-trained volunteers. Other providers are utilized when needed such as physical therapy and others. Care is usually given in the home but may also be in the hospital, nursing home, or free-standing facility. Symptoms are managed aggressively including physical symptoms such as pain, shortness of breath, and nausea; emotional symptoms such as anxiety and depression; and psychological symptoms of family issues and spiritual issues. Hospice is a team approach which includes treating the patient and the family. Bereavement follow up is given to the family for up to a year after the patient’s death.

When we enter the later stages of our lives and the symptoms of chronic conditions become too burdensome, we have the option to change the focus of our care to quality of life and aggressive treatment of symptoms. Discuss your care or the care of a family member with your primary care physician to decide when this might be appropriate.

“Nothing they say is more certain than death, and nothing is more uncertain than the time of dying.”

Thomas Paine