Hospice Treatment Basics
What is "palliative care"?
Palliative care is a way of providing care that's geared to comfort, not cure. Palliative care can be provided in a number of settings. Palliative care can be provided along with hospice care, and most hospice care is palliative in nature. But, many hospitals these days also have palliative care programs. In a palliative care program in a hospital, they will provide additional resources in terms of symptom management and emotional support for you while you're hospitalized.
How does hospice administer palliative care?
A hospice administers palliative care through the services they provide in making sure that your loved one is always comfortable and their symptoms are managed well, their emotional needs and spiritual needs are getting met. In the hospital setting, there may be a whole separate team that provides palliative care: there may be a physician, there may be different nurses who, in addition to the nurses and the physicians that normally care for you on your floor, are also there as a resource to help you, earlier on in your care. So sometimes if you are admitted to a hospice to receive palliative care maybe six months or a year before you may be facing the end of life, palliative care in the hospital setting, can be two to three years out and can help you with earlier issues.
Who determines what my hospice care involves?
In terms of determining what hospice care you're going to get, the wonderful thing about hospice is you have a say. You and your family are going to work with your physician and the hospice team to decide what kind of care, and how much, is right for you.
Can I keep my own physician during hospice care?
When you enter hospice care, whether it be in a facility or in your home, your physician can stay on your case if you both decide that that would be beneficial. There's always a medical director there who's available. Many physicians choose to stay on, and sometimes they will turn over the care to the hospice physician. It really depends on what your physician and you decide.
Does hospice offer choices in medication and treatment?
Hospice is really about you getting the exact type of care that you want so yes it offers choices in medication and treatment. Your nurse and the physician will really talk to you about which treatments you want, which will be beneficial to you, which won't be beneficial to you and why. So you can really have a customized plan of care that's just right for you. For some people when they're looking at hospice care, they may feel like a hospital bed would really make them comfortable, and really can provide different positions to help them interact with visitors more. There's other people who feel like, "The last thing I want in my home at this point is a hospital bed." Hospice is really great of not having an agenda and really letting you do it your way in terms of medication and treatment.
How does hospice manage pain?
Hospice manages pain very well. Hospice will manage pain through medications; there are wonderful medications out there these days to take care of patients at this important time of their life. There are medications that can be given orally in pill form, under your tongue or by patches that can be put on. Hospice is very good at choosing the medication that really is right for you: not too much, not too little, but just right. The nurses that you work with in hospice are going to be watching your pain very closely. They want to make sure that they're ahead of the pain, that if they see an increase coming they have a higher dose ready, and if you're having less pain, they want to be able to switch you to a lower dose so that you don't have any unnecessary drowsiness. Hospice nurses want to make sure that your family is trained on how to give pain medication, if that is something they want to do and if it becomes necessary. They also want to make sure you have measures in place to manage your pain during the night, around the clock and on weekends. They want to really take care of your pain and make sure you're as pain free as possible.
What should I do if hospice is not managing my pain?
If for any reason the hospice is not managing your pain, don't ever be afraid to call the hospice supervisor. If that doesn't work, please call the head of the hospice. It's very important to hospices around the country and the world that pain management is really the cornerstone of our care. So don't be afraid to go up the ladder of command. Don't be afraid to call the hospice medical director if your pain isn't being managed. If you're not getting the results you want, don't be afraid to switch hospices. This is your life and it's important that you be pain-free.
Will my loved one become addicted to their pain medications?
Families are often concerned that their loved one will become addicted to pain medications. There's a time in our lives to worry about addiction and there is a time in our lives to worry about managing the pain at the end of life. These two are very different times. Less than one percent of the population gets addicted to pain medications at the end of life. So, just know, we want to make sure that your loved one gets the pain management they need, and its very unlikely that they will get addicted. When people are concerned a loved one may be addicted, sometimes what's happening is what we call pseudo addiction. That is, all of a sudden, your loved one may want to take their pain medication more and more. From the outside it may look like drug seeking behavior. But really, what your loved one is doing is pain relief seeking behavior. Our goal is to get your loved one off that short term pain relief agent and put them on something more continuous that manages their pain medication without them to have to constantly ask for something every few hours.
Can I change physicians during my hospice care?
If, for any reason, you find yourself on hospice care and unhappy with your physician, if he's your primary physician who has followed your case before, you can certainly turn the care over to the hospice medical director. If it's the hospice medical director you're unhappy with, please let the hospice know. They often have alternative medical directors that can also facilitate your hospice care.
