What Is Palliative Care?

What is palliative care?
Palliative care works to relieve uncomfortable symptoms and reduce the negative effects of illness. Palliative care is appropriate in any serious or life-limiting illness, but it is especially helpful for persons whose illness may be chronic or not curable.  

Palliative care promotes the best quality of life possible, as defined by each person and family. It addresses physical problems such as pain, fatigue, and nausea but also helps with the emotional, social, and spiritual concerns of the individual and family.

Is it a medical specialty? Are there "palliative care" doctors and nurses? How would I find one?
In mid-2006, the American Board of Medical Specialties made palliative care an official medical “sub-specialty.” There are specially trained “palliative care” doctors and nurses and programs.  

To find palliative care, first talk with your primary physician what services might be helpful and available. Many hospitals are developing palliative care services, so check with your hospital of choice to see what they can offer.  

What kinds of illnesses are treated with palliative care?
Right now, palliative care is most available to those suffering from chronic or “life-limiting” illnesses, such as COPD, congestive heart failure, Alzheimer’s disease, Multiple Sclerosis, kidney or liver disease, Parkinson’s, AIDS, cancer, ALS (Lou Gehrig’s disease), diabetes, and others.  

How is palliative care different from hospice services?
All hospice care is palliative care, but not all palliative care is hospice care. When hospice care is paid for by Medicare, the person's physician and the hospice medical director must “certify” that the person’s illness is terminal and that he or she is unlikely to live for longer than 6 months. The person must decline any treatments that are not specifically intended for comfort and quality of life.

All costs of hospice care—including the cost of drugs, medical equipment and supplies, the services of the entire hospice team, and bereavement support for the family—are paid for by Medicare.

A person may receive palliative care, however, even if the disease is not terminal or life expectancy is longer than 6 months. The person may continue treatments that are directed toward curing the disease along with palliative care. Medicare, however, does not cover palliative care as yet, and only a few private insurers offer a palliative care benefit. See more below on payment for palliative care. 

Do I have to give up on seeking a cure for my disease?
No, not with palliative care. The palliative care team can help you and your family sort out the ongoing risks and benefits of treatments aimed at curing the disease. 

Do I have to give up my familiar physicians and transfer to someone else?
The palliative care team typically works with your current physicians. 

I don’t see “palliative care” mentioned in my insurance plan – does that mean I’d have to pay for it?
Some hospitals provide palliative care consultations and a limited number of ongoing visits with their own team of professionals. These services would be covered by typical insurance reimbursement for medical or nursing services. Medicare will cover the cost of one palliative care consultation with a hospice physician. If you have questions about your insurance coverage, you should consult directly with your insurance agent or carrier. 

What good will “palliative care” do me if it won't help cure my disease? And anyway, doesn’t regular medical care address pain and distressing symptoms? Why would I need a whole other team of people to take care of all this?
Medicine today can do wonders, but sometimes when the focus is solely on the cure, treatment side effects or symptoms of the disease are not given the attention they deserve. Nausea, dry mouth, pain, skin breakdown, shortness of breath, sleep problems, weakness and fatigue, anxiety, depression, fear, family conflict, financial pressures, caregiving burdens, and other problems can make the experience of a life-threatening or chronic illness even more difficult to bear. Traditional medical approaches to disease sometimes fail to ease pain and suffering – and sometimes treatments can even increase discomfort. Palliative care focuses solely on helping you feel better, to live as fully as you can for as long as you can. Even when diseases are incurable, people receiving palliative care often live longer and better than those who don’t.  

When in the course of my illness would I start palliative care? When would it stop?
Palliative care is most appropriate when your illness, or its treatment, is seriously harming your quality of life; for instance, if you have a lot of pain that makes it difficult to move or concentrate; if you have nausea or diarrhea or other problems with your ability to eat and digest; if you are depressed or upset so that you aren’t able to communicate well or enjoy life; if your family is having a tough time. Any such situation might suggest a palliative care approach. Palliative care would supplement your medical treatment to support you and your family as long as you have ongoing needs. 

Where can I get palliative care? From any doctor at any hospital or clinic?
At the moment, palliative care is a relatively new approach and not every hospital, clinic, or nursing home offers it. Currently in Colorado, there are about two dozen hospitals that offer some kind of palliative care services. Denver’s Children’s Hospital in partnership with Centura Health at Home has a special palliative care program just for children called The Butterfly Program. There are private practice palliative care physicians and nurse practitioners. All Veterans Health Administration hospitals offer palliative care, and many hospice agencies offer “pre-hospice” palliative care programs. Talk to your primary physician or the specialist treating your illness first to see what palliative care services might be helpful and available. Additionally, helpful consumer resources may be found at Caring Connections (www.CaringConnections.org), sponsored by the National Hospice and Palliative Care Organization. The Web site includes plentiful information on end-of-life care, advance care planning, financial planning for health care crises, pain relief, caregiver support, and grief and bereavement. Among other useful tools, this site has state-specific, downloadable advance directive documents such as living wills and medical durable powers of attorney.