Palliative care: Encyclopedia II - Palliative care - Palliative care practice

Palliative care - Palliative care practice

Palliative care most often occurs in the dying person's home. It is also provided in free-standing inpatient (hospice) units and within regular hospital units.

In most countries, hospice care is provided by an interdisciplinary team consisting of physicians, registered nurses, chaplains, social workers, physiotherapists, occupational therapists, complimentary therapists, volunteers and, most importantly, the family. The focus of the team is to optimize the patient's comfort. Additional members of the team are likely to include home health care aides, volunteers from the community, and housekeepers. In the UK palliative care services offer inpatient care, day care, day treatment and outpatients and work in close partnership with mainstream services. Hospices often house a full range of services and professionals.

In the US, a patient is usually admitted into a palliative care program if there is a reasonable expectation of death within 6 months. This does not mean, however, that if a patient is still living after six months in hospice, he or she will be discharged from the service. Such restrictions do not exist in other countries such as the UK. Opportunities for caregiver respite are some of the services hospices provide to promote caregiver well-being. Respite may be for several hours or up to several days (the latter being done usually by placing the patient in a nursing home or in-patient hospice unit for several days).

Because palliative care sees an increasingly wide range of conditions in patients at varying stages of their illness, it follows that palliative care teams offer a wide range of care. This may range from managing the physical symptoms in patients receiving active treatment for cancer, through treating depression in patients with advanced disease, to the care of patients in their last hours and days. Much of the work involves helping patients with complex or severe physical, psychological, social and spiritual problems. In the UK over half of patients are improved sufficiently to return home. If a patient dies, it is common for most hospice organizations to offer bereavement counseling to the patient's partner or family.

In the US, board certification for physicians in palliative care is through the American Board of Hospice and Palliative Medicine. In the UK, palliative care has been a full speciality of medicine since 1989 and training is governed by the same regulations through the Royal Colleges of Medicine as with any other medical speciality. In the United States it is important to note that while in hospice care, a Medicare patient gives up his or her claims to reimbursement for any treatment of the terminal condition, with the exception of what the hospice considers palliative treatment. (Though a hospice patient may later opt out of hospice care.) Also, Medicare does not reimburse for what is considered custodial care. In the UK and many other countries all palliaitve care is offered free to the patient and their family, either through the National Health Service or through charities working in partnership with the NHS.

Adapted from the Wikipedia article "Palliative care practice", under the G.N U Free Docmentation License. Please also see http://en.wikipedia.org/wiki