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End Of Life Care Options

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Last Updated: 02 July 2021

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End-of-life care can be provided in a variety of settingswhich are greatly dependent upon the level of care that is require, resources that are available, and patients ' goals for care. Hospice care is for individuals who have been diagnosed with terminal illness and are certified as having a life expectancy of 6 months or less. Patients can receive Hospice care in various settingsincluding, at home, hospital, long-term care facility, or free-standing Hospice facility. Care is focused on comfortnot on recoveryand is provided by an interdisciplinary team that addresses physical, psychosocial, and spiritual needs. For those who are eligible, care relating to admitting diagnosis to hospice is covered under Medicare / Medicaid Hospice Benefit. Private insurance may cover some costs, depending upon policy. If there is cost to patients or families, it is typically based on sliding scale fee structurehowever,. Hospices cannot refuse care due to patients ' inability to pay. Although hospice care always includes palliative care, individuals with severe illnesses who require pain and symptom managementbut do not necessarily have a life expectancy of 6 months or lesscan benefit greatly from stand-alone palliative care. Palliative care programs that are separate from Hospice provide comfort care, but offer the option of continued focus on curative care. Services can be received in any settingwith support provided by an interdisciplinary team of healthcare professionals who are palliative care experts and skilled at discussing end-of-life care goals. Palliative care is covered in the same way as other medical services. Most insurance plans, including Medicare and Medicaid, cover all or part of palliative care costs. Studies of hospitalized patients show that when patients are receiving care from a palliative care team, they are less likely to end up in an intensive care unitwhich, better aligns with end-of-life preferences for many patients and decreases hospital costs. The ability for individuals to benefit from home-base care is largely dependent upon whether they have needed resources to receive care in this setting. This is intrinsically linked with patients ' goals for care, patients condition, and the amount and quality of caregiving support available. There are numerous benefits for patients who receive end-of-life care at home, including the ability to remain in a familiar and comfortable settingand ability to enjoy more autonomy regarding care, visitors, and the environment. Costs for home-base care are highly dependent upon the type, intensity, and frequency of care that is needed. Care may be provided by Hospice, community-base palliative care programs, home health agencies, professional caregivers, and family members. Payment sources are dependent upon care needs and eligibility, and include Medicare and Medicaid, private and long-term care insurance, Department of Veterans Affairs, and patient and family resources. If not covered by other resources, patients and families often cover costs of home health aide and homemaker servicesboth of which can be approximately 20 per hour.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Understanding Palliative Care

For individuals living with serious illnesses and for their caregiving family and friends, Palliative Care offers medical and related treatment towards living as well and as fully as possible. Healthcare professionals embrace patients ' values, goals, and wishes when considering disease management and burden relief from pain, anxiety, fear, and other symptoms. Patients ' plans and wishes are shared with family and friends who provide care, and support is provided to help relieve burdens. Most importantly, this patient / family-center care is appropriate at any age and at any stage in serious or chronic illness. For example, person with cancer may be treated for unrelenting pain and appetite loss concurrent with curative treatment; person living with Alzheimer's disease may be treated for anxiety and sleeplessness. Care may be offered in hospital,s long-term care facility,s at home, or in outpatient clinics. First used in 15 century, term Palliative today means to remedy or lessen without curing. Although in the past, Palliative Care and hospice Care were bind together, now they can consider two related approaches that respond to serious illnesses depending on patients ' condition and wishes. They share similar philosophies, and person in Palliative Care may transition to hospice Care if they are approaching the end of life. Looking deeper into concept, National Consensus Project on Palliative Care describes it this way: Palliative Care is both philosophy of care and organize, highly structured system for delivering care. The goal of Palliative Care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of stage of disease or need for other therapies. Palliative Care expands traditional disease-model medical treatments to include goals of enhancing quality of life for patients and family members, helping with decision making, and providing opportunities for personal growth. Palliative Care can be rendered along with life-prolonging treatment or as the main focus of care. What is an organize, highly structured system, and how has it come to be so widespread now in healthcare? First, Palliative Care takes a collaborative, interdisciplinary team approach. In addition to patients and family, specially trained team can consist of: doctors, registered nurses, social workers, chaplains, dieticians, pharmacists, licensed mental health professionals, physical and occupational therapists, music therapists, massage therapists, and others. Most common health conditions addrest in Palliative Care include: cancer, Congestive heart failure, kidney failure, liver failure, Chronic obstructive pulmonary disease or other lung diseases, HIV / AIDS, Spinal cord injuries, brain diseases such as stroke, ALS, or Parkinsons, Multiple sclerosis, Alzheimers and other dementias when patients choose to begin Palliative Care, they receive formal assessment of their health early in process. Symptoms most commonly addressed include: pain or discomfort, Shortness of breath, Fatigue, Anxiety, Depression, Lack of appetite, Nausea Constipation Adjusting to and living with the diagnosis of serious health conditions Sleep problems. There will be discussions about the need for an Advance Directive and preferences about withholding or withdrawing Life-sustaining treatments.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Understanding Hospice Care

Hospice Care is for terminally ill people who's expected to have six months or less to live. But Hospice Care can be provided for as long as the person's doctor and Hospice Care team certify that condition remain life-limiting. Many people who receive Hospice Care have cancer, while others have heart disease, dementia, kidney failure or chronic obstructive pulmonary disease. Enrolling in Hospice Care early helps you live better and live longer. Hospice Care decreases the burden on family, decreases the family's likelihood of having complicated grief and prepares family members for their loved one's death. Hospices also allow patients to be cared for at facility for a period of time, not because the patient needs it, but because family caregivers need a break. This is known as respite Care.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

End-of-Life Care in Nursing Homes

Residents in ALFs may withhold their concerns and may not initiate dialogue because they make assumptions about information wanted by nurses and physicians. 9 Elders may think their family members already know their EOL Care preferences, which is another potential barrier to discussion. 10 in focus groups in Senior centers and ALFs, participants said they were comfortable discussing EOL Care issues, but they viewed others as being uncomfortable and resisting discussion about EOL decisions and expressing that the provider's emphasis on cure and treatment prevented discussion. 11 Demographic characteristics may also influence opportunities for and responses to discussion about EOL decisions. Daaleman et al 12 found in a sample of more than 1000 deaths in nursing homes and ALFs that resident factors of nonwhite race and lack of private insurance correlated with lower prevalence of advance directives. The elderly are most open to discussing EOL preferences when they, family member,ss or friends have experienced serious or life-threatening illnesses 9 13 Analysis of focus group data from three different elderly populations with ethnic and socioeconomic diversity reveals four categories of influence for their participation in advanced Care planning: concern for themselves, concern for others; expectations about how advanced Care planning would impact them; and their own anecdotes, stories, and experiences. 14 Additional factors that facilitate EOL discussion are a straightforward approach and having someone else initiate and facilitate discussion. 13 Content for advance healthcare planning and EOL discussion can include listening to elderly story, their fears and anxieties, importance of family and friends, and loss of dreams; addressing what to expect in progression of end of life; and exploring how elderly wish to handle decline in health when it come. Elders need uninterrupted time and someone who is skilled in communication-active listening, encouraging disclosure and allowing silence, providing writing material, and addressing inconsistency in verbal and nonverbal messages. 9 15 assist Living and long-term Care settings emphasize maintaining health and rehabilitation, which can lead to confusion about care goals for EOL Care. In one study, based on interviews with LTC staff, researchers suggest that staff members do not have a formal script or set of expectations for discussing end of Life and providing palliative Care. 16 When death becomes hidden rather than understood as a natural and inevitable occurrence, tension results between policies that focus on increasing independence and policies that emphasize providing supportive comfort care for dying residents. 17 palliative Care needs of ALF residents may fall through cracks in the model that provides palliative Care only for imminently terminally ill residents. 18 elderly residing in private homes, Nursing homes, hospitals, and ALFs have similar experiences of symptom distress at the end of life and need to discuss EOL preferences. 5 19 20 Conflicting expectations may result when there is lack of discussion about EOL healthcare.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Late Stage and End-of-Life Care

In the final stages of many terminal illnesses, care priorities tend to shift. Instead of ongoing curative measures, focus often changes to palliative Care for relief of pain, symptoms, and emotional stress. Ensuring loved ones final months, weeks, or days are as good as they can be requires more than just a series of care choices. Anticipating demands of end-of-life caregiving can help ease the journey from care and grief towards acceptance and healing. Understanding late-stage care in the final stages of life-limiting illness, it can become evident that in spite of best care, attention, and treatment, your loved one is approaching the end of his or her life. Patient Care continue, although focus shifts to making patients as comfortable as possible. Depending on the nature of illness and patients ' circumstances, this final stage period may last from a matter of weeks or months to several years. During this time, palliative care measures can provide patients with medication and treatments to control pain and other symptoms, such as constipation, nausea, or shortness of breath. Even with years of experience, caregivers often find the last stages of life uniquely challenging. Simple acts of daily care are often combined with complex end-of-life decisions and painful feelings of bereavement. End-of-life caregiving requires support, available from a variety of sources such as home health agents, nursing home personnel, hospice providers, and palliative care physicians. Identifying need for end-of-life Care There isnt single specific point in illness. When end-of-life care begin; it very much depends on the individual. In the case of Alzheimer's disease, patients ' doctors likely provide you with information on stages in diagnosis. These stages can provide general guidelines for understanding the progression of Alzheimer's symptoms and planning appropriate care. For other life-limiting illnesses, following are signs that you may want to talk to your loved one about palliative, rather than curative care options: patient has made multiple trips to the emergency room, their condition has been stabilize, but the illness continues to progress significantly, affecting their quality of life. Theyve been admitted to hospital several times within the last year with the same or worsening symptoms. They wish to remain at home, rather than spend time in hospital. They have decided to stop receiving treatments for their disease. Patients and caregivers needs in late-stage Care Practical Care and assistance. Perhaps your loved one can no longer talk, sit, walk, eat, or make sense of the world. Routine activities, including bathing, feeding, toileting, dressing, and turning may require total support and increased physical strength on the part of the caregiver. These tasks can be supported by personal care assistants, hospice team, or physician-order nursing services. Comfort and dignity. Even if patients ' cognitive and memory functions are deplete, their capacity to feel frightened or at peace, love or lonely, and sad or secure remains.


What is palliative care?

Palliative care is treatment, care and support for people with life-limiting illness, and their family and friends. Its sometimes called supportive care. The aim of palliative care is to help you to have a good quality of life, including being as well and active as possible in the time you have leave. It can involve: managing physical symptoms such as pain, emotional, spiritual and psychological support, social care, including help with things like washing, dressing or eating support for your family and friends. A Life-limiting illness is an illness that ca be cured and that youre likely to die from. You might hear this type of illness called life-threatening or terminal. People might also use terms progressive or advanced to describe these illnesses. Examples of life-limiting illnesses include advanced cancer, motor neuron disease and dementia. You can receive palliative care at any stage in your illness. Having palliative care doesnt necessarily mean that youre likely to die soon-some people receive palliative care for years. You can also have palliative care alongside treatments, therapies and medicines aimed at controlling your illness, such as chemotherapy or radiotherapy. However, palliative care does include caring for people who are nearing the end of life-this is sometimes called end of life care.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

What is Life-Sustaining Treatment?

Caring for Patients at the End of Life is a privilege that draws deeply on physicians ' commitment to alleviating suffering. The fact that crisis standards of care have been invoked during pandemic outbreaks should not obscure the importance of ensuring that every patient reaching the end of life receives appropriate supportive care. Ama Code of Medical Ethics addresses key issues at End of Life In: Opinion 5. 3, Withholding or Withdrawing Life-Sustaining Treatment Opinion 5. 5, Medically Ineffective Interventions Opinion 5. 6, Sedation To Unconsciousness in End-of-Life Care Opinion 5. 3 recognize that decisions to withhold or withdraw Life-Sustaining Interventions can be ethically and emotionally challenging for everyone involve. It reminds physicians that patients who have decision-making capacity have the right to knowingly decline Life-saving Care even against physicians ' recommendations. When patients are not able to participate in decision making, their surrogates may make such decisions on their behalf. Ideally, patients will have to discuss their preferences and goals for care with their physicians before a decision needs urgently to be make. When a patient has an Advance directive, preferences set out in the directive should govern care decisions. Often, however, patients have not give much think to what care they will or will not want at the end of life. In such cases, physicians should elicit Patients values, goals for care, and treatment preferences and capture those preferences in medical record. A Decision to withhold or withdraw Life-Sustaining Treatment is not a decision to withhold or withdraw Care entirely. Opinion 5. 2 require that physicians eassure patient and / or surrogates that all other Medically appropriate care will be provide, including aggressive Palliative Care, appropriate symptom management if that is what the patient wishes. When it proves impossible to adequately manage symptoms despite vigorous Palliative Care efforts, for some terminally ill Patients option of last resort is Sedation To Unconsciousness. Opinion 5. 6, Sedation To Unconsciousness in End of Life Care, directs physicians to reserve this option for patients in the final stages of terminal illness, and to ensure that options for appropriate, symptom-specific Palliative Care have been exhaust, ideally in consultation with a multi-specialty team. The patient, or surrogate, must give informed consent before Sedation is administered and the decision appropriately recorded in medical record. For guidance on surrogate decision making, Advance Care Planning, and use of Advance Directives, see Opinion 2. 12, Decisions For Adult Patients Who Lack Capacity, Opinion 5. 1, Advance Care Planning, and Opinion 5. 2, Advance Directives, respectively.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

End of Life Symptoms

There are symptoms that are common at the end of life, and these can be distressing for family and caregivers. These include loss of appetite, breathlessness, and / or loud respiration / breathing. There are several non-medical strategies to ease someone's discomfort at the end of their life. The loss of appetite is an almost universal symptom in individuals who are dying. Appetite stimulants and tube-feeding do not prolong survival and should not be used. Ice chips, ice pops, moist swabs, or artificial saliva can help prevent mouth from becoming dry and crack. Breathlessness at the end of life is common and often distressing. Individuals can feel breathless even if their breathing and oxygen levels are normal. Moving cool air across face from the window or with fan can be helpful. Oxygen therapy and, in some cases, medications can also help. Terminal Respiratory secretions are a sign that death is close. These sounds are caused by fluid that collects in the back of the throat and windpipe in individuals who no longer have swallowing or cough reflex. Repositioning and elevating the head of bed can be helpful. Gentle suctioning and medications to dry up secretions may also be used

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

End of Life Option Act

Californians with terminal illnesses now have the option to work with their physicians to choose aid in dying, and while statistics on use of the California End of Life Option Act have yet to be release, news reports have profile several terminally ill patients who have used the law. By design, process contains multiple steps and opportunities for patients to change their minds before being given access to prescription medications that will hasten their deaths. Safeguards in law include getting both attending physician and consulting physician to verify terminal diagnosis, 6-month prognosis and mental capacity. Patients also have to complete final attestation within 48 hours of ingesting medication to confirm they are making an inform, voluntary choice.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Home-Based Care

Costs are highly dependent upon the type, intensity and frequency of care that patients require. Care may be received from Hospice, community-base Palliative Care programs, home health agencies, professional caregivers and patients ' personal support team, such as family members and friends. Payment sources are dependent upon care needs and eligibility and include Medicare, Medicaid, private insurance, long-term Care insurance, Veterans Administration and private Patient / family resources. If not covered by other sources, patients and families often cover costs of home health and homemaker / companion services privately, both of which can be approximately 20 per hour, depending upon location, needs and time frame of services. For some patients, these costs may be well worth adding comfort of remaining at home and may even be less costly than care in a hospital or long-term care facility.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

Sources

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions.

* Please keep in mind that all text is machine-generated, we do not bear any responsibility, and you should always get advice from professionals before taking any actions

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