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Palliative 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 Palliative Care team, they are less likely to end up in 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 need 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

Hospice can be thought of as a specific type of Palliative Care. For example, hospice patients are usually referred when doctors believe they have six months or less to live, where Palliative Care is not subject to any timing restrictions. Palliative Care can apply over period of weeks, months, or even years, and can work alongside long - term treatment plans that aim at patient recovery and healing. Palliative Care can assist with life - limiting conditions, and can also apply when active treatment to combat that illness is still being undertake. Like hospice, Palliative Care can include Pain Management, help with understanding care options towards the End of Life, help at home, and emotional support for patients and for loved ones. Family, friends, and community members are more likely to be involved in hospice care alongside doctors and nurses. Depending on insurance arrangements, eligibility may also be different for hospice and Palliative 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

Understanding Hospice Care

The main difference between palliative and hospice care is when each type of care is offer. For people with serious and potentially life - threatening condition, Palliative Care is available at any time, regardless of stage of illness. It doesnt depend on your prognosis or life expectancy. In contrast, hospice care is only available at the end of life, when illness is no longer responding to treatment. At this time, individual may decide to stop treatment and begin hospice Care, also know as end - of - life Care. Like Palliative Care, hospice focuses on persons overall comfort, including their emotional, physical, and spiritual well - being. In fact, hospice is considered a form of Palliative Care. However, receiving Palliative Care doesnt necessarily mean youre in hospice. To qualify for hospice care, doctor has to estimate that your life expectancy is 6 months or less. This can be incredibly difficult to determine. Hospice Care does always signal the end of life. Its possible to receive hospice care and then resume curative or life - prolonging treatments.


What Is 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 of 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

What you can expect

Everyone with a serious illness such as cancer can benefit from palliative care as part of their treatment plan. Palliative care includes supportive care managed by your care team, such as relief from symptoms, pain, and stress. In cancer care, it is meant to improve the quality of life for patients and their families. Medicines To control pain, nausea, and other symptoms Help with emotional and spiritual needs Support to help you better understand your disease and diagnosis Assistance with making medical decisions Coordination with your other doctors Assurance that all your care needs emotional, spiritual, and social - are being addrest Sometimes people confuse palliative care with hospice care. Both focus on improving people's quality of life while they are living. But palliative care is appropriate at any age and at any stage of serious illness. People can get it throughout illness, including while they are getting active treatment for cancer or other serious illnesses. Hospice care, on the other hand, is given near the end of life, usually when treatment for illness has stopped working. You can get palliative care from your regular health care team, or from palliative care specialists. If you have a need that is not being meet, talk to your doctor, nurse, or health care team about incorporating palliative care into your treatment.

* 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

Social

Services are provided by a coordinated team that draws upon many different kinds of professionals who provide medical care and support services. The team also ensure that services and resources are available and provided when needed without family having to locate and arrange for them. When staying at home, family and friends are encouraged to participate in patient care as much as possible. When someone does have family who can serve as caregivers, team may be able to help identify friends and people in the community who volunteer to help. Hospice teams remain available to help and support to patients and families. Chaplain Hospice Aide Physician * Hospice Aides Social Services Nursing Trained Volunteers * Your personal Physician is also a welcome part of the Hospice team and may continue to bill for professional services. Additional Hospice Benefits Bereavement counseling and support is provided to families for up to 13 months or longer, if needed after the death of their loved one. All medications relate to terminal diagnosis. Medical supplies and appliances relate to terminal illness. Patient and family education. Short - term inpatient Care, including respite Care. Other Services as require, including: physical, occupational, dietary and speech - language therapy.

* 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

Mental

While Palliative Care is growing as an interdisciplinary specialty, more clinicians are asking how it can benefit certain patients with severe mental illnesses. Palliative Care, which developed with the founding of hospices in 1960s, initially focused on patients who were dying from cancer. Specialty - which emphasizes improving patients ' quality of life rather than finding cure, and which is different from hospice - can now be used for patients with noncancer - diagnoses such as dementia and HIV / AIDS. Some psychiatrists think that certain patients with another diagnosis would benefit from Palliative Care: those with severe persistent mental illness. In fact, this approach might apply to psychiatric patients who are in long - term residential care with severe / chronic schizophrenia and insufficient quality of life, those with therapy - refractory depressions and repeat suicide attempts, and those with severe long - standing therapy - refractory anorexia nervosa, write Manuel Trachsel, MD, PhD, and his colleagues BMC Psychiatry. Scott. Irwin, MD, PhD, who coauthored that article and letter examining these issues, said Dr. Trachsels theories lie on frontiers of current thinking about incorporating Palliative Care and Psychiatric medicine. Meanwhile, both Dr. Irwin and Maria I. Lapid, MD, another psychiatrist with expertise in Palliative Care, say that in many ways, field of Psychiatry is inherently Palliative in nature.


Methods

The cross - sectional survey was based on research questions. Case vignettes drew on previously published material and were adapted to suit the format and goal of the survey. The content of survey items and case vignettes was revised by an advisory group that includes experts and trainees in psychiatric practice and / or research, as well as biostatisticians. Participants were asked to respond to 18 items on a 7 - point Likert scale, ranging from completely disagree to completely agree, with a neutral mid - point, or from unimportant to very important. Items related to three case vignettes adopt the same response format. The total number of items was 42. Who definition of palliative care was also provide. To examine how psychiatrists would evaluate patients ' life expectancy, case vignettes include surprise question. In palliative care, variants of surprise questions are often used for patient prognosis near the end of life. The survey includes items concerning attitudes to palliative sedation and physician - assist dying for SPMI patients. These are reported in a separate article.


Results

The first research question addresses available empirically studied tools and interventions that can be used in Palliative Care for people with SMI and their relatives. Four studies describe a total of two tools and one multi - component intervention for Palliative Care. These concern: tool to identify patients who might need Palliative Care tool to talk about medical decisions that must be made with respect to care needs and preferences of patients and their relatives National Palliative Care Standard describing multi - component intervention for providing good quality Palliative Care. Two tools and the Palliative Care Standard are described below and characteristics are shown in Table 3. The first tool, described in the study by Burton et al., Is intended for identification of patients who might need Palliative Care. The tool is based on CARING criteria, which apply to people admitted to the psychiatric unit.S Caring criteria are set of five prognostic criteria that have been proposed for identification of persons who are near the end of life upon hospital admission. Five indicators are C ancer as primary diagnosis, dmitted at least two times in the past year for chronic illness, R esident in nursing home and I ntensive Care Unit admission due to multi - organ failure. N on - cancer hospice G uideline is used for the fifth criterion, which is score depending on the nature of the main problem. Objective of study by Burton et al. It was to examine the validity of these criteria when applied to patients admitted to acute inpatient psychiatric Unit after being referred from academic tertiary Care centre. The second tool, described in two studies by Foti et al., Is the Health Care Preferences Questionnaire. Hcpq provides information for advanced care planning and end - of - life Preferences of people with SMI. Two hypothetical scenarios are used to assess persons advance care planning preferences. These scenarios present patients who have conditions that prevent them from expressing choice between different types of Palliative Care, aggressive treatments for their somatic condition and life support. Two scenarios concern patient with terminal metastatic cancer who is in terrible pain and patient with total paralysis and irreparable brain damage. Other examples of topics in HCPQ are previous experiences with advanced care planning and who should be designated as proxy to make healthcare decisions for person who is too sick to do. So in this study, HCPQ was administered by trained interviewers. Thirdly, Dutch national Palliative Care Standard is described in a study by Smits et al. Defines high - quality Palliative Care and can be used by professionals and organizations providing Palliative Care in various healthcare settings. The Palliative Care Standard contains six building blocks: vision and policy on Palliative Care. This section is about the need to have a vision that enjoys broad support and which should be translated into specific policies and agreements to provide high - quality Palliative Care. Identification of Palliative phase.


Background

According to the World Health Organization, alliative care is an approach that improves the quality of life of patients and their families facing problems associated with life - threatening illness, through prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Base on this broad definition, some psychiatric interventions may be considered palliative, as they aim primarily to enhance quality of life by means of adequate symptom control and by focusing on disability rather than on curing illness. However, palliative care as a deliberate approach has not been widely implemented in mental healthcare, and its tools have not been deployed in psychiatric practice. Its relevance in treatment of certain severe and persistent mental illnesses such as severe and persistent depression, schizophrenia and anorexia nervosa has only recently been suggest. Studies have consistently shown higher mortality among patients with SPMI, WHO die 10 to 20 years earlier on average than people in the general population. At the same time, large body of research has focused on ultra - high risk and prodromal paradigms, representing clear emphasis on early interventions, perhaps at the cost of development of adequate psychosocial care for patients in later stages of disease. Although full remission or recovery is the primary goal of acute psychiatric treatment, substantial number of patients diagnosed with major depressive disorder are resistant to evidence - base treatments, including treatments for chronic depression such as electro - convulsive therapy or ketamine infusion, and remission rates decrease with each additional treatment trial. In cases of schizophrenia, about one fifth of all patients show little or no therapeutic response and exhibit increased susceptibility to several life - threatening comorbidities. For these patients, evidence - based illness - modifying approaches are unavailable or remain ineffective, leading to low quality of life and frequent use of healthcare services. Contentious scholarly discourse surrounding application of palliative care approach centres on futility debate and is often linked to anecdotal reports, usually in the context of severe anorexia nervosa. In these circumstances, there is a risk that palliative care approaches in psychiatry may be perceived as inevitably intertwine with giving up and losing hope rather than as complementary to recovery - orient models for specific cases of SPMI. However, it is important to acknowledge that additional experimental treatment trials can sometimes leave patients more demoralized as they are caught in a cycle of false hope. For patients with low probability of favourable treatment outcome, it is therefore important to develop the modern concept of supportive care that does not ignore or trivialise the catastrophic effect some mental illnesses can have. Such approaches should focus on psychosocial support systems that go beyond the traditional mindset of psychiatric care. The acceptability of certain palliative care approaches for severe and persistent mentally ill patients whose needs cannot be met by contemporary therapeutic interventions, however, is unclear.


Discussion

This systematic review focuses on empirically based tools and interventions that can be used in Palliative Care for people with SMI. The first research question addrest kinds of tools and interventions used for Palliative Care. Only four relevant empirical studies were find. They cover two tools and one multi - component intervention: tool for early identification of Palliative Care needs, tool to discuss medical decisions and end - of - life Care planning with patients and relatives and a multi - component Care Standard describing building blocks for high - quality Palliative Care. The paucity of interventions and scarcity of empirical studies addressing Palliative Care for people with SMI were also mentioned in earlier studies. Feasibility and usability were discussed in all four studies, although this was often not the main focus of study. Tools for discussing medical decisions and Care Standards were found to be feasible and usable. Tools for identifying Palliative Care needs appear not to be usable in Palliative Care for patients with SMI, and major adaptions were suggested by researchers. None of the included studies examined effects that use of tools or interventions had on the quality of life of patients or on quality of care. This fits with conclusions in systematic reviews of Palliative Care tools or interventions for other specific target groups, such as people with intellectual disabilities or homeless people. Despite the very limited evidence base, we can conclude that at least some tools and interventions for Palliative Care in people with SMI exist. Tool described by Burton et al. Addresses criteria for timely identification of approaching death in patients with SMI. Use of this tool might make professionals more alert to the possibility that a person is in Palliative phase. However, tool addresses a very specific group, and some of the criteria that are part of this tool would probably have to be adapted for use in other Palliative - Care patients with SMI. The second tool, investigated by Foti et al., Aims to involve patients with SMI in advance care planning, which is found to be feasible. Discussing medical decisions with people with SMI does not result in severe distress. This was also found in a review of mental health advance treatment directives for people with SMI WHO might become unable to adequately express their mental health treatment preferences in future due to acute symptoms of their psychiatric disorder. However, this review finds little data indicating that mental health advanced treatment directives lead to more favourable healthcare outcomes. The third intervention, described by Smits et al., Concerns multi - component intervention, Palliative Care Standard. This Care Standard is found to be useful for formulating intervention programme to improve Palliative Care for people with SMI, although adjustments and tailoring to suit specific characteristics of the patient population and mental healthcare setting were found to be necessary. Previous publications primarily focused on whether current Palliative Care is already tailored to the needs of people with SMI.

* 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

Financial

Palliative Care is an interdisciplinary Care philosophy addressing patient and family needs and goals without providing cure for underlying disease. Palliative Care can be successfully provided alongside curative Care, which focuses on treating disease. Studies have indicated that Palliative Care offers a variety of quality of life benefits to both patient and family. Prompt by the rapid growth of Hospital - base Palliative Care, we explore literature to better understand financial incentives and barriers to these programs. Although patients who receive Palliative Care in hospital have lower hospital costs than matched patients who do not receive Palliative Care, many hospitals face challenges in being reimbursed for services rendered by their interdisciplinary teams. In some cases, hospitals may absorb 50 percent of the costs of their Palliative Care teams because of lack of adequate reimbursement. Despite opportunities for cost savings for a variety of stakeholders, without payment reform, hospitals may be constrained from providing Palliative Care to all who might benefit. Additional Research is needed to understand how patients, hospitals, and payers may participate in cost savings attributable to Palliative Care so that policymakers can effectively promote these services.


Hospice Costs & End-of-Life Options

Hospitals offer around - clock medical care from doctors and nurses, full range of treatment choices, modern medical equipment, teams of specialists, and the ability to receive tests and life - saving procedures. High - intensity hospital care includes Intensive Care Units and Coronary Care Units. Approximately 60% of Americans die in acute care hospitals, with 20% spending their last days in ICU. Nursing homes, also know as skilled nursing facilities, offer around - clock nursing care, although a doctor is not always present. There are more than 15 400 nursing homes in the country, housing more than 1. 4 million residents. According to the US Census Bureau, just over 5 percent of countries are 49. 2 million, 65 - plus aged population live in nursing home. Residency ratios increase with age: 50 percent of those older than 95 live there. Overall, 20 percent of deaths in the United States take place in nursing homes. Studies show that while 80% of Americans prefer to die at home, only about 20 percent do. This gap is largely due to difficulties and costs of caring for terminally ill patients at home; in most cases, nursing care and special equipment are require.

* 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

For children

Palliative care is not only for people with cancer. It can also include support for caregivers and children of people with cancer. Love ones often provide important physical, practical, and emotional support to person with cancer. Caregivers can also experience stress, anxiety, depression, and frustration. Palliative care can help caregivers balance providing care while also improving their quality of life. If you are a parent with cancer, you may need extra support from others for your children. This might include after - school care or help with making their meals. Taking care of your own health helps you be a good caregiver. Your health care team or social worker can help you find palliative care for caregivers and other family members.


What Is Pediatric Palliative Care?

Palliative care provides physical, emotional, and spiritual support to sick children and their families. A medical care team including doctors, pain management specialists, nurses, social workers, and therapists helps prevent and relieve pain and suffering while also easing stress, anxiety, and fear associated with serious illness. Palliative care is not to be confused with end - of - life care or hospice care, which provides care for patients who are not expected to recover. The goal of Palliative care is to enhance the quality of life for children and family during serious illness and to help families make important decisions about their children's 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

Is it covered by Medicare?

To qualify for Hospice Care, hospice doctor and your doctor must certify that youre terminally ill, meaning you have a life expectancy of 6 months or less. When you agree to Hospice Care, you agree to comfort care instead of care to cure your illness. You also must sign a statement choosing Hospice Care instead of other Medicare - covered treatments for your terminal illness and related conditions. Coverage include: all items and services needed for pain relief and symptom management Medical, nursing, and social Services Drugs for pain management, Durable Medical equipment for pain relief and symptom management, Aide and homemaker Services Other cover services you need to manage your pain and other symptoms, as well as spiritual and grief counseling for you and Your family. Medicare - certified Hospice Care is usually given in your home or other facility where you live, like a nursing home.


What is palliative care?

Palliative Care is based on need, not prognosis. It can be appropriate at any age and during any stage of serious illness, whether the condition is curable, life - threatening or chronic. Palliative Care can be provided alongside curative treatments like chemotherapy, radiation or surgery. According to the Center for Advance Palliative Care, illnesses most commonly treated with Palliative Care are heart disease, cancer, stroke, diabetes, kidney disease, Parkinson's disease and Alzheimer's disease. Research shows that Palliative Care improves pain and symptoms, increases family satisfaction with care loved ones receive and reduces health care costs. It has even been shown to help some patients live longer.


Part A

Medicare Part D is prescription drug coverage. Part D may cover medications needed during palliative care. According to the World Health Organization, medications are commonly prescribed for the following conditions during palliative care: anorexia, anxiety, constipation, delirium depression, diarrhea dyspnea, fatigue, mucus buildup, nausea, pain vomiting. Medications for these conditions may include antidepressants, anxiolytics, antipsychotics, stool softeners, antidiarrheals, and opioid and nonopioid analgesics. If you are receiving hospice care, most medications are covered under hospice benefit with 0 to 5 copayment per prescription drug. Medications that aren't covered under hospice benefit may still be covered under the Medicare Part D plan.

* 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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