Introduction to Palliative Care Dr. Sandhya Bhalla-Regev, MD Introduce my self – Where I am from Introduction to Palliative Care Dr. Sandhya Bhalla-Regev, MD

Position I submit to you that pc is the right… Palliative care is the right of every individual suffering from incurable illness.

What is Palliative Care? Palliative care (pronounced pal-lee-uh-tiv) is specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness—whatever the diagnosis. The goal is to improve quality of life for both the patient and the family. What is Palliative Care?

Difference between Palliative care and Hospice programs Hospice provides palliative care to the terminally ill. It is A medicare benefitted program Medicare eligibility requires a prognosis of six months or less. Difference between Palliative care and Hospice programs

Curative care is directed at healing or curing a disease Curative care is directed at healing or curing a disease....like taking an antibiotic for a bladder infection, Vitamin C if you have scurvy or receiving therapy following a stroke. Palliative care involves offering care that helps relieve the symptoms, but does not cure or treat the cause of a disease...like getting a massage for a stiff neck and sore shoulder which is caused by a ruptured disc in the cervical spine. The massage helps alleviate some of the pain, but does not cure the spinal defect. Care Defined

Palliative Treatments Treatments and interventions that enhance comfort and improve quality of life. No specific therapy is excluded from consideration. Pallitave care doesn’t exclude any treatment options Palliative Treatments

Why Palliative Care? From a patient perspective: Provides patient centric care, promoting dignity and compassion Enhances comfort and improve quality of life. No specific therapy is excluded from consideration. Allows for an earlier transition to appropriate community resources such as hospice. Why Palliative Care?

Palliative Care in the Elderly

Mr. H is an 80 year old male with advanced Parkinson’s disease He was a neuroscientist until retiring 10 years ago. Diagnosed with Parkinson’s Disease 10 years ago He can no longer walk, is wheel chair to bed bound, cannot make his needs known He is dependent on caregivers for feeding, toileting, dressing, walking and transfers. He has been married for 55 years. He has two children who live in other states His wife is his sole caregiver and distraught over his decline and feels very guilty about making decisions for her husband. Mr. H’s Story

Mr. H has been hospitalized many times for UTI and pneumonia Mr. H has been losing weight. Mr. H gets agitated when doing personal care. Mr. H has just moved to and RCFE due to continued decline He Suffered from pain from contractures in his legs and arms Mr. H’s Story Continued

Palliative Care Consult requested to discuss goals of care with Mrs Palliative Care Consult requested to discuss goals of care with Mrs. H and children. His wife confirmed that what gave meaning to Mr. H’s life was his intellect and his family She felt that he would not have wanted to continue getting aggressive treatments Started on methadone for pain management Mr. H went onto hospice care and a month later went into respiratory distress from aspiration and died of pneumonia His family members were much more prepared after going through discussions with the palliative care team

Palliative care consult 1. Address pain and other uncomfortable symptoms. 2. Assist patients with difficult decision making. 3.Coordinate care with other providers to help patients navigate the health system. 4. Guide patients to make a plan for living well based on their needs, concerns and goals. 5. Address code status/POLST. 6.Provide advanced illness prognostication. If you have a pc team in your hospital – They can be a service in many areas: Palliative care consult

Expected Benefits of Palliative Care Relief from symptoms, such as; Pain Shortness of breath Fatigue Constipation/Diarrhea Nausea/Vomiting Loss of appetite Difficulty sleeping

Who Provides Palliative Care? Palliative care is provided by a team of doctors, nurses, social workers and other specialists who work together with a patient’s other doctor(s) to provide an extra layer of support. The care team may also include, clergy, massage therapists, pharmacists, nutritionists and others as needed per specific patient needs. Our team is comprised of physicians, nurse practiioners, a social worker, a nurse manager Who Provides Palliative Care?

The palliative care team works in partnership with you own doctor(s) to provide an extra layer of support for you and patient and family. The team works together to provide additional support for communication, navigation of the health system and symptom management. What About my Doctor?

Where can I receive palliative care? Palliative Care is provided in a variety of settings. Hospitals Outpatient clinics Home Hospice Long term care facilities (skilled nursing homes)

Criteria for Palliative Care Consult 1. Presence of a serious illness : Cancer advanced COPD CVA ESRD Advanced Heart Disease Liver Disease ALS HIV Alzheimer’s Dementia Criteria for Palliative Care Consult

2. And one or more of the following… Declining ability to complete ADLs Weight loss or considering tube feeding Metastatic cancer despite treatments Two or more hospitalizations in 3 months Difficult to control physical or emotional symptoms Patient, family uncertainty regarding treatment Family distress impairing decision making 2. And one or more of the following…

Who Pays for Palliative Care? Most insurance plans, including Medicare and Medical, cover palliative care. If cost is a concern, a social worker or financial consultant from the palliative care team can assist in determining your options. Who Pays for Palliative Care?

How Do I Get Palliative Care? Ask for it! Tell your doctors, nurses, family and caregivers that you want palliative care. How Do I Get Palliative Care?

Get Palliative Care.Org Resources

To cure sometimes, to relieve often, to comfort always

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