1. 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

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

3. 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?

4. 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

5. 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

6. 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

7. 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?

8. Palliative Care in the Elderly

9. 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

10. 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

11. 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

12. 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

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

14. 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?

15. 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?

16. 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)

17. 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

18. 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…

19. 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?

20. 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?

21. Get Palliative Care.Org
Resources

22. To cure sometimes, to relieve often, to comfort always

23. Questions???