Changes in Palliative Care and Hospice
Rotarian Dwight Wilson, Director of Mission Hospice and Home Care in San Mateo was our featured speaker and he presented information on the recent changes in area of palliative care and hospice.
There's significant change occurring in treatment modalities and symptom management has become more important in overall care of the patient. With increasing treatment options, patients often misinterpret information provided to them. Medicare is also changing the way they pay for inpatient services. Specialty practice such as Oncology are being more accepting of palliative care involvement.
These changes have an impact on hospice programs. The integration with palliative care programs becomes more critical. Although patients and families continue to struggle with the hopeless concept of hospice, the changes have increased the treatment options under the hospice benefit. The patient population will be sicker and entering into the program later in the dying process. This makes it more important to clearly articulate the benefit choices and connecting with goals of care for each patient.
Families and their patients face challenges during this difficult time. To help ease the process, families are encouraged to discuss life choice options at the beginning of a terminal or serious chronic life event and at times when there are changes in overall health. Discussions should focus on quality of life, challenges of treatment and family/patient desires and goals of their care. In addition, hospice programs need to be reviewed as each has a different admission criteria. Collaboration with the facility and family is crucial.
What can families and individuals do now?
Families should discuss openly their preferences of treatment and life desires. Involving adult children early on especially as health changes begin to occur is highly encouraged. Ask questions to whom will be the decision maker "Can you honor my wishes?". Ask the question of each other at least once a year "What are your hopes and dreams?"
Equally important, become familiar with the Advance Directive for HealthCare and the POLST document. Become familiar with what treatments can and cannot do for you especially during the last year of life.