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July 3, 2015
Well, not so. Clearing up this confusion may increase the ways in which we take care of the chronically ill and aged.
Hospice predates palliative care by about 30 years. Hospice came to the U.S. in the 1950s, pioneered by Dame Cicely Saunders.
Brought over from the U.K., the work of hospice follows the theory of Florence Nightingale, whose school was started at St. Thomas Hospital where Saunders studied. Caring for the ill, mitigating suffering, and focusing solely on the welfare of the patient was the essence of Nightingale’s work.
Today, hospice care is about reducing pain and suffering; serving the physical, emotional, and spiritual needs of the patient. All of this together is considered “palliation.”
Indeed, palliative care and hospice share the same philosophy. However, insurance and Medicare regulations call for hospice patients to have ceased any curative treatment and been given a six month (or less) life expectancy. Today, hospice care is delivered in a myriad of settings — home, stand-alone facilities, and units within hospitals.
Palliative care came into healthcare in the 1990s, wanting to fill the gap between curative treatment and no treatment. When patients may have more than six months (maybe years) to live, but are in need of support for pain and other symptoms related to their condition and treatment.
Palliative care programs are appropriate anywhere, any time for patients who can benefit from support in managing their condition, and making decisions about treatment options and their impact on their quality of life.
So, palliative care is not necessarily about dying; it’s about living. About setting goals and investing equally in curing and healing, with curing being optional, and perhaps not even possible. But, healing is always possible.
A patient can heal into death, die well, and die without fear and or discomfort. Can patients who have chronic conditions live the way in which they would eventually like to die? For patients who have life-limiting or long-range terminal conditions, is it possible to help them invest more in their living than in their dying?
As Elisabeth Kubler-Ross said, “My patients taught me not how to die, but how to live.”