Death is one of the most frightening and confusing times a person can go through. Watching a loved one pass away is also one of the hardest trials a person can experience. Many people assume that death is a time of pain and the only thing that they can do is mourn and watch their loved one fade away. But there are programs out there to help not just the dying person but also the families of the dying person. Palliative care and Hospice care are two of the programs in the U.S that are tailored to medical care, pain management, and emotional and spiritual support for the patient and family. At the center of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so.
Palliative care focuses on relieving symptoms that are related to chronic illnesses, such as cancer, cardiac disease, respiratory disease, kidney failure, Alzheimer’s and other dementias, AIDS, Amyotrophic Lateral Sclerosis and other neurological diseases. World Health Organization defines Palliative care as “improving the quality of life of patients and families who face life-threatening illness, by providing pain and symptom relief, spiritual and psychosocial support to from diagnosis to the end of life and bereavement” (“WHO”, 2013). Palliative care is accessed at any point during the course of a chronic illness regardless of life expectancy. It is typically provided through regular physician and nursing visits in an inpatient consultation service in a hospital setting. Palliative care is provided by a team of doctors, nurses and other specialists who work together with a patient’s other doctors to provide an extra layer of support. Some treatments and medications may be covered through private insurance therefore it is underfunded and difficult to access. There is a huge increase in number of Americans with chronic illnesses that the growth of palliative care has been one of the fastest growing trends in health care; 600 hospitals in 2000 to more than 1600 in 2012 – an approximately 148% increased (“Center to advance palliative care”, 2012).
On the other hand, Hospice is a special way of caring for people with terminal illnesses and their families. It is a palliative in nature. Hospice is multidisciplinary health care program that is responsible for palliative and supportive care with consideration of the patient's and family’s wishes. Hospice focuses on promoting care, not to cure. Unlike Palliative care, Hospice are for patients that have an illness with a life expectancy of 6 months or less that is certified by a physician (“AAHPM”, 2008). A team of physicians, nurses, social workers, chaplains, volunteers, home health aides and others provides hospice care. It is also covered under Medicare, Medicaid, most private insurance plans, HMOs and other managed organizations Hospice care is most often provided in patient’s home setting, or a relative, a nursing home or assisted living facility, or retirement community. Moreover, some hospices offer inpatient services in dedicated hospice facilities. Hospice care is important because it provides many benefits that aren't possible in a traditional acute or long-term health care setting. Within hospice, the family of the patient is directly involved in making decisions and helping their loved one. Hospice also gives the patient to have a great amount of control by deciding where they want to spend the rest of their lives.
The role of the expert nurse is complex and unique. The nurse functions as an integral part of a Multidisciplinary team, providing expert skilled assessment and nursing care, supporting the patient and the family to make informed choices thereby encouraging the patient to continue to make autonomous decisions about their care towards the end of their life. The End-of-Life Nursing Education Consortium (ELNEC) is a nationwide education program to improve palliative care in which they provide training to nursing faculty, specialty nurses, staff educators and other nurses. ELNEC reports that so far, more than over 15,100 nurses and other healthcare professionals, representing all 50 US states, plus 73 international countries have received ELNEC training through their national courses and are sharing the new expertise in educational and clinical settings (“Elnec fact sheet”, 2013).
Hospice and Palliative care is considered a more humane and sensible approach to terminal illness, combining care, comfort, and support of family and friends as the individual faces death. Their concern for dignity and for maintaining quality of life rather than mere quantity lead to the following practical principles as an appropriate approach to care for the dying and their families. The patient must be as symptom-free as possible in order to enjoy the remaining portion of life as fully as possible. The patient’s and family’s life style must be preserved, and their life philosophies respected by the health care practitioners.

References

American Academy of Hospice and Palliative Medicine, (2008). Position statements. Retrieved from website: http://www.aahpm.org/positions/default/access.html

American Association of Colleges of Nursing, (2013). Elnec fact sheet. Retrieved from website: https://www.aacn.nche.edu/elnec/about/fact-sheet Center to Advance Palliative Care (2012). Growth of palliative care in U.S. hospitals. Retrieved from website: http://reportcard.capc.org/pdf/capc-growth-analysis-snapshot-2011.pdf World Health Organization (2013). Palliative care. Retrieved from website: http://www.who.int/cancer/palliative/en/