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Palliative Care Vs. Curative Medicine


Palliative Care Vs. Curative Medicine Speaker: Vicki Wilhelm, MD Medical Director, Sentara Hospice for the Greater Peninsula and Western Tidewater Region – PowerPoint PPT presentation

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Title: Palliative Care Vs. Curative Medicine

Palliative Care Vs. Curative Medicine Speaker
Vicki Wilhelm, MDMedical Director, Sentara
Hospice for the Greater Peninsula and Western
Tidewater Region

Sentara Home Health Hospice Services Greater
Peninsula Phone (757)736-0700Serving
Williamsburg, Middle Peninsula and Peninsula
What is Restorative Medicine?
A cross-disciplinary approach for 21st century
medicine based on restoring organ function and
repairing tissue damage. It is not simply
treating symptoms and palliating medical
conditions. It combines complementary therapies
combined with lifestyle changes with the ultimate
goal to prevent future diseases and slow down the
progression of existing diseases.
Curative Medicine
  • Seeks a cure for an existent disease or medical
  • Differs from preventive care which aims at
    preventing the appearance of diseases through
    immunization, exercise and lifestyle
  • Differs from symptomatic treatment which is
    medical therapy of a disease that only affects
    its symptoms not its causes (ex. Analgesic,
    anti-inflammatory, antitussives, antihistaminic,

What is Palliative Care?
  • Interdisciplinary medical care that aims to
    relieve suffering and improve quality of life for
    families and patients with advanced illness.
  • It is offered simultaneously with all other
    appropriate medical treatment.
  • Palliate From the Latin word pallium, meaning
  • To make less severe or intense

Our Definition of Palliative Care
  • Interdisciplinary care that
  • Changes the medical approach from crisis
    intervention to crisis prevention through advance
    care planning and clarity re the goals of care.
  • Assesses and works towards the relief of
    distressing symptoms and improvement of quality
    of life.
  • Tends to the whole-person in the context of their
    family and their community.
  • Provides access to support for patients and their
    families at any stage of illness and in any
    setting, regardless of prognosis.

Palliative care is It is NOT
  • evidence-based medical treatment
  • vigorous care of pain and symptoms throughout
  • care that patients want at the same time as
    efforts to cure or prolong life
  • giving up
  • provided in place of curative or life-prolonging
  • the same as hospice
  • the same as comfort care

What is Hospice?
Hospice is quality, compassionate care for
people with life-limiting or life-threatening
illness or injury. Care is tailored to each
patients needs and wishes with the goal being to
maximize patients quality of life as they travel
along this last journey.
Why isHospice the Ultimate Gift?
Goal of Hospice
The goal of hospice is to improve the quality of
life and provide comfort and dignity in
death. Hospice care neither prolongs life nor
hastens death. Hospice focuses on whole person
directed treatments with attention to family as
part of the experience.
When to ask for Hospice Services
  • Early! Crisis avoidance vs. Crisis intervention
  • A proactive vs. a reactive approach
  • more integrated, organized route to wholistic
    care for a patient and family and
  • decreases stress and anxiety for all involved.

Admission to Hospice requires a Doctors
order.The Hospice staff can also provide an
evaluation for appropriateness of admission to
hospice and provide a recommendation back to the
Disease Trajectories
Disease Trajectories
Where does Hospice occur?
  1. At home
  2. Independent or assisted living facilities
  3. Long-term care or skilled care facilities
  4. Hospital
  5. Hospice inpatient units
  6. Hospice House

Dispelling Hospice Myths
  • You do not need to be DNR to enter Hospice
  • Hospice is not a 24-hour nurse coverage
  • It relies on family and coordinates support
    including HHA
  • Hospice patients are offered antibiotics for
    reversible infections
  • Medications related to the admitting diagnosis
    are covered under the Hospice Benefit
  • Hospice is liberal in its use of Opioids, but
    only in response to symptom management
  • Hospice services have been shown to prolong
    survival and reduce costs at end of life.

Interdisciplinary Hospice Team
  • Patient and family
  • The patients primary physician
  • Hospice physician
  • Nurses
  • Certified nursing assistants
  • Chaplains
  • Social workers
  • Music Care Services

The Medicare Hospice Benefit
  • Criteria
  • Eligible for Part A of Medicare
  • Terminally ill with a life expectancy of 6 months
    or less
  • Coverage
  • Physician services
  • Medical care through the hospice Medical Director
  • Case management
  • Medical appliances and supplies
  • Medications related to the terminal illness and
    palliation of symptoms
  • Speech therapy
  • Short-term inpatient and respite care
  • Physical and occupational therapy
  • Dietary counseling
  • Homemaker and home health aide services
  • Counseling and social work services
  • Spiritual care
  • Volunteer participation
  • Bereavement services

  • Important factors to consider
  • Co-morbid illnesses
  • Rate of decline
  • Nutritional status
  • Functional status
  • Cognitive status
  • Age and gender
  • Number of hospitalizations in past year
  • Will to live
  • Other (psychosocial, emotional and spiritual)

The Prognosis
  • A study in 2000 by Christakis and colleagues 10
    found that
  • Prognostic accuracy generally erred on the side
    of optimism. Only 20 of physicians prognoses
    were accurate within 33 of actual survival time
  • 63 were over-optimistic about life expectancy
  • 17 underestimated survival time
  • As the duration of the doctor-patient
    relationship increased, prognostic accuracy
  • In general, there was an 8-fold overestimation of
    life expectancy for patients who died within 30
    days of the prognostic determination.
  • 10 Christakis NA, Lamont EB, BMJ

Medicare Hospice Benefit Eligibility
  • Patients must be eligible for Medicare Part A,
  • and
  • The patients doctor and hospice medical director
    certify that s/he may have six months or less to
    live if their illness runs its normal course,
  • Patient chooses a Medicare approved Hospice
  • and
  • Patient signs a statement choosing hospice care
    instead of other Medicare-covered treatment

What does Medicare pay for?
  • Physician and Nurse Services
  • Medical Equipment
  • Medical Supplies
  • Medications for pain and symptom management
  • Health Aide Services
  • Social Worker Services

Additional Medicare coverage
  • Physical and Occupational Therapy
  • Speech Therapy
  • Dietary Counseling
  • Short Term In-Patient Care
  • Grief and Loss Counseling for patient and for
    patients family
  • Short Term Respite Care (small co-pay applies)

A patient can continue to qualify for hospice if
they are showing documented signs of decline and
at the time of recertification they still appear
to have less than six months of life expectancy.
Hospice Medicare benefitdoes not cover
  • Treatment intended to cure terminal illness
  • Prescription drugs to cure illness rather than
    for symptom control or pain relief
  • Room and board
  • Care from providers not arranged by the hospice
    team, including
  • Emergency Room care
  • Inpatient facility care
  • Ambulance transportation

Important Reminder
  • Medicare will still pay for covered benefits for
    any health problems that are not related to the
    terminal illness.

Timing of Referrals to Hospice and Palliative
Care is Late
  • Median length of stay in hospice 10 days
  • 42 of hospice patients receive care for lt 1 week
    before death
  • 4.8 180 days or more
  • Median LOS in hospitals before palliative care
    consultation 18 days (CDC Natl Center for
    Health Statistics 2004)
  • Mount Sinai Hospital Palliative
    Care Consult Service data
  • CDC National Center for Health Statistics 2004

Does hospice provide help to the family after the
patient dies?
Yes, hospice provides continued contact and
support for family and friends for a minimum of
13 months following the death of a loved
one. Team members of Sentara Hospice include
professional chaplains and counselors
specifically trained to provide bereavement
Why does it take several doctors to treat a
patient but only 1 nurse?
Sentara Home Care Hospice Services
200 Enterprise DriveNewport News, VA
23603 Phone (757) 736-0700Fax (757) 969-6610
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