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What is Palliative Care?

You may have heard of a new medical term-palliative care (pronounced PAH-LEE-UH-TIVE). For the last 30 years, palliative care has been provided by hospice programs for dying Americans. Currently these programs serve more than 1 million patients and their families each year. Now this very same approach to care is being used by other health care providers, including teams in hospitals, nursing facilities and home health agencies in combination with other medical treatments to help people who are seriously ill.

To palliate means to make comfortable by treating a person's symptoms from an illness. Hospice and palliative care both focus on helping a person be comfortable by addressing issues causing physical or emotional pain, or suffering. Hospice and other palliative care providers have teams of people working together to provide care. The goals of palliative care are to improve the quality of a seriously ill person's life and to support that person and their family during and after treatment.

Hospice focuses on relieving symptoms and supporting patients with a life expectancy of months, not years, and their families. However, palliative care may be given at any time during a patient's illness; from the initial diagnosis. Most hospices have a set of defined services, team members, and rules and regulations. Some hospices provide palliative care as a separate program or service, which can be very confusing to patients and families.

The list of questions below provides answers to common questions about the difference between hospice and palliative care.

Who can benefit from Palliative Medicine?

Patients with life-limiting illnesses, including, but not limited to:

Metastatic or recurrent cancer
Dementia
Liver disease
COPD
HIV/AIDS
Cardiac disease
Stroke
Renal disease
Persistent coma

Patients with uncontrolled physical symptoms, including, but not limited to:

Pain
Delirium
Dyspnea (shortness of breath)
Insomnia
Nausea (and/or vomiting)
Anxiety
Agitation
Cough

Patients and/or families wishing to discuss:

Advance care planning
Goals of therapy
Comfort-directed therapy
Withdrawal of mechanical ventilation, artificial nutrition, and/or other forms of artificial life support

Frequently Asked Questions

Question	Palliative Care	Hospice Care
Who can receive this care?	Anyone with a serious illness, regardless of life expectancy, can receive palliative care	Someone with an illness with a life expectancy measured in months not years
Can I continue to receive treatments to cure my illness	You may receive palliative care and curative care at the same time	Treatments and medicines aimed at relieving symptoms are provided by hospice
Does Medicare pay?	Some treatments and medications may be covered	Medicare pays all charges related to hospice
Does Medicaid pay?	Some treatments and medications may be covered	In 47 states, Medicaid pays all charges related to hospice
Does private insurance pay?	Some treatments and medications may be covered	Most insurance plans have a hospice benefit
Is this a package deal?	No, there is no 'palliative care' package, the services are flexible and based on the patient's needs	Medicare and Medicaid hospice benefits are package deals
How long can I receive care?	This will depend upon your care needs, and the coverage you have through Medicare, Medicaid or private insurance	As long as you meet the hospice's criteria of an illness with a life expectancy of months not years
What organization provides these services?	Hospitals Hospices Nursing Facilities Health Care Clinics	Hospice organizations Hospice programs based out of a hospital Other health care organizations
Where are services provided?	Home Assisted living facility Nursing facility Hospital	Usually, wherever the patient resides, in their home, assisted living facility, nursing facility, or hospital. Some hospices have facilities where people can live, like a hospice residence, or receive care for short-term reasons, such as acute pain or symptom management.
Who provides these services?	It varies. However usually there is a team including doctors, nurses, social workers and chaplains, similar to the hospice team.	A team - doctor, nurse, social worker, chaplain, volunteer, home health aide and others.
Do they offer expert end-of-life care?	This varies, be sure to ask	Yes, staff are experts in end of life care.

Meet The Team

Dr. Mai Amy Ha, MD	1997 – Graduate of SABA University Medical School, Netherlands-Antilles 1997- 2000 - Internal Medicine Residency – Hahnemann University Hospitals – MCP, Pennsylvania 2000-2001 Geriatrics Fellowship - University of Miami, Florida 2001-2003 – Assistant Medical Director/Assistant Professor at University of Miami/Veterans Affairs Medical Center Home Based Primary Care Program 2004 – Present Blue Ridge Hospice 2005 Named Medical Director at Blue Ridge Hospice Board Certified in Internal Medicine, Geriatrics, Hospice and Palliative Care Full staff privileges at Winchester Medical Center and Courtesy staff privileges at Shenandoah Memorial Hospital
Dr. Wright Jack Wright, MD	1982 – Graduate of University of Virginia Medical School 1982 – 1985 - Internship/Residency at Womack Army Hospital, Fort Bragg, NC in Family Medicine 1985 - Board certified and credentialed in Family Medicine 2008 - Board Certified and credentialed in Hospice and Palliative Medicine 2009 to Present – Blue Ridge Hospice Practiced in the Army for six years post residency, then civilian for eighteen years (Harrisonburg, VA), Volunteer medical director with Rockingham Memorial Hospital Hospice for fourteen years Full staff privileges at Winchester Medical Center
Gina Caudill Gina Caudill, LCSW-C	1979 – Graduate of University of Missouri-Columbia - BSW 1980 – Graduate of University of Missouri-Columbia - MSW 1982 - Member of Academy of Certified Social Workers 2005 – 2009 Blue Ridge Hospice - Social Work Case Manager 2009 to Present – Blue Ridge Hospice – Manager of Counseling Services.
Rachel Schwartz Rachel Schwartz, LCSW	1991 – Graduate of Oberlin College – Oberlin, Ohio 1993 – Graduate of University of Maryland at Baltimore – MSW 1993-2006 – Employed as a Social Worker at various community based organizations with a focus on mental health 1997 – Received LCSW Licensing – State of Virginia 2006 to Present – Blue Ridge Hospice

End-Of-Life Planning Tools

Have an advance directive (PDF/23.6k) in place that authorizes a person of your choosing to make decisions if you become unable to do so for yourself.

Draw up a living will of instructions (PDF/23.6k) to make known what you want done if, for example, you are seriously ill and the only way you can be kept alive is by artificial means.

Encourage your family and loved ones to complete their own advance directive. (PDF/24k)

Get the information you need about services provided by Blue Ridge Hospice.

Discuss your thoughts, concerns and choices with your family and friends.

Talk to your health care agent, family and doctor about your choices.

Engage others in discussions about end-of-life care issues and encourage them to complete their own advance directives.

Seek out opportunities to help others who are dealing with end-of-life care issues such as volunteering with a local hospice or end-of-life care coalition.

For more information about Palliative Medicine, please contact Mandy J. Powers, Physician Practice Manager, at mpowers@blueridgehospice.org or (540) 536-5013.

For more information, please visit the Center to Advance Palliative Care and the National Consensus Project.

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