End of Life Care: Palliative or Hospice? PDF Print E-mail

Landscape from Graphic StockBoth Palliative Care and Hospice Care use a team approach between the patient, his/her physician, primary caregiver, and Hospice team. The decisions of the individual must be followed. For this reason it is important to articulate your wishes in the form of an Advance Directive, Living Will, or Durable Power of Attorney.

(More information about those forms next issue).

Palliative Care is for persons with a serious illness, regardless of life expectancy.

Goals are to improve the quality of a seriously ill person's life and to support that person and their family during and after treatment. Some of the services include symptom management, physical therapy, counseling for the person who is ill and their family, and spiritual support. The location of Palliative Care may be the person's home, assisted living facilities, hospitals or long-term care facilities. Not all insurance plans (including Medicare and Medicaid) cover palliative care.

As terminal illness progresses Hospice Care may become more appropriate.

Hospice focuses on relieving symptoms and promoting patient comfort and spiritual and emotional support for the patient and loved ones when life expectancy is months, not years. Choosing a Hospice program requires discerning questions about what treatments will be given or allowed and what will be covered by insurance. Hospice does not prolong life or hasten death. Some hospice programs specify that they will not provide any nutrition or hydration. While worksheets (see resources at end of this article) may provide guidance in choosing a hospice, Christians will want to choose a program that honors God's ownership of human life and His creative activity at life's end as at life's beginning.

What can I expect in the dying process?

Even for people with a strong faith in God, most of us have some measure of fear about facing death--our own or the death of someone we love. At least part of what we fear is the unknown nature of the dying process. Every person's death is unique, but there are some commonalities in the process of dying. These changes are natural and may happen over months, days, or hours:

  1. A turning inward accompanied by a loss of interest in things once deemed important. They may want to share memories of joy and sorrow, tie up loose ends or talk about where to find documents, photo albums, etc.
  2. Your loved one may sleep much more or be wakeful at night due to worries or concerns.
  3. There will be good days and bad with increasing weakness and fatigue. You can help by assisting with daily care allowing them save energy for things that are important to them.
  4. As a natural part of the body shutting down he/she will eat less and will appreciate small amounts of favorite foods, particularly those that do not require chewing which takes energy. Offer sips of fluids, using a flexible straw as it becomes difficult for them to sit up and offering ice chips when they can no longer swallow. Lip balm and mouth cleaning with a soft damp cloth can help promote comfort.
  5. People often experience a thinning of the walls between this earth and the next and may report speaking with loved ones who have died. It may help to let them talk about what they are experiencing if they find it disturbing.

When death is imminent the dying individual may sleep more or be unable to respond at all, perhaps even be unconscious. Continue to talk to them or read favorite bible passages. Touch them and share memories and favorite music and pray as they may hear you. You will notice bowel changes and decreased urination. Provide the comfort of clean, dry bedding and touch as long as it does not cause pain. Expect changes in breathing patterns and discoloration and coolness in some parts of the body as blood flow slows. Don't hesitate to contact your physician and hospice team with questions.

Above all, remember you can trust God with your own life and with the life of your loved one who is dying. Jesus has been this way before. He knows the dying process and the resurrection to follow. He can be trusted with your life and the lives of those you love.

Resources to assist in choosing Palliative Care or Hospice Care:

Download a worksheet with questions to ask and a place for your notes

Editor's note: The above article borrows heavily from information found here.
More resources on end of life care.



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