Right Program, Right Time: Unique Care at Crossroads
As a nurse practitioner, I am often asked about the difference between hospice and palliative care. The words “hospice” and “palliative” can trigger different emotions and hold different meanings for different people. The examples below can offer some clarity on these differences as well as how these types of care work together at Crossroads Hospice & Palliative Care.
What is Palliative Care?
Palliative care is specialized medical care for people who are living with a serious illness. According to the Center to Advance Palliative Care: “This type of care is focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and family.”
Furthermore, palliative care works together with a patient’s other doctors to provide an extra layer of support and is appropriate at any stage of a serious illness. It can be provided alongside curative treatments like chemotherapy.
Palliative care requires a referral from either a patient’s primary care provider or from another specialist related to their condition. A patient’s insurance provider will determine if palliative care is a covered service and, if so, which provider is in-network. An added bonus of palliative care is that providers like Crossroads will see patients wherever they call home.
The Role of Palliative Care at Crossroads
While palliative care can be appropriate regardless of the stage or prognosis of a serious illness, hospice is specifically for patients at end of life. Hospice is provided as a Medicare benefit for people who have a terminal illness with a prognosis of six months or less. While hospice has been the core service at Crossroads over the past 28 years, we found many of the patient referrals we received were not yet eligible.
In 2016, Crossroads created a palliative care program so that these patients could get the care they needed – controlling symptoms related to their serious illness and maximizing both their quality and length of life. At Crossroads, our mission is to provide the Right Program at the Right Time for patients in need of care. That’s why both the palliative and hospice care we offer is highly individualized based on their specific condition and goals of care.
Here are two examples that highlight how palliative and hospice care work together at Crossroads:
Transition from Palliative to Hospice Care
Paul was referred to Crossroads last year by his oncologist. He needed help with his symptoms related to the chemotherapy he was receiving for his colon cancer. While working closely with Paul’s oncologist, the palliative care nurse practitioner met with Paul at his house once a month. During those visits, the palliative care nurse practitioner evaluated Paul and prescribed medications to help control his nausea and pain as well as improve his appetite.
After some months of chemotherapy, a repeat scan showed that Paul’s cancer had unfortunately progressed and spread to other parts of his body. Based on these results, the oncologist discussed the pros and cons of continuing chemotherapy with Paul. Ultimately, hospice care was recommended. Paul and his family were torn. They were not ready to give up. But Paul also did not want to endure more chemotherapy if it was unlikely to cure his cancer.
Having developed rapport and trust with the palliative care nurse practitioner, Paul and his family looked to him to help guide their decision. The palliative care nurse practitioner explored their goals, hopes, and concerns. After a difficult conversation, Paul and his family decided that comfort was their primary goal and that hospice was what they needed. Since both palliative and hospice services are both offered by Crossroads, the nurse practitioner was able to coordinate a timely and smooth transition of care. Paul was able to start hospice care the very next day.
Transition from Hospice to Palliative Care
Julie had been on hospice for several months due to her end-stage COPD. Prior to starting hospice care, Julie was having worsening shortness of breath despite using oxygen. She also had been having frequent COPD exacerbations requiring multiple hospitalizations.
Sometimes patients receiving hospice actually improve due to the high quality and more frequent care provided by nurses and aides. This is what Julie experienced, with breathing becoming easier over time, allowing her to be more active at home. She was able to tend to her garden more and spend more quality time with her grandchildren. After several months on hospice, Crossroads determined that Julie’s prognosis and medical condition had significantly improved, and she no longer qualified for hospice.
Rather than simply taking Julie off from our hospice program, we transitioned her to our palliative care program so that our nurse practitioners could continue providing comfort care and improve quality of life. At the same time, our nurse practitioners continued to monitor for signs and symptoms that may require Julie to transition back to hospice.
Crossroads is constantly assessing what the Right Program is at the Right Time with each and every patient. A seamless transition of care when necessary is a unique benefit that comes along with Crossroads offering both palliative and hospice care services. If you or your family members are living with a serious illness and need help, please reach out to your primary care provider or directly to us at 1-888-564-3405 so that we can help assess what may be the Right Program for you.
Scott Nguy
Vice President of Nurse Practitioner Education
Crossroads Hospice & Palliative Care
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