Understanding “Palliative Care”

Helen McNeal, Executive Director of the CSU Institute for Palliative Care, and Caroline Boaz, Associate Director, spoke to members of the club at the April monthly meeting. The common misperception is that palliative care is the same as hospice care, with a focus on end-of-life issues. In fact, it has a much broader definition that additionally focuses on relieving symptoms of chronic and curable illnesses.

In the 20th century we’ve been focused on curing diseases, but many, such as diabetes and Alzheimer’s, are not curable. This is where palliative care comes in. It is a multidisciplinary approach that includes both the patient and their families which aims to relieve suffering in all areas of life for those with serious or chronic illnesses.

Palliative care practitioners bring in a variety of specialists trained to handle issues ranging from the psychological and spiritual to the medical and financial aspects of the patient’s situation. A palliative care team is comprised of medical professionals, social workers, spiritual advisors, pharmacists, and any other profession needed to fulfill the needs of the entire family.

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It starts with the palliative care staff working with you to really understand what is most important in your life. Is it family? Friends? Volunteer work? Making a difference? A Pet? Whatever it may be, it’s important to be clear on what gives meaning to your life so that you can learn to focus on those objectives as much as possible throughout the course of your illness. An important part of the process is to create a new “measuring stick” based on what you are able to do now, rather than on what you used to be able to do. Hospice care is that part of the process that occurs at the very end of a terminal illness.

Although palliative care has been disparaged in the past as the implementation of the famous “death panels,” it actually has been shown that when a palliative care team comes on board, hospital costs decrease by approximately $500 a day. This is because patients are happier, symptoms are managed, and patients are sent home with the right treatments rather than the more reactive care that results in a patient bouncing between the ER, ICU, home, then re-admitted again to repeat the process.

Within our San Diego area, every major health care system in the county has palliative care except for Tri-City. It may not be called palliative care, but it is a multidisciplinary approach to treating patients. Be aware so that you can ask for it should you be in need. It is already in place in all public San Diego hospitals, however it is limited for outpatient care.

The Palliative Care Institute at Cal State San Marcos is working hard to achieve their goals which include the education of current professionals and a future workforce; building community awareness and advocacy; and creating a local model that will then be replicated across the country.

The Affordable Care Act is allowing for pilot programs. Twenty-six programs of different sizes and locations are in place that offer concurrent curative and hospice care and are fully reimbursed. The goal is to show that it does indeed save money. Currently Hospice care ends curative treatment, therefore patients are often reluctant to request hospice care, and physicians do not assign patients until it is determined they have only six months to live. The goal is to change this. Medicare’s pilot program is called “Medicare Choices,” while some are providing it under different names that include terms such as “Supportive Care” or “Prime Care.”

A Lake San Marcos resident stressed there are workforce shortages in this field, as training and programs are still ramping up. She suggested we can all engage in a “palliative care” supportive model by caring for one another within our communities. “We need to move back towards the concept of the village,” Helen explained, “and be aware of the well-being of those around us.”
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