Elderly End of Life Care
They say that you cannot cheat death nor taxes and at some point in our lives we must all face death. End of life care is not just about death but about respect. It is a branch of medicine that cares for people who are nearing the end of their lives but who are not necessarily on death's door. Keep reading to learn more about end of life care.
What Is End of Life Care (EoLC)?
To say that end of life care is just one thing is not accurate. This is a discipline that takes on the entire scope of what a person who is terminally ill and their family must face. There are also different approaches to EoLC which is a benefit because people can choose a discipline that fits their life and their beliefs.
- Physical Needs: EoLC addresses the physical needs of people including pain management, continued treatment, and nursing.
- Spiritual and Emotional Needs: Many EoLC programs address the spiritual needs and emotional needs of the entire family unit. For example, Hospice care has a resident chaplain and depending on the organization they have connections or contracts with clergy of most faiths, even those that are non-Christian. In addition, there is often a licensed social worker involved to work with the family and patient to deal with grief and other personal issues that impact not only the patient but the whole family.
- Financial – Some programs work at no or little cost to the patient. Again, in the case of hospice, they work with the amount paid by Medicare and many have programs available to help cover other expenses. Hospice is one of many types of EoLC. Other's work with Medicare or private insurance.
- Ethics and Patient Rights: The focus is, or should always be, about the patient and care within an EoLC program and includes a patient's rights, especially those that are about self-determination, including riskier treatments and experimental medicine. End of life care is not just about dying, but about dying with personal dignity, spiritual dignity, and with access to treatment and treatment philosophies that are outside of conventional medicine. In short, EoLC is about the patient, their family, and their wishes.
What Are Some End of Life Care Options?
There are a number of different options available and some of them overlap or are available through the same organization. Here is a short list of options and programs with links to help you learn more.
Hospice End of Life Care
Hospice works with people who have an illness that is either incurable, such as end-stage dementia or one where the medical treatment is not working, such as some forms of cancer. The goal of hospice is to maintain a positive quality of life, including pain management, and to treat the entire family as the patient. Hospice care involves personal and medical care that supports quality of life. Hospice care does not provide treatment for the disease, social care or spiritual care. Most end of life hospice care centers work based on the fee provided by Medicare. To be admitted to hospice, a doctor must declare that you are in your last six months of Medicare. You must also qualify for Medicare Part A.
Learn more at the Hospice Foundation of America.
Palliative End of Life Care
Palliative care is different from hospice, though many hospices offer palliative care. This is a form of treatment that helps patients overcome the negative side of an illness. It is appropriate for people who have terminal diseases or who are just beginning their battle with a serious illness. One difference between palliative care and hospice is that under palliative care you can still receive aggressive treatment for your disease.
The goal of palliative care is to make the patient as comfortable as possible whether that is surgery to remove a tumor or pain control so that people can focus on overcoming their illness rather than on being in pain.
Comfort care is about relieving suffering, both physical and emotional. It is about making someone as comfortable as possible by improving their quality of life. This is typically a true end of life approach and helps people with spiritual and physical difficulties. This is an essential part of all medicine from hospice to acute care. It is about respect and respecting the patient's wishes while overcoming the challenges they face.
Learn more about comfort care at the National Institute on Aging
End of Life Care at Home
In-home end of life care keeps the patient in their home rather than on a unit in a hospital, hospice, or at a skilled nursing facility. Care is provided by one of the many organizations that provide EoLC, such as hospice, or from an in-home care provider. The goals mirror those of other organizations, which are to keep the patient comfortable while addressing physical, medical, and spiritual needs.
Learn more about the Ethical Decisions that patients and families face with in-home care at end of life.
Clinical Trials have an ethical component that everyone who considers this avenue must face. These are investigational medicines, technology, and devices that may or may not improve the quality of life for someone with a terminal illness. The ethical dilemma is one based out of desperation. Will new and untried medications, technology, or a medical device save me? There is also the approach, from the patient's perspective, that if I am going to die, my death might as well advance treatment. When traditional medicine does not work and there are no other options but to die, people turn to clinical trials both as a last hope and as a heroic effort. The deal with some clinical trials is the placebo. You might or might not actually receive a new medication. This is not true of all trials, but that weight also plays a part in the ethical dilemma of these options.
Read more about Exploring a Right to Try for Terminally Ill Patients, via the FDA.
While end of life care is something we will all face, either as a supporting family member or when it is our turn, we have options and hope. What is important to take away from this is that there are many options and that while they overlap, they are different enough to fit most of our needs and last wishes.