Thursday, February 2, 2012

Hospice placement vs. palliative care treatment, comfort measures

Differences exist between a hospice placement and palliative care treatment. It is important to differentiate between the two.
All patients need a treatment plan, physicians must be clear. Patients and family members are demanding honesty, and a patient-centred approach.

A placement is very important and there is a range=> being at home, in a retirement home, long-term care, or hospital.

Delivering palliative care in a retirement home is often difficult. With complex co-morbidities a patient must have comfort measures in place. DNR orders are often disrespected in retirement homes, as staff cannot manage and will send a patient to emergency, rather than treating the client in house. This is why so many die in the ER, unattended, without a bed.

We must ensure that we understand the best placement, and why our aging seniors need patient advocates to intervene with families and help assist them in understanding the situation.

The status of the patient, the complexity of needs, must be assessed on a case-by-case basis. The ability of the facility to manage care, and adequate supervision. Those who are palliative require turning every 2 hours or so. They may require pain medication. They need comfort measures.

Patients and residents, can live for many months in these conditions. Many of my hospice clients are thin, frail, have numerous needs, but last far longer than anyone expects.

My father died in long-term care, while I was by his side. He was palliative, and in LTC we didn't qualify for extra services, as CCAC doesn't go into LTC. Staff insisted on getting him up and about, and stuffing him into a wheelchair for meals. He wasn't eating. He was in unmedicated pain.
We need better training and more information for care staff in all placements.

We need to educate family members. We need to educate doctors.
Many live much longer, despite appearing palliative and that death is imminent. Many require catheters, which need to be changed regularly, but this is the job of a PSW, not a nurse. For those with IVs, they must have nursing interventions, especially if a vein collapses.

Sisters want palliative care for dying aunt but gravely ill 98-year-old ‘doesn’t meet requirements’

Loranger has to move from the retirement home because it can’t guarantee staffing to deal with her immobility.
Mondor, who is Loranger’s power of attorney, noticed an improvement when she visited her aunt Tuesday evening. She talked, was in a good mood and ate some pudding. But until recently, she was on oxygen, was not conscious most of the time, had coughing fits, didn’t eat and hardly spoke when she came around. She is on a catheter and in isolation. Mondor has to wear a gown and gloves when she visits. “She’s skin and bones,” says Bowie-Ducharme.

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