Palliative care, by definition, is any form of medical care or treatment that concentrates on reducing the severity of the disease symptoms, rather than striving to halt, delay or reverse progression of the disease itself or to provide a cure. The goal is to prevent and relieve suffering and to improve quality of life for people facing serious complex illnesses.
As a geriatric care manager, much of my work involves palliative care. It’s always a privilege to be with families during these challenging times. Regardless of the circumstances, even when care is palliative it never inhibits us from assisting our clients to maximize their lives to the fullest. Respecting personal values and choices while participating in advocacy for a client’s wishes at home, in hospital or in long-term care is my mission, even when the conditions are adverse.
Maintaining quality of life
In Dr. Kubler-Ross’s famous book On Death and Dying, she tells us about the five stages of dying and discusses the journey to the conclusion, which culminates in peaceful acceptance by both patient and family. Once this acceptance is reached, the goals of palliative care are relief from suffering, treatment of pain and other distressing symptoms, psychological and spiritual care, and providing support systems to help the individual live as actively as possible. Support is also given to sustain and assist the individual’s family.
The teams that I work with recognize that personal expectations and beliefs become increasingly important as life draws to a close. Last commitments and decisions are often the culmination of a person’s life and must be respected. A good death is not to be underestimated and feeling a sense of achievement and satisfaction, with no regrets, as life draws to a close surely must rank high. We also recognize that the family’s time together is precious. Facilitating memory sharing and giving clients the opportunity to be surrounded by their loved ones are essential parts of care.
The best place
Palliative support and care can be organized and conducted in a variety of places, such as a hospital, palliative care centre, hospice or at home. The palliative care team can visit and manage care at home through government homecare, a private care provider or a combination of these. Family members are more often than not part of the team.
It is important that people are allowed to die on their own terms in the location of their choice, with the dignity that they deserve. There are some who want to spend their last hours in a facility where hospice and palliative care units offer the skilled care required.
However, many palliative patients still find themselves in a hospital when they would have preferred to end their days at home. Today, it is essential to know that there are excellent palliative teams who can provide care in the comfort of the family residence when necessary. In my experience, the clients who have been well cared for at home have had the most peaceful deaths that I have witnessed.
Something can be done
Unfortunately, palliative care is an area of specialization that is often under-taught during nursing and medical training, underestimated as a priority and, in many parts of the country, underfunded. Palliative care at home often becomes a reality as a result of family advocacy or careful pre-planning. Don’t hesitate to ask for a palliative care team or insist on specialist support to meet a loved one’s needs.
Nurses primarily manage a palliative client’s care with skilled medication management from attending physicians. The nurses involved must be experienced, able to think on their feet, possess excellent assessment skills and have access to the state-of-the-art medical interventions necessary to provide excellent nursing care during this critical time. A nurse may provide sedation or manage symptoms related to shortness of breath or other life-threatening symptoms.
Palliative care is often needed for a very short period of time, but in many cases it can be required for weeks or months. Some chronically ill patients manage to