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The term “hospice” is probably more familiar to most people than “palliative care.”

The concept of hospice care began in England in the late 1940s, and was introduced in the United States in the 1960s. Hospice care focuses on providing comfort rather than curative treatment for individuals who are experiencing a terminal illness. This type of care is provided near the end of life, and in 1978, a task force of the U.S. Department of Health, Education and Welfare recognized the concept of hospice care as a feasible way of providing more humane care for the dying.

It was in 1986 that hospice became a permanent Medicare benefit, but it wasn’t until 2006 that the American Board of Medical Specialties recognized hospice as a distinct area of practice.

American society continues to harbor misconceptions about hospice services, including the idea that to enlist hospice services means that an individual is “giving up.” Instead, hospice services should be viewed as a change in the focus of treatment.

In many situations, aggressive medical treatment can be successful and the time commitment and side effects of the treatment are secondary to the cure of an acute illness or control of a chronic condition. In contrast, hospice care acknowledges the presence of a disease that cannot be cured and seeks to control symptoms while avoiding time-consuming medical appointments, as well as unnecessary or unpleasant medical tests and procedures.

Focusing on comfort and energy conservation allows an individual to participate meaningfully in his/her daily life and pursue activities that provide personal fulfillment as much as possible.

A common perception of both medical professionals and the general population is that hospice and palliative care are synonymous. In fact, they are two related but distinct types of service.

Palliative care developed as an outgrowth of hospice when professionals began to recognize that people who are not at the end stage of life, but are experiencing the effects of chronic disease, could benefit from an individualized focus of care. Unlike hospice, people who receive palliative care may continue to pursue aggressive treatment for their disease; but similar to hospice, the treatment is personalized and designed to reduce the physical and emotional stress of illness. Palliative care can be provided at any time during the course of a disease.

While hospice is always palliative care, not all palliative care is hospice.

So what does palliative care entail? According to Dr. Arlene Bobonich and doctor of nursing Kelly McCormack, of the palliative care department of Geisinger Holy Spirit Hospital, palliative care seeks to accomplish the following objectives:

Assist the patient and family to better understand the disease and establish goals for care

Align treatment with patient preferences

Improve quality of life

Manage symptoms that may be difficult to control

When is palliative care appropriate? Palliative care should be considered when there is a serious disease process such as (but not limited to) chronic obstructive pulmonary disease, congestive heart failure or end-stage renal disease, which is complicated by other factors such as:

A secondary health condition such as dementia or liver disease

A decline in functional status (self-care and/or ambulation)

Unacceptable levels of emotional distress

Poorly controlled physical symptoms (pain, nausea, shortness of breath)

More than one hospitalization for the same diagnosis within 30 days

Prolonged hospital stay (greater than five days) with little progress

Prolonged stay in a hospital intensive care unit with little progress

How does one obtain palliative care? Although palliative care programs outside of hospice began to emerge in the United States in the mid 1980s, progress has been slow.

The process for professional certification, lower salaries than other medical specialties, lack of understanding about the practice of palliative care, and the payment structure of our health care system have hindered its growth, despite the fact that ongoing research is showing that this type of care is desired by patients and provides tangible benefits.

Most palliative care programs in existence today are hospital-based, although community programs are beginning to develop. UPMC Pinnacle offers both inpatient and outpatient palliative care services, with the outpatient services being provided at the Bloom Outpatient Center in Harrisburg. Geisinger Holy Spirit has an established inpatient palliative care program and is currently exploring the development of an outpatient program.

Several local hospices also offer various levels of palliative care services for individuals who may not qualify for hospice. Be aware that these services may not be covered by insurance.

Multiple factors such as diagnosis, general health status, the availability of personal support systems and individual preferences affect decisions about how to approach health care at specific times in one’s life. Palliative care is designed to provide holistic support to people with life-limiting conditions, and has the capability of improving quality of life while promoting more effective utilization of health care resources.

Keystone Elder Law, in conjunction with Beltone @Home, is offering free hearing aid cleaning and hearing screenings on Thursday, Dec. 5. Please call 717-697-3223 to register.

Learn more about the article’s author, and other community education opportunities, at Check out the book, “Long Term Care Guide: Essential Tools for Solving the Elder Care Puzzle,” at the Whistlestop Bookshop or Amazon, and see Keystone’s free directory of services for older adults at Keystone Elder Law has offices in Mechanicsburg and Carlisle. Call 717-697-3223 for a free telephone consultation.


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