What are Hospice and Palliative Care?

A Conversation with Calvary Experts

In this article Calvary’s expert team led by Christopher P. Comfort, MD, Nancy S. D’Agostino, RN, MSN, CHPN, and Kathleen Lynch, RN offer their insight to address common questions asked by those researching palliative care and hospice care.

In this article, you will learn how palliative and hospice care are similar and how they differ. Estimated read time: 4 minutes

Christopher P. Comfort

Christopher P. Comfort, MD

Chief Operating Officer

After serving as medical director for 20 years, Dr. Comfort was promoted to COO in 2019.

Nancy S. D'Agostino

Nancy S. D’Agostino RN, MSN, CHPN

Vice President of Community Patient Services

Ms. D’Agostino leads Calvary@Home, which provides home care and hospice.

Kathleen Lynch

Kathleen Lynch, RN

Administrator of Admitting, Intake & Outreach Services

Ms. Lynch has served Calvary in various roles for over 32 years.

A Historical Look at Palliative and Hospice Care

“Palliative care began with a focus on the care of the dying. Dr. Cicely Saunders first articulated her ideas about modern hospice care in the late 1950s based on the careful observation of dying patients. She advocated that only an interdisciplinary team could relieve the “total pain” of a dying person in the context of his or her family, and the team concept is still at the core of palliative care.” Matthew J. Loscalzo, Hematology Am Soc Hematol Educ Program (2008) 2008 (1): 465. https://ashpublications.org/hematology/article/2008/1/465/95868/Palliative-Care-An-Historical-Perspective

The word “hospice” first began being used in the mid-1800s to describe caring for dying patients by Mrs. Jeanne Garnier, the Founder of the Dames du Calvaire in Lyon France.”
http://www.hindshospice.org

Then, in 1899, a small group of widows in New York, inspired by the work of the Women of Calvary (Dames de Calvaire), who cared for destitute women in France with terminal diseases, decided to do the same in New York City. They took care of the women first in their own homes, then in two brownstone houses on Perry Street in Greenwich Village.

The work Calvary Hospital does today is directly related to these women and their predecessors in France. Today we carry on their mission to care for the dying, to offer compassion, support and to ease the process for the patient and their loved ones as best we can.

Q. What is palliative care?
A. Kathy Lynch, RN

Palliative care offers comfort, pain relief and symptom management for patients with serious illnesses. The goal of palliative care is quality of life for patients and their families. Anyone with a serious illness, chronic, or life-threatening disease, regardless of age or stage of illness can receive palliative care.

30 years ago, when a person heard the term palliative care, that usually meant that that person was doing poorly and there may not be anything more medical science could offer. Luckily, that concept has matured.

Nowadays, palliative care is increasingly being chosen by patients while they’re pursuing curative care options. When and if these patients need hospice care, the goal of their program of care will focus on the end of life.

At any time while a person is receiving curative treatment, they may choose to incorporate palliative care into their program of care. When and if they receive the news that they have a life expectancy of six months or less, the palliative care that they receive can be transitioned to the hospice comprehensive program of care. Palliative care can be utilized at any point in a person’s life.

Q. What is hospice care?
A. Nancy S. D’Agostino, RN, MSN, CHPN

The National Hospice and Palliative Care Organization defines Hospice as a “health care system of interdisciplinary services provided to patients and their families during the final stage of life.”

Hospice care is comprehensive interdisciplinary care provided within the last six months of a person’s life. Hospice care is patient-directed and is designed to assist the patient in maintaining comfort, dignity, and quality of life. It is important to understand, Hospice is a philosophy of care rather than a physical place.

The primary difference between home care, palliative care, and hospice care is the goal of the service. People come into a traditional home care program like Calvary’s Certified Home Health Agency to get better after a serious illness or surgery. The anticipated goal is that the patients’ pre-illness status will be achieved.

Others require palliative services in order to remain pain-free and comfortable. In instances where recovery is deemed not possible and the patient is expected to have less than six months of life left, hospice services can be provided.

Palliative Care Hospice
Definition When quality of life is a priority even during curative treatment. Comprehensive interdisciplinary care that incorporates palliative care concepts for those with limited prognosis.
Ideal Time to Use At any time that a person wants to maximize their quality of life.  When patients are told that they have life expectancy of six months or less
Settings Can be delivered in a variety of settings from inpatient or in the community. Can be delivered in a variety of settings from inpatient or in the community.

Patients with a life-limiting illness who are no longer pursuing treatment and want to spend their final days in comfort, are candidates for hospice care. Hospice also provides much-needed support for family and friends throughout the hospice services and during our 13-month bereavement services. 

Hospice care is largely provided at home with short-term inpatient care and is available if symptoms greatly worsen. Calvary’s program of care allows a broad continuum to choose from as patient needs evolve.

Q. What should I expect with hospice care?
A. Nancy S. D’Agostino, RN, MSN, CHPN

Each Hospice care program and experience will be different. I am going to answer this question as if it was asked about, our program, Calvary@Home. Our hospice care program, like the majority of hospice programs, is designed to support the physical and mental-emotional needs of terminally ill patients and their loved ones. 

In a hospice care setting, a team of nurses, social workers, pastoral care, home health aides and physicians come together and design a plan for each patient with the goal of supporting that person and their specific needs. 

The positive impact of the service can best be realized by reviewing comments of the loved ones and family members who have experienced CalvaryCare®. Angela Calabrese, whose mother was received our hospice care, has this to share: “At the height of the pandemic, Calvary Home Hospice rescued us. Nurse Kelly guided me through every step on making sure Mom was pain-free and comfortable. She was accessible to me 24/7. Eight days later, Mom passed on, with the same dignity and grace she had all her life. We knew God had sent us an angel.”

Q. Where can you receive hospice care outside a hospital?
A. Nancy S. D’Agostino, RN, MSN, CHPN

Our staff is proud to provide CalvaryCare® – compassionate and thorough services to patients, whether they reside at home, in a hospital room, skilled nursing facility, assisted living, group home, or at any other type of care center.

Hospice care supports the philosophy of aging in place by bringing clinical, emotional, and spiritual hospice services directly to patients and families.
CalvaryCare® allows patients to transition between inpatient and home setting as needs change. We do recommend finding a complete and comprehensive program. One that keeps all care options on the table and within a connected system of care, this approach offers substantial advantages to patients and their loved one.

Q. Does everyone in hospice care die?
A. Nancy S. D’Agostino, RN, MSN, CHPN

The philosophy of hospice is to care for and support patients and families during the natural process of death. That being said, in some cases, patient conditions have improved after receiving the medical, physical, and spiritual support offered by hospice services. 

The decision to start hospice care is never carved in stone. At times, we have patients who feel better after several weeks of hospice and may opt for additional curative attempts.

It should be noted that many studies have shown including the New England Journal of Medicine that palliative care extends life. Of course, it improves its quality but it actually has been proven to extend a patient’s life. 

We encourage families to seek and ask for palliative care as soon as they can to help improve the quality of life enjoyed by their loved ones even when a cure is not possible.

Q. How has the perception of Palliative & hospice care changed over the years?
A. Christopher P. Comfort, MD

In his best-selling book, Being Mortal: Medicine and What Matters in the End, Dr. Atul Ghawande says: “Being mortal is about the struggle to cope with the constraints of our biology, with the limits set by genes and cells and flesh and bone. Medical science has given us remarkable power to push against these limits…” but in the end, each life does have a limit. In order to be enrolled in hospice care, a patient must be expected to live for less than six months and it is during this sensitive time that we meet the majority of our patients. 

One important but little-known fact is that life is often extended and improved through hospice and palliative care modalities. Predictions regarding the time that remains for a patient following a diagnosis of a life-limiting illness can be elusive, mysterious, and often not important.

Ten years ago, there was a fascinating study that came out of Harvard that took stage-4 cancer patients at the onset of their treatment and provided them with palliative care. One group received state-of-the-art treatment the other had the same treatment plus palliative care.

To everyone’s surprise, the results of the study showed that the group that got regular treatment plus palliative care lived three months longer than the group that got state-of-the-art medical treatment alone. The goal of hospice is to increase comfort and quality of life. This study demonstrated that the positive effect of palliative care and hospice services should not be underestimated.

It cannot be stressed enough that the most important aspect of CalvaryCare® services is the way we have designed our various care modalities to work hand in hand. We endeavor to create a care model that works for real people and families. A seamless supportive continuum of care, that offers patients appropriate treatment in the most suitable setting, implemented by the proper professionals, throughout all the changing conditions arising from their unique illness. 

Calvary is the only fully accredited acute care hospital in the U.S. devoted exclusively to the palliative care of adult patients. Based in The Bronx, we strive to provide education to the global community – for the betterment of all those facing the end of life journey. Please reach out with questions, comments or to engage one of our experts. Visit: www.calvaryhospital.org or www.calvaryhospice.org

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