Prolong Life and Reduce Suffering in Patients With Serious Illness Using Palliative Care

Palliative Care and Home Care

"Most people who get palliative care are still in their own homes," said Dr. Porter Storey, executive vice president of the American Academy of Hospice and Palliative Medicine.

According to Dr. Storey, in Europe, Canada, and Australia, all care is synonymous, but in the United States, palliative care is also used when people are still pursuing a cure for their illness. Because of U.S. government rules, hospice is limited to those with six months or less to live.

A recent study that was published in the New England Journal of Medicine of 151 patients determined that of the 86% of surviving patients, "Patients assigned to early care had a better quality of life than did patients assigned to standard care." In addition, survival was longer in those who received early palliative care.

The New England Journal of Medicine study also stated that these care programs have the potential to reduce hospital expenditures-an important issue in a time of rising health care costs.

A Team Approach to Serious Illness

This kind of care is provided by a team of professionals-including doctors, nurses, social workers, nutritionists, chaplains and others-who have received board certification specifically for care. The team works in conjunction with the patient, in home caregivers and other loved ones, as well as with the patient's own doctor.

Once you've decided to end the aggressive treatments and therapies, it's time for palliative care, said Alex Morrison, Homewatch Caregiver's field sales and support manager in Denver, Colorado. Mr. Morrison's parents died within 36 hours of one another in March. "It substantially improved their quality of life before dying, which gave me piece of mind during a very difficult time" he said of his choice to get them care.

Although Mr. Morrison's parents did not enter palliative care until near the end of their lives, he said it was the best way to eliminate additional suffering caused by bad medication interactions. Experts do recommend palliative care for patients soon after their diagnosis with a serious illness for this reason, among others.

Meeting a Range of Needs

Often people seek-out palliative care to deal with the physical pain of their illness and its treatment. At both AAHPM and The Center to Advance Palliative Care, there are stories of actual patients who had palliative care and how it benefited them or what they hoped to get from it.

These stories are about people with illnesses such as lung disease (the study written about in the New England Journal of Medicine focused on patients with newly diagnosed metastatic non-small-cell lung cancer), cancer, dementia, liver failure, heart disease and many more.

And while some of these are survivor stories, Dr. Storey said that people can and should seek out palliative care when they are not certain of the possible outcomes. "There are more and more medical treatments for people who are really sick," he said. "Lots of people are in this limbo and not ready for hospice." This is where a special kind of care comes in and has been developed to address the questions patients and their families may have about treatments, home care resources, and more.

Palliative care is now available in at least 70% of U.S. hospitals (those with over 300 beds), and a directory on the Center to Advance Palliative Care website, provides a list and links to those facilities.

Not only does palliative care assist patients with serious and life-threatening illness, but also their caregivers. "Families really don't know what to do," said Dr. Storey. "And they are concerned about what to do next."

Dr. Storey said that both hospice and palliative should be used sooner by patients and their loved ones. "Hospice is still a wonderful, wonderful service that people don't elect to use early enough. And hospice has the widest array of services in the home," he said. "It's not like palliative is a substitute for hospice. It's a marvelous support for the caregivers and should be used sooner."

Homewatch CareGivers is the largest, most experienced international provider of full-service in-home care for people of all ages - including seniors, children, veterans, the chronically ill, and those recovering from medical procedures. We invite you to visit the Homewatch CareGivers website (http://www.homewatchcaregivers.com/) where you can read articles related to home health, Dementia Care Tips and home care news; or download PDF home care resources. From health care coordination and hospital discharge planning to home care transportation and daily living assistance, let our family of caregivers care for yours.

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Hemodialysis Patients - Taking Care of Them

People suffering from end stage renal disease (ESRD) and under hemodialysis may already have a different outlook in life. It may be that they already lost hope for a life they once had. However, anyone can help these individuals live happily everyday.

Taking care of hemodialysis patients can be very difficult, you will face many hindrances from them. Some will say that what you will do is nothing important as they are nearing the end of their lives. But, you must know that these persons must be reminded that they can still enjoy their lives while on dialysis. In addition to the basic needs, dialysis can become a part of one's daily or weekly regimen.

Pre-dialysis Regimen
Knowing the schedule of the patient's therapy is very important. If he is for the morning schedule, arrange an early morning breakfast. Most centers do not allow patients to eat during treatment. If the patient is diabetic, make sure that he receives his insulin shot and breakfast before treatment.

Another important note to consider when taking care of a hemodialysis patient is to give his medications only after hemodialysis. Most of these drugs are water-soluble and can be washed out of the system. Ask a physician about specific medications that can be taken during dialysis.

Moreover, patients are at risk for compounding hypotension during hemodialysis. The doctor must be consulted for any anti-hypertensive drugs that must be withheld or postponed after treatment.

Blood Works and IV Medications
If there is an order of a blood work, coordinate with the nurse in the unit on who will extract the blood. This will avoid too many blood loss and needle sticks on your patient.

Send I.V. medications, such as antibiotics and iron supplements, with the patient. The nurse in the unit will administer them, and this will avoid further needle sticks to the patient.

Monitoring The Access Site
Regularly assess the access of the patient by palpating the AV (arteriovenous) fistula, observing for a thrill or a vibrating sensation. If it is absent, notify the physician and the nurse immediately. Remind all staff to avoid using the arm where the dialysis access is for administering IV medications, taking the BP, or drawing blood. Avoid constrictive jewelries or tight clothing on the arm.

After the dialysis session, check the access site for any signs of bleeding, redness, warmth, discharge, or aneurysm. Monitor the patient's vital signs before allowing him to resume any activity. If bleeding occurs, apply direct pressure for 15 minutes. If bleeding does not stop, notify the physician and note the observation on your daily log. Make sure to remove the dressing after 24 hours.

Diet Changes and Water Restriction
Taking care of a hemodialysis patient also includes monitoring the food he ingests. Hyperkalemia is very common in hemodialysis patients, monitor serum potassium regularly. Teach the patient to avoid foods rich in potassium and sodium. Exchange orange juice with an apple juice since citrus foods and juices are high in potassium.

Each patient has limited water intake, depending on the doctor's assessment. Teach him how to control his urges and note his water intake. Provide frequent oral care to prevent drying on the oral mucosa.

Monitor for Bleeding
Blood-thinning agents are prescribed to most patients and used during dialysis, putting the patient at risk for internal bleeding. Monitor for black, tarry stools, bruising anywhere in the body, eye hemorrhages, and signs of severe anemia. Monitor his hematocrit and hemoglobin level for sudden changes and notify the physician when any of these symptoms occur.

Psychological Well-Being
The emotional well-being is very important in taking care of a hemodialysis patient. At most times, allow the patient to take control of his care to promote independence. More importantly, address the psychological aspect of ESRD patients since it causes many issues about employment, health, finances, and sexual functioning, leading to anger or depression.

It is very important that patients know that they are not alone in their times of crisis. Taking care of a hemodialysis patient gives you self-satisfaction and hope for those individuals who are sick.

I am a nurse in the dialysis unit and have been serving patients for many years. It has been my crusade to help people understand the disease, their treatment, and what the family and loved ones can do to help. Check out my blog for more at The Kidneys

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