End of Life
Types Of Care
Make Your Preferences Known
Many Americans die in facilities such as hospitals or nursing homes receiving care that is not consistent with their wishes. To make sure that doesn’t happen, people need to know what their end-of-life care options are and state their preferences in advance.
For example, if a person wants to die at home receiving end-of-life care for pain and other symptoms and makes this known to health care providers and family, it is less likely he or she will die in a hospital receiving unwanted treatments.
There are several factors to consider when choosing end-of-life care, including the desire to pursue life-extending or curative treatments, how long someone has left to live, and the preferred setting for care.
What Is Palliative Care?
Palliative care is comprehensive treatment of the discomfort, symptoms, and stress of serious illness, whatever the diagnosis. It works with a patient’s main treatment and can be given along with all other medical care. It may be started as soon as other care begins and can last during the whole illness.
The main goal of palliative care is to improve quality of life. It focuses not just on a patient’s physical and medical needs, but also his or her emotional, social, and spiritual concerns. It also provides support to the patient’s family.
Palliative care is not just for people who might die soon. It is a resource for anyone with a long-term chronic disease that may, in time, cause death. These diseases include heart failure, chronic obstructive pulmonary disease (COPD), cystic fibrosis, HIV/AIDS, and Parkinson's disease.
The organized services available through palliative care can also be helpful to any older person having a lot of general discomfort and disability late in life. Palliative care can also help patients, family members, and health care providers talk through treatment and care decisions.
How and Where Palliative Care Is Provided
Palliative care is provided by a health care team that typically includes doctors, nurses, therapists, social workers, spiritual counselors, and others as needed. Together they make sure a patient’s needs are met, including when a patient changes setting, such as going home from the hospital.
Palliative care can be provided in any setting, including hospitals, nursing homes, outpatient palliative care clinics, other specialized clinics, or at home. All Veterans Health Administration hospitals now have a palliative care program.
People sometimes confuse palliative care with hospice care, but they are different—for instance, you do not need to give up curative treatments to receive palliative care. Palliative care is available to patients of any age who have a serious chronic illness, as well as to those who are dying.
To learn more about palliative care, or to request a brochure, available in English and Spanish, that answers many common questions about palliative care, see the National Institute on Nursing Research's online palliative care brochure.
What Is Hospice Care?
Like palliative care, hospice provides comprehensive comfort care to the dying person as well as support to his or her family. But in hospice, attempts to cure the person's illness are stopped. Candidates for hospice care are people with a serious illness who a health care provider thinks has less than 6 months to live.
The goal of hospice is to relieve symptoms. It tries to make a dying person as comfortable as possible, maintaining that person’s quality of life and dignity. Hospice care does not provide 24-hour, around-the-clock nursing care, so many patients are also cared for by family members, hired caregivers, or nursing home staff.
Some people think a health care provider’s suggestion to consider hospice means death is very near, but that is not always the case. Sometimes people do not start hospice care soon enough to take full advantage of the help it offers.
Where Is Hospice Provided?
Hospice is not tied to a specific place. It can be provided in the home, at an assisted living facility or nursing home, or in a hospital. There are also hospice centers, which are care facilities that admit those who are near the end of life. Patients are free to leave hospice care to seek curative treatment at any time.
Benefits of Hospice
Research shows that families of people who received care through a hospice program are more satisfied with end-of-life care than are people who did not have hospice services. Hospice recipients are more likely to have their pain controlled and less likely to undergo unnecessary tests or be given medicines they don’t need than people who don’t use hospice care.