Tuesday, August 23, 2016

Palliative Care and Hospice

As some of you may know my daytime job is as a medical secretary in a multi-MD practice in my home town. My job is doing all the Prior Authorizations for Medications, sending the prescriptions and required documentation to suppliers for durable medical equipment, getting people oxygen, CPAP machines and supplies, nebulizers, helping them get transportation too and from appointments, getting miscellaneous paperwork signed by the doctors and returned in a timely manner, helping patients who can't afford their medications fill out Patient Assistance forms, and getting the orders and paperwork together and sent to various VNA agencies to connect patients home care services. A part of my job also involves connecting patients and their families with palliative care providers and hospice services.

That is the part of my job that has the biggest effect on me. I've lost both of my parents, my mother-in-law and the majority of my relatives already. I know death intimately, yet I still cry when a patient I have known through providing them various assistance through the years reaches the point where the end of their life is approaching and they and their family members have to think about palliative care or hospice.

I have the tender-hearted gene. My father was a weeper. So was my mother, who was a nurse. I still vividly remember her coming home from work and breaking down over the passing of one of her patients from cancer. She would also cry (with happiness) for patients like the young couple with fertility issues who finally conceived and had a baby. She would often be invited to patient's homes to visit the babies because she was the kind of person who truly cared about other people.

I sat in a meeting with the representatives of the combined regional VNA/Hospice service in this area. The hospice and palliative care representatives were at the office today to talk to the doctors, mid-levelers, me and a medical assistant who had signed up to attend about the centralized office and the palliative care services they provide, something we have struggled with hooking people up with in the past due to a shortage of providers in the area. They brought their magazine, and a little book they give to patients and their families that helps them understand the different between palliative care and hospice. I had to really struggle hard not to cry because it was only 7 months ago we lost John's Mom, and I really struggled with keeping my temper in check when I felt they weren't getting her the best care possible. And now I'm thinking about John's Dad who is growing more frail each day as he approaches #95 in November.

Now I understand the difference between Palliative Care and Hospice. It was explained clearly by these experts. Palliative care is when a patient is having frequent hospitalizations for their chronic diseases, who may rally and improve, or have ups and downs in their disease processes, however they are not at the point where they are terminal. Palliative care can help them through the lows and prepare the patient and the family for changes ahead in the disease process, what to look for, when to contact the doctor, the changes as end of life approaches so they are better prepared for the road ahead which could meander over months or even years. It's preparation for the end of life.

Hospice is for terminal patients with a limited life expectancy and includes comfort measures that address anxiety and pain. Hospice provides counseling for family members, and bereavement services for the family after the patient passes to help them cope with their grief. This service can last 3-13 months or even longer while the family copes and comes to terms with their loss.

Ultimately, everyone dies. No one lives forever. Palliative care and hospice help families prepare for and cope with the impending death of a family member.

It's the saddest, more heart-wrenching aspect of my job but I'm glad I'm in the position to help other people prepare for their losses. I have plenty of experience with loss.

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