Informative

Hospice and palliative care are two different types of care that are often confused. Both provide pain and symptom relief for people with serious illness, but there are important differences. Learning more about the difference between hospice and palliative care will help you find the right care for your situation.

10 Ways Hospice and Palliative Care are the Same

It’s important to understand the difference between hospice and palliative care, but let’s start with the similarities. Both offer:

1. Compassionate care for patients with serious illnesses
2. Pain and symptom relief
3. Greater independence and control
4. Fewer unnecessary trips to the hospital
5. Comfort and quality of life as the primary goals
6. Physical, emotional and spiritual support
7. Treatment teams made up of professionals with a variety of special skills
8. Social and emotional support for family caregivers
9. Education on health conditions and what to expect during care
10. Care coordination with the patient’s current primary care doctor/healthcare team

8 Differences Between Hospice and Palliative Care

The most important things to understand about the palliative care vs. hospice definitions are:

1. Start Time

• Hospice care begins in the later stages of illness, when the person is expected to live about six months, and is also called end of life care.
• Palliative care can start at any stage of an illness. This includes when the person is diagnosed, when they’re receiving treatment to cure their illness or when they’re nearing the end of their life.

2. Goals of Care

• When a patient chooses hospice, the goals of care shift from curing illness to focusing on comfort and quality of life.
• When a patient chooses palliative care, quality of life and comfort is also key. However, patients can receive palliative care at the same time that they’re trying to cure their illness. Their goal is to recover and/or extend life while staying as comfortable as possible.

3. Payment

• Hospice costs are 100% covered by Medicare, Medicaid, the Veterans Administration and most private insurance plans for qualifying patients. Benefits cover the cost of hospice services and medications, as well as medical equipment and supplies related to the terminal illness. Medications and services that are unrelated to the terminal illness fall under the patient’s traditional Medicare, Medicaid or private insurance benefits.
• Palliative care costs are usually paid for by insurance or out of pocket by the patient. Some costs may be covered by Medicare, Medicaid or private insurance, depending on the patient’s plan.

4. Frequency

• Hospice care involves regular visits from a nurse, certified nurses’ aide and other hospice staff including chaplains, volunteers and more. These visits may happen multiple times per week, depending on the patient’s needs.
• Palliative care visits are also dependent on each patient’s needs as they change. In some cases, this can be weekly, monthly or even less frequently.

5. Eligibility

• To receive hospice under Medicare, patients have to meet eligibility requirements (prognosis of six months or less as determined by a doctor).
• Since Medicare only covers parts of palliative care, patients do not need to meet specific requirements to be eligible.

6. Length of Care

• Patients can receive hospice care for six months or longer if a doctor certifies that they continue to meet eligibility criteria.
• Palliative care is available starting upon diagnosis and continuing until the patient’s illness is cured or they transition to end-of-life care.

7. Location

• Hospice is provided wherever the patient calls home, whether that be a private residence, a nursing home, a hospital or other location. Patients do not have to travel to receive these services.
• Palliative care can also be provided at home or in a hospital or facility. In some cases, palliative care is offered through special outpatient clinics, where patients may travel to visit with palliative care providers.

8. Support

• Hospice services include some in-home care, such as nursing care, a certified nurse’s assistant who can help with activities of daily living and other support.
• Palliative care may include nursing visits but focuses heavily on advanced care planning and care coordination, helping patients to work with resources available to them to receive additional support in the home.

Although there are many differences between hospice and palliative care, both types of care can make a difficult time easier for patients and their families. If you  or a loved-one are struggling with a serious illness, ask your health care provider which is the best option for you, palliative vs. hospice.

Hospice is:

• Medical care for people facing life-limiting illnesses, allowing individuals to live the remainder of their lives focusing on symptom management, pain control, and quality of life.

• An interdisciplinary team of professionals trained to address physical, psychosocial, and spiritual needs of the person; the team also supports family members and other intimate unpaid caregivers.

• Specialty care that is person-centered, stressing coordination of care, clarification of goals of care, and communication.

• Provided primarily where a person lives, whether that is a private residence, nursing home, or community living arrangement, allowing the patient to be with important objects, memories, and family.

• Care that includes periodic visits to the patient and family caregivers by hospice team members. Hospice providers are available 24 hours a day, 7 days a week to respond if patient or caregiver concerns arise.

• The only medical care that includes bereavement care, which is available during the illness and for more than a year after the death for the family/intimate network.

• A Medicare benefit; to which all Medicare enrollees have a right. Hospice care also is covered by most private health insurance at varying levels, and in almost every state, by Medicaid.

 

Who is eligible to receive hospice care?

• Adults with a terminal illness and lifetime prognosis of 6 months or less are eligible for hospice care.

• Hospice care is also available for children and adolescents. Rules and regulations regarding hospice services and coverage for children are different from those utilized in the adult population.

• Common diagnoses of those who receive hospice care include, but are not limited to: cancer, heart disease, dementia, Parkinson’s disease, lung disease, stroke, chronic kidney disease, cirrhosis, and Lou Gehrig’s disease (ALS).

 

How does someone initiate hospice care?

Many individuals and families could benefit from hospice care but are unaware of how to access hospice services. Some are afraid to discuss it, some wait for a physician to suggest it, and some don’t know that they can initiate hospice care on their own, as long as eligibility criteria are met.

To qualify for hospice services:

• A hospice physician and a second physician (often the individual’s attending physician or specialist) must certify that the patient meets specific medical eligibility criteria indicating that an individual’s life expectancy is 6 months or less if the illness or condition runs its typical course. These established criteria vary by illness and condition.
• Typically, referral to hospice care begins with the attending/specialist physician knowledgeable about the person’s medical history, and hospice eligibility is confirmed by the hospice physician.
• Self and family referral is possible (the person and/or family may contact hospice directly), but eligibility must be confirmed by physicians prior to receiving care.

Content provided by Hospice Foundation of America

Nearly one in five cases of dementia could be related to vision loss, according to a new analysis. The findings suggest that better vision care could lead to lower rates of dementia in old age. Alzheimer’s disease remains the leading cause of dementia in older Americans.

For the study, researchers at the Johns Hopkins School of Public Health looked at 2,767 Americans older than 70. Study volunteers had undergone extensive tests of thinking and memory skills, and about 11 percent had been diagnosed with Alzheimer’s disease or other forms of dementia.

Participants also completed eye exams to test for three kinds of visual impairment: near acuity, or the ability to see small objects up close, such as when reading or sewing; distance acuity, or identifying the smallest letters or objects you can make out from a distance of about 20 feet, such as when viewing an eye chart; and contrast sensitivity, or the ability to perceive crisp and clear outlines of very small objects. About a third of those in the study had impairments in one or more of these visual abilities.

Overall, the researchers estimated that 19 percent of all dementia cases could be attributable to at least one type of visual impairment. Poor contrast sensitivity showed the strongest association with memory and thinking impairments, though near and distant vision loss also contributed to cognitive loss.

The findings, published in the journal JAMA Ophthalmology, show only an association and do not prove cause-and-effect. But they add to growing evidence that vision loss may contribute to faster cognitive decline and an increased risk of Alzheimer’s disease and other forms of dementia later in life. A long-running 2020 study from Korea, for example, that looked at more than six million middle-aged and older adults found that dementia risk increased with the severity of vision loss. Other studies have found that people who have surgery to correct cataracts, a leading cause of cloudy vision in older people, are at lower risk of dementia than those who have cataracts but don’t have the surgery.

The Lancet Commission, an international panel of experts that regularly reviews the scientific literature on Alzheimer’s and dementia, recently added vision loss to a list of 14 modifiable risk factors that can raise the risk of developing dementia in older age. They estimate that about 40 percent of dementia cases could be prevented or delayed by addressing these risk factors, which also include hearing loss, smoking, high blood pressure, diabetes, obesity, head injuries, excessive alcohol use, air pollution, and lack of social interaction.

The authors of the current study note that “the results from this cross-sectional study suggest that nearly one in five prevalent dementia cases in community-dwelling U.S. adults aged 71 years or older could have at maximum been avoided if vision impairment had been eliminated. Overall, these data support the inclusion of sensory impairments as potentially modifiable risk factors for dementia prevention strategies.”

Poor vision, like poor hearing, is a form of sensory deprivation, in which the brain gets only limited stimulation. Stimulation of the brain, whether it’s through the senses or through cognitively stimulating activities like reading a newspaper or doing crossword puzzles, has been linked to a lower risk of Alzheimer’s disease. Poor vision may also limit a person’s ability to drive or get out of the house and socialize with others, and social interaction has been shown to be critical in helping to keep the aging brain in good working order.

About 80 percent of vision impairment occurs in adults aged 50 and older, and 90 percent of cases are preventable or have yet to be treated. One of the most common causes of blurry vision in older adults is cataracts, but eye diseases like glaucoma, macular degeneration and diabetes-related retinopathy are also prevalent in older people. Regular eye exams can help to identify these problems early, and effective treatments to limit vision loss are available for many of these eye problems.

The American Academy of Ophthalmology recommends that all adults who are healthy and with good vision should have a complete eye exam at least once in their 20s and twice in their 30s, increasing to up to every year or two at age 65 or older. If you wear contact lenses, see your eye doctor every year. If you have diabetes or high blood pressure or have a family history of eye disease, you may need to see the eye doctor more often.

Regular vision checks are also important for those who already have Alzheimer’s disease. Earlier studies have shown that one in three nursing home residents with Alzheimer’s disease who need eyeglasses don’t have the right glasses and can’t see clearly. Poorly corrected vision may mean they are missing out on mentally stimulating activities that may help to ease aggravation and soothe symptoms of dementia.

Experts recommend that if you care for someone with Alzheimer’s disease, a few simple steps can help avoid vision-related problems. These include labeling eyeglasses with a person’s name and phone number so that if they are lost they can be more easily recovered; having a spare pair of glasses on hand; and scheduling regular eye exams ahead of time to make sure vision prescriptions are up to date.

Content provided by Fisher Center for Alzheimer’s Research Foundation

A big challenge and source of stress in Alzheimer’s disease and dementia is the uncertainty. No one can predict what will happen with an older adult’s cognitive ability or when changes will happen. Understanding the stages of dementia can give a sense of what to expect and can be used as guidelines to plan for the future.

Here we will explain the 3 typical stages of dementia (including Alzheimer’s), the common symptoms, and why symptoms don’t always fit into these stages. It’s important to remember that the progression of the disease is unique and different for each person.

Early – mild dementia

• Able to live independently, but may have memory lapses, like forgetting familiar words or the location of everyday objects. Other people that start to notice something “seems off”.
• Symptoms may include:
  • Struggling to find the right word or name
  • Finding it difficult to do everyday tasks in social or work settings
  • Forgetting something that they just read
  • Frequently losing or misplacing things
  • Increasing trouble with planning or organizing
  • Making decisions with uncharacteristically poor judgment

Middle – moderate dementia

• This is the longest stage that can last many years. You may notice that they get words mixed up, are often frustrated or angry, or act in unexpected ways, like refusing to bathe. Damage in the brain can make it difficult to express themselves and do everyday things.
• Symptoms may include:
  • Forgetting things that happened recently or major events in their life
  • Being moody or withdrawn, especially in social situations or when something requires  too much thought
  • Not being able to remember significant things like their address, phone number or where they went to high school
  • Getting confused about where they are or what day it is
  • Needing help choosing appropriate clothes for the season or occasion
  • For some, trouble with incontinence
  • Changing sleep patterns, like sleeping during the day and being restless at night
  • An increased risk of wandering and getting lost
  • Personality and behavior changes, including paranoia, delusions, and compulsive, repetitive behavior like hand wringing

Late-stage dementia

• Progressively lose the ability to engage in the world, to hold conversations, and control their muscles. They may still be able to talk, but communicating and expressing thoughts becomes difficult – even something as basic as pain.
• You may see significant personality changes or the  fading of their personality altogether.
• At this stage, symptoms and needs typically include:
  • 24/7 help with daily activities and personal care
  • Increasing difficulty communicating
  • Loss of awareness or recent experiences and their surroundings
  • Gradual and progressive loss of physical abilities, including walking, sitting and swallowing
  • More likely to develop infections, especially pneumonia

A person with dementia doesn’t always fit into one stage. It affects each person in a unique way and changes different parts of the brain at different points in the disease progression. Plus, different types of dementia tend to have different symptoms. For example, someone with frontotemporal dementia may first show extreme behavior and personality changes. But someone with Alzheimer’s would first experience short-term memory loss and struggle with everyday tasks.

Another common occurrence is for someone in the middle stages to suddenly have a clear moment, hour, or day and seem like they’re back to their pre-dementia abilities. They could be sharp for a little while only to go back to having obvious cognitive impairment. When this happens, some may feel like the person is “faking” their symptoms or just not trying hard enough. This is not true. It’s the dementia that’s causing their declining abilities, as well as those moments of clarity.

Even if the stages aren’t exact and the symptoms still unpredictable, being able to plan ahead is essential. Dementia care is expensive and time-consuming, and being financially prepared for increasing care needs is a necessity. On an emotional level, having an understanding of what to expect can help you find ways to cope with challenging behaviors, and give you a chance to mentally prepare yourself for the inevitable changes in your loved-one.

Content provided by DailyCaring Editorial Team (DailyCaring.com; award winning senior caregiving website)

Frontotemporal dementia (FTD) is a disease that results in progressive damage to the temporal and/or frontal lobes of the brain. FTD typically presents between the ages of 40 and 65 and impacts behavior, personality, movement and language.

Types of Frontotemporal Dementia

Frontotemporal dementia is often broken down into 3 subtypes:

Behavioral Variant FTD was previously called Pick’s disease. Some patients with bvFTD show evidence of Pick bodies —abnormal proteins in the brain. It is the most common form of frontotemporal dementia. It is common for memory to remain intact with bvFTD; personality and behavior changes are the primary symptom.

Primary Progressive Aphasia impacts an individual’s ability to communicate. The non-fluent variant of aphasia affects speech, whereas the semantic variant interferes with a person’s ability to understand, process and use language.

Movement-related frontotemporal dementias occur due atrophy and damage to areas of the brain that control movement. The symptoms are similar to the motor dysfunctions characteristic of Parkinson’s disease such as loss of physical control, difficulty with balance, stiffness and a fixed stare.

Symptoms of Frontotemporal Dementia

Instead of the memory issues that are widely understood to be the most common indicators of dementia, FTD is more often associated with marked personality and behavior changes. For this reason, symptoms associated with atrophy of the frontal lobe are often misdiagnosed as mental illness.

Symptoms of FTD include:

• -Socially inappropriate behavior such as swearing, stealing and    repetition
• -Impaired judgment and reasoning
• -Dramatic personality changes and fluctuations in mood
• -Loss of interest in activities
• -Increased interest in sex and lack of self-awareness into inappropriate sexual inhibitions
• -Lack of empathy and flat affect, often seen as emotional indifference
• -Deterioration in hygiene
• -Impulsive behavior and agitation, sometimes demonstrated as restlessness, compulsive clapping, pacing or putting inedible objects in the mouth
• -Changes in speech, such as loss of understanding, misnaming objects and less frequent speech
• -Problems in movement similar to Parkinson’s disease, such as tremors, muscle spasms, or loss of coordination

Caring for Someone with FTD

Frontotemporal is a degenerative and progressive disease. There is no cure or treatment available, however medications may be available to address some symptoms, and behavioral interventions may help alleviate problematic behaviors.

In early stages of the disease, it is possible to manage the progression of changes by designing daily routines and setting proper expectations. However, behavioral and cognitive symptoms will worsen over time. As these problem behaviors and language deficits increase and motor skills decline, individuals with FTD eventually require 24-hour care.

Caring for a loved one with FTD can be especially challenging. We will partner with your family to provide the right amount of care needed to ensure you have the breaks from caregiving you need for your own health and wellbeing.

Contact us at 410.919.0190 to schedule a free in-home assessment to learn more about our specialized services.

Content provided by AgingCare.com

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