About palliative care and hospices; hospitals and acute care
The focus of palliative care services and treatment is to improve the quality of life for people with a terminal illness.
The World Health Organization (WHO) says palliative care has a significant focus on the concept of ‘quality of life’ and uses many measures to prevent and alleviate suffering – physical, emotional, spiritual.
This includes providing relief from pain and other distressing symptoms and offering a support system to patients and their families that may also incorporate bereavement counselling.
Where did the term ‘palliative’ come from?
The word palliative is from ‘palliasse’ or straw mattress that was provided by the early hospices for pilgrims to sleep on thus palliating or alleviating the discomfort of bare boards or stone floors.
Modern definitions include to: “alleviate symptoms of disease and ease suffering without curing”.
In 1990, the World Health Organization (WHO) characterised palliative care as:
- the active total care of patients whose disease is not responsive to curative treatment
- the importance of the control of pain, of other symptoms, and of psychological, social and spiritual problems
- the achievement of the best quality of life for patients and their families.
The WHO describes the practice of palliative care as one that:
- affirms life and regards death as a normal process
- neither hastens nor postpones death
- integrates the spiritual aspects of care
- offers a support system to help patients live as actively as possible until death
- offers a support system to help their family cope during the patient’s illness and their own bereavement
Quality palliative care relies on a diverse network of dedicated and compassionate professionals and volunteers.
Where did the term ‘hospice’ come from?
The word ‘hospice’ is derived from the Latin, ‘hospitare’ meaning to receive a guest. From as early as the 6th Century in Europe monasteries and nunneries began to take in the sick and the disabled who were unable to look after themselves.
The first hospices were established as early as the 6th Century, when monasteries and nunnaries began to take in and care for people who were sick, disabled and unable to look after themselves.
Until the 17th Century hospices continued to be refuges for the destitute, sick and dying, as well as places of rest for weary travellers and religious pilgrims.
In 1842 Madame Jeanne Garnier founded the Dames of Calaire in Lyon, France. It was the first organisation to assist in hospice care and its establishment marked the contemporary definition of the word hospice as the care of the dying.
In 1890 the Sisters of Charity at St Vincent’s Hospital opened Sacred Heart Hospice, the first hospice in Australia.
The person acknowledged as the founder of the modern hospice movement is Dame Cicely Saunders (1918-2005). She was a nurse, medical social worker and physician, and the founder of St Christopher’s Hospice in London in 1967.
The aim of a modern-day hospice is to provide a quiet and tranquil home-like atmosphere as much like a family home environment as possible where patients are cared for by palliative care specialist staff and volunteers.
Why are people admitted to a hospice?
It is a common misconception that a hospice/palliative care unit is only for people who are dying, but patients are admitted for a variety of reasons.
In his book, Caring for the Living and the Dying, Dr Michael Barbato, who has been medical practice for more than 50 years, a palliative care physician for over 20 years, and SHCH Patron, identifies three key reasons for admission to a hospice:
If a symptom does not respond to treatment at home, or if the symptom is too distressing, admission to a hospice or palliative care unit is often the best way to achieve rapid relief. Once this is achieved, the patient is discharged to his/her home
This is a pre-planned admission with the express purpose of giving the carer a break. Depending on the circumstances, duration may be as short as one day or as long as two weeks. This gives the carer the opportunity to catch up on rest and other matters.
This is for people who cannot be cared for at home during the final days or weeks of life. Most people with a terminal illness express the wish to die at home, but only some achieve their wish. In many cases carers are often physically unable to cope with their patients as they near death. Patients must then be admitted to a hospice if one is available; if not patients will be admitted to acute care hospitals – public or private- and not all hospitals have palliative care beds or wards or specialised palliative care staff.
How is a hospice different to a hospital?
A hospice is purpose-built to provide palliative care services to patients with life-limiting illnesses and their families in a peaceful home-like environment. Hospices usually have a small number of beds, eg, 10, and are designed to be quiet, peaceful and tranquil and able to accommodate loved ones staying overnight with the patient
Patients are cared for by specialist palliative care professionals, supported by dedicated volunteers.
The most common and best known hospitals are general hospitals where the focus is on acute care services and treatments.
Patients receive active but short-term treatment for severe injury or episode of illness, an urgent medical condition, or during recovery from surgery. In medical terms, care for acute health conditions is the opposite from chronic care, or longer term care.
A 2013 WHO Bulletin, Health systems and services: the role of acute care, describes acute care:
“A reasonable working definition of acute care would include the most time-sensitive, individually-oriented diagnostic and curative actions whose primary purpose is to improve health. A proposed definition of acute care includes the health system components, or care delivery platforms, used to treat sudden, often unexpected, urgent or emergent episodes of injury and illness that can lead to death or disability without rapid intervention. The term acute care encompasses a range of clinical health-care functions, including emergency medicine, trauma care, pre-hospital emergency care, acute care surgery, critical care, urgent care and short-term inpatient stabilization.”
Volunteering in palliative care
Dr Michael Barbato is Patron of the Southern Highlands Community Hospice, Inc. He has been in medical practice for more than 50 years and a palliative care physician for over 20 years. Michael gave a presentation to SHCH volunteers on volunteering in palliative care and outlined some of the reasons people commit their time and themselves to this role.