Understanding Differences Between Hospice Care and Palliative Medicine

Hospice care is something most people don’t give much thought to until they absolutely must, and while it may not be the happiest subject, it is an important one. We had the chance to speak with Christopher Bierman, MD, the Medical Director for Lehigh Valley Hospital (LVH)–Pocono Hospice, who explained the difference between hospice and palliative care and what you can expect if and when the time comes.

My residency was with internal medicine, but I found there wasn’t adequate time to spend with the patients and families as I would like. I had a physician introduce me to hospice and palliative medicine during my second year of training. I was really drawn to the specialty due to the amount of time I could spend with someone and getting to know them. I firmly believe everyone deserves to die peacefully, and I am glad I get to help them and their family navigate this difficult time in their lives.

While hospice and palliative care have a lot of overlap, there are some key differences. Both will help manage any symptoms someone is experiencing, whether it is physical, emotional or spiritual. Palliative care can be involved at any stage of a disease. Often the patients are receiving life-prolonging and possibly curative treatments. Hospice comes into play when physicians feel someone is in the last six months of life. Someone may want to stop receiving life-prolonging therapies due to side effects, lack of response, or any reason they decide.

When someone elects for hospice care, we offer a number of services to help the family. We will send our services to the home of the patient, including nurses, CNAs, chaplain, social worker and volunteers. If there are any needs while the nurse is there, they will reach out to the attending physician and take care of changes while in the home. All of this reduces the need for someone to have to go out to see their doctor to address issues. Our goal is to bring everything to you, to help you stay in the comfort of your home. We also recognize that at times it can be difficult to get our loved ones to doctor appointments. Our nurses are available 24 hours a day, so at any time a patient or loved one can call in with any issues and have them dealt with promptly.

The Monroe County Hospice House is a great resource to the people and families we serve. This location can offer multiple things for families and patients. Most importantly, it is where we do our aggressive symptom management. Some patients will start in the Hospice House to get their symptoms controlled prior to going home on medications that we have found to work to keep them comfortable.  If someone cannot be kept comfortable in their home with oral medications, we will bring them to the Inpatient Unit to find a regimen that will control their symptoms. We can offer IV medications if needed here until we find what works and get them back to an oral regimen. Another great benefit is our respite stays. This is a Medicare benefit for hospice patients. A patient can come in for five nights to give their caregivers a well-deserved rest before returning home.

Most of our hospice patients will be in their home. This means they are able to have symptoms managed with oral medications. If the medications are not working for them, they can be taken to the Inpatient Unit for a short stay to get their symptoms controlled before going back home. The Monroe Country Hospice House is meant for short stays for symptom management or to give the caregivers a break. Once symptoms are controlled, the patients will return home on the new regimen. Some patients do stay in the hospital for symptom management, but this is mainly provided at LVH–Cedar Crest and LVH–Muhlenberg hospitals. This is meant for someone who is near the end of their life, and doctors do not feel they would survive transport to the inpatient unit.

Coming to the decision to elect hospice care can be scary. There are a lot of unknowns that come with end of life. I would encourage patients and families to lean on our team in times of need. We are here for all of your questions or concerns. Our goal is to support everyone through this time, as well as after with our bereavement services that start at or before the time of someone’s death.

We have a great team who I believe is a benefit to all our patients and families. We are constantly evaluating our processes and changing things as necessary to better serve our patients and staff. Everyone works well together to adjust things in meaningful ways to improve our program.