Principles of Long-term Care and Palliative Care

Long-term care involves a variety of services designed to meet a person's

health or personal care needs during a short or long period of time. These services
help people live as independently and safely as possible when they can no longer
perform everyday activities on their own.

A palliative approach can be implemented simultaneously with restorative

care. When an older adult is admitted into Long term care, there should be some
palliative goals of care. As the person continues to live in Long term care, the focus of
the care becomes more palliative until the resident’s death.

According to WHO, Palliative care is defined as “the active total care of

patients whose disease is not responsive to curative treatment. Control of pain, of
other symptoms, and of psychological, social and spiritual problems, is paramount.
The goal of palliative care is achievement of the best quality of life for patients and
their families. Many aspects of palliative care are also applicable earlier in the course
of the illness in conjunction with anti-cancer treatment (1990).

WHO expanded the definition to include six additional points regarding palliative
care. Palliative care:

 affirms life and regards dying as a normal process;

 neither hastens nor postpones death;
 provides relief from pain and other distressing symptoms;
 integrates the psychological and spiritual aspects of care, fostering opportunities
to grow;
 offers an interdisciplinary team to help residents live as actively as possible
until death; and
 offers support systems for the family during the resident’s illness and their own
bereavement

A patient becomes eligible for palliative care when the patient:

 has been diagnosed with a terminal or life ending illness;

 has a life expectancy of six months or less, as determined by the attending
physician and the hospice interdisciplinary team;
 is seeking palliative care (pain and symptom relief) rather than curative treatment.
 understands, as do the family and his or her physicians that artificial, life
prolonging procedures are not consistent with hospice care; and
 has been approved for admission to hospice services by the attending physician
and the hospice medical director.

There are also principles that are applicable to the Long Term Care facility which
becomes guide at providing humane, palliative care:

 Respect the dignity of both patient [resident] and care givers

 Be sensitive and respectful of the patient’s [resident’s] and family’s wishes.
 Use the most appropriate measures that are consistent with patient [resident]
choices.
 Encompass alleviation of pain and other physical symptoms.
 Assess and manage psychological, social and spiritual/religious problems.
 Offer continuity (the patient should be able to continue to be cared for if so
desired by his primary care and specialist providers).
 Provide access to any therapy that may be expected to improve the patient’s
[resident’s] quality of life including alternative or nontraditional treatments.
 Provide access to palliative care and hospice care.
 Respect the right to refuse treatment.
 Respect the physician’s professional responsibility to discontinue some
treatments when appropriate with consideration of both patient [resident] and
family preferences.
 Promote clinical and evidence-based research on providing care at the end of life.

Patterns of disease in the last years of life are also changing, with more people
dying from chronic debilitating conditions, such as cardiovascular disease, chronic
obstructive pulmonary disease, diabetes, cancer and dementia. Since many of these
illnesses often occur together among older people, this age group frequently
experiences multiple health problems and disabilities. Older people experiences
symptoms such as pain, anorexia, low mood, mental confusion, constipation,
insomnia and problems with bladder and bowel control. And palliative care focuses
on relieving those symptoms.

Palliative care focuses on controlling pain and other symptoms, defining needs
around patients receiving care and their families and being flexible about doing what
is necessary to help patients and their families to adapt and cope with their situation.
The patients have preferences based on religion, culture, life experiences, family
relationships, and one’s particular view of living and dying. The patient’s views may
change over time as life circumstances change. Therefore, ongoing discussions are
done to ensure that the health care team understands the patient’s current view of life.
The team’s openness and acceptance would facilitate understanding of what quality of
life means to the patient. End-of-life care discussions may include CPR, artificial
nutrition and hydration, hospital transfer, withholding diagnostic tests, and treatment
of an existing diagnosis. In conclusion, patients and their families have the right right
to accept or refuse medical or surgical treatment, and the right to formulate advance
directives, and the palliative care facility is not required to provide care that conflicts
with an advance directive.

However, for some patients receiving palliative care, they find it can negating
their hope of recovery since palliative care generally is not used unless the patient has
six months or less to live, and for many people, the knowledge that death is eminent is
overwhelming and heartbreaking. In addition, the expense of palliative care for a
disease is also a problem. Families who go the palliative care route often have to pay
for the care out-of-pocket, and sometimes the costs deplete any savings the patient
had or planned to give as inheritance.

Although Palliative care can be given in facilities such as nursing homes and
hospitals, but often families choose to receive palliative care at home because it costs
less not to have the patient in a formal institution but the family members often have
to adjust their schedules, giving considerable time to the patient. This can also be
emotionally draining for the family’s part. And also when a person receives palliative
care at home, when there are complications, families does not have the adequate tools
for the patient compared in a facility and a health care professional is not close by.
This causes patient to suffer unnecessarily or even passes away due to the lack of
immediate response.

In contrary, the focus of palliative care is on relieving symptoms, not curing

the disease, so people understand that the choice toward palliative care means that the
patient likely will see a decline in their health. Individuals who receive this care are
often more comfortable, not only because they can be at home if desired, but also
because they typically do not have to go through as many medical procedures. In this
way, palliative care for a disease improves quality of life.

Older adults who uses palliative care also sometimes feel as though they have
more control over what is happening to them. They do not feel as though they are
caught in a whirlwind of procedures and tests that might or might not prove
beneficial. During the final stages of disease, this can let a person maintain a sense of
dignity and autonomy. They are surrounded by familiar items and often have more
privacy which can reduce the patient's stress, which in turn might have a positive
effect on their health.

In conclusion, the goal of palliative care is the achievement of the best quality
of life for patients and their families. Palliative care essentially means that a person is
at the end of their life, and a provides a big focus on keeping them comfortable so that
they are able to live out their final time on this earth with a focus on quality of life
rather than counting the days.

References:

https://www.nia.nih.gov/health/what-long-term-care
https://www.palliativealliance.ca/assets/files/Module_2_Draft.pdf
https://health.mo.gov/safety/showmelongtermcare/pdf/EndofLifeManual.pdf
https://www.wise-geek.com/what-are-the-pros-and-cons-of-palliative-care-for-
cancer.htm
https://www.euro.who.int/__data/assets/pdf_file/0017/143153/e95052.pdf