What is Hospice and Palliative Care

Hospice according to the Center for Medicare and Medicaid Services is a support program of care for a dying person whose doctor and a hospice medical director certify has less than 6 months to live. The service is available 24 hours per day and 7 days per week. The focus of care for hospice is on comfort and not on curative care. This means that a patient must be willing to give up curative treatments in order to receive hospice care. For some people giving up treatment is not a desirable option. For them, palliative care may be an option. With Palliative care, you do not have to give up curative treatments to receive care. Palliative care may be an alternate course of treatment at the end of life care but can also be used to anyone at any age who is suffering from discomforts, symptoms, and stress of a serious illness. Palliative care is meant to help people find relief from their chronic conditions and treatments.
Hospice can be provided in a home, assisted living facility, nursing home, hospice care center, or hospital setting.

What is the difference between Hospice and Palliative Care?

	Hospice	Palliative Care
Stage	End of Life	Any stage of illness
Life expectancy	< 6 months	As long as necessary
Care or Treatment	Comfort or relief	Curative treatment OK
Focus	To provide comfort, care and support for terminally ill	To provide relief from discomforts, symptoms and stress of a serious illness

What is End of Life Care?

No one really knows exactly when someone is going to die. Accepting hospice means accepting help, getting the resources you need and being of acceptable of the unpredictable. End of life care is giving support and medical care during the time surrounding death. End of life care is the days, weeks and even months before death not simply before breathing ceases and the heart stops beating.

Why is Hospice so Important in the End of Life Care?

Talking about death is highly emotional. Just talking about death can break hearts. Experiencing death in a patient or family member changes the lives of the living. No one likes to talk about death because it is a very painful subject. Death is unpredictable. No one really knows when a person is going to die. The end of life is just as important as all stages of life. A dying person deserves to be treated with dignity, respect, openness and gentleness. This includes talking about it and embracing death. Care providers needs to be educated to be prepared.
Accepting hospice and/or the diagnosis dying can be very difficult. There are many barriers to accepting hospice. There is often hope that a person will get better. Disagreement on how sick a person may actually be is often a barrier. Failure to recognize a person is actively dying may result in increased suffering. Continuation of standard medical care can actually make things worse. Starting hospice care can manage uncomfortable symptoms in death, pain in particular, and contribute to comfort in the final days and hours of life.

What should I do if the patient does not want to eats?

As someone is dying, they eat less food. Eating less food is part of the process. A decline in eating can bring about high levels of emotional stress for care providers.
Eating at the end of life care plays an important part of end of life nutrition. Things change at the end of life. Nutrition and eating at the end of life also changes. See a patient eating less at the end of life can be stressful and hard to accept. Food is often associated with nourishment and love. Well-meaning care providers may try to push, force foods because they do not want them to “starve to death” or they fell they are not taking proper care of the patient. However, forcing foods/fluids will not enhance or even prolong life. It may even be a burden or even detrimental. The worst part is that this can lead to the “food fight” where precious time is wasted arguing over food. Avoid food fights. The “food fight” includes arguments and fighting over whether a person at the very end of life should eat. Let the patient decide when they want to eat or drink.

Remember this:

For a person who is in the final stages of terminal illness, and is close to death, there is no proof that increasing eating more food will improve their strength, their energy level, their ability to function or even prolong their life.

Forcing a dying person to eat will not extend their life

How Long Can a Person Live without Food or Liquid?

How long a person can live without food or liquids is a tough is complex. There are several variables that can affect how long a person can live without food or liquids but no one really knows the exact answer. People can live for quite a long time eating and drinking very little. However when someone stops eating and drinking all together, we know time left is short.

Caring for a Dying Patient

A person at the end of life does not get hungry or thirsty in the same way a healthy person does. A decreased appetite and loss of thirst are natural processes that allow the body to prepare for death. Normally when a healthy person eats food and the food is used to build and repair tissue. During the dying processing the body shifts and starts to break down components in the body to create energy it needs for the end of life. This is a natural part of the dying process that occurs whether or not food and fluids are provided. Starvation and dehydration is a natural part of the dying process. Starvation at very of life is not caused by lack of food-because a caregiver isn’t feeding them enough. It is a natural part of the dying process. Starvation in the prime of life is different than at the end of life. At the end of life your body actually has processes that enables people to feel less pain. Starvation the dying process does not cause suffering, it can actually alleviate it.

What about artificial hydration?

Providing artificial hydration (an IV of fluids) may seem like a good idea when someone is at the end of life and can no longer drink but research has shown that if just does not improve outcomes at the end of life. In general, it is not a recommended practice. It is ultimately up to the dying patient to determine if this is something they would like to pursue or not.

Ways to Manage End of Life Symptoms

Common nutrition related symptoms at end of life may include:

Poor appetite

• Small frequent meals with favorite foods
• Eat high calorie foods to “make every bite count”

Dry mouth

• Prove ice chips, popsicles, or moistened swabs
• Keep lips moistened with petroleum jelly or lip balm
• Swab mouth with coconut oil

Mouth Pain

• Try soft of pureed foods
• Eat bland, non-irritating foods

Constipation

• Eat plenty of fiber as tolerated (start slowly and gradually increase)
• Drink plenty of liquids
• Try prune juice

Diarrhea

• Avoid those “trigger foods” that stimulate the bowels/ diarrhea (simple sugars, sugar alcohols, caffeine, alcohol, high fiber, and gas producing foods)
• Drink plenty of fluids and electrolytes to prevent dehydration with diarrhea

Nausea or vomiting

• Eat bland foods (think crackers, toast)
• Limit sights, sounds, smells that trigger nausea/vomiting Altered taste and smell
• Maintain good oral hygiene
• Experiment with seasonings/flavorings (lemon juice, vinegar, herbs etc.) Pressure injuries (bed sores)
• Eat plenty of protein and vitamin /minerals your body needs
• Provide good cushioning, turn and reposition regularly (if possible)

Important Rules to Remember

1. Have foods available
2. Provide their favorite foods
3. Provide mouth care
4. Ask them what they would like to eat

As the dying person:

1. Eat when hungry
2. Enjoy food