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Qualifications For Palliative Care: Is My Loved One Eligible?

qualifications for palliative care - palliative caregiver smiling at elderly woman

If your elderly loved one is facing a serious terminal or non-terminal illness, it can take a toll on them and family members involved in their care.

Frequent hospitalizations, escalating symptoms, coordinating with different healthcare specialists, and making complex decisions about their treatment may be too much for you or the family caregiver to handle.

In that case, palliative care provided by a team may be necessary. This type of care aims to help your loved one find relief from their symptoms, and lead a quality life. It also ensures the family’s physical and emotional needs are considered.

But, what are the qualifications for palliative care, and how do you ascertain if your loved one qualifies? Keep reading to learn more, and find out how you can get started with palliative care.

Quick Facts About Palliative Care

You may have probably heard about palliative care and what it entails. But just in case you don’t fully understand it, here are some fast facts about palliative care.

What is palliative care?

Palliative care focuses on improving the quality of life for individuals with chronic health conditions such as cancer or end-stage liver disease. Care is provided to help patients find relief from their symptoms while exploring curative treatment.

A team of medical professionals including doctors, registered nurses, psychologists, therapists, and spiritual counselors make up the palliative care team. Their goal is to provide comprehensive care that covers the physical, emotional, and spiritual aspects.

What are the benefits?

benefits of palliative care - caregiver comforting elderly senior man

Palliative care is beneficial to the ill individual and their family in many ways.

  • Improves the quality of life of the individual
  • Reduces hospitalizations
  • Relieves pain
  • Manages other symptoms of the illness
  • Helps coordinate care among healthcare professionals
  • Guides in making complex decisions involving treatment and advanced care planning.

Where can my loved one receive care?

Your loved one can receive palliative care in a variety of settings. This includes their home, your home, or wherever they call home like an assisted living home or a nursing home.

The benefit of a home-like environment is the familiarity it brings, and how it makes it easy for family members and friends to be involved in the care of the individual.

On the other hand, they can choose to receive palliative care in a hospital setting, an outpatient clinic, or a palliative care center.

A hospital or care center is beneficial if your loved one requires round-the-clock supervision that may be impossible to provide at home.

Your beloved senior may first begin to receive palliative care in a hospital, then transition to a home-like environment as soon as their condition is stable.

Is palliative care the same as hospice?

No. Although they have some similarities, they are different. Palliative care can be initiated as soon as an individual is diagnosed with a serious health condition. The focus is on improving the quality of life while pursuing available treatment options.

Hospice care on the flip side is only prescribed once treatment has stopped, and the individual has a prognosis of six months or less to live.

Qualifications for Palliative Care

How do you qualify for palliative care?

There are no national eligibility requirements for palliative care, unlike hospice care. For instance, for a person to qualify for hospice, they must meet the qualification requirements established by the US Centers for Medicare and Medicaid Services.

For palliative care, it’s left to you or your loved one’s primary physician to identify the situations surrounding your loved one’s illness that necessitate the need for palliative care.

Here are some questions to answer to determine if your elderly loved one meets palliative care qualifications.

Has your elderly loved one been diagnosed with a serious illness?

Examples of such serious illnesses include:

  • Cancer
  • End-stage liver disease
  • Advanced Alzheimer’s Disease
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Congestive heart failure

palliative care qualification - a sick elderly woman in bed

YES: Once a diagnosis of a serious illness is made, it’s advisable to start palliative care early, so the individual can benefit from all it has to offer. However, palliative care can start at any stage of the serious illness. Although palliative care first started with cancer, it has evolved and can be provided for other serious illnesses as mentioned above.

NO: If your beloved senior’s illness is not considered serious, then palliative care may not be necessary. Suppose they had a fall, and require hip surgery, or caught the flu, or other age-related illnesses. In that case, they can find the services of a caregiver useful, instead of a palliative care team. The caregiver can help with daily activities while they recover, meal preparation, running errands, and transportation to and from the doctor’s appointment.

Is your loved one experiencing symptoms that are difficult to cope with?

Seniors facing serious illnesses may have symptoms that affect the quality of their lives. This could include:

  • Pain
  • Shortness of breath
  • Fatigue
  • Appetite loss
  • Sleep issues
  • Nausea
  • Digestive issues
  • Dementia

YES: The palliative care team will help manage your loved one’s symptoms, so the quality of their life can improve. For instance, if your loved one has chronic pain, pain medications or other forms of pain therapy might be incorporated to help them find relief. If they have digestive issues, a dietician or nutritionist can come up with a food plan, or suggest ways to improve their appetite. An occupational therapist can help them regain functionality, and improve their sleep. This team effort ensures your loved one receives holistic care that addresses all their symptoms.

NO: If your senior isn’t experiencing such symptoms, they may not need palliative care yet. Maybe they are in the early stage of their diagnosis, or the symptoms can be handled. However, in some cases, palliative care may be recommended to address possible symptoms before they escalate and become difficult to cope with.

Does your loved one find it difficult to cope with the sickness emotionally?

Chronic health conditions can take a toll on your loved one’s mental health, and that of family members. They may fall into depression, experience anxiety, or begin to shy away from socializing with others.

elderly man facing depression from a serious illness diagnosis

YES: One of the goals of palliative care is to offer emotional support to the patient and the family. Your loved one might be finding it difficult to accept a diagnosis, become complacent about their condition, and “resign to fate”. Psychologists and psychiatrists may provide mental support to help your loved one cope.

NO: If you or your loved one has a good grip on the emotional aspect of the sickness, then you may not need palliative care. Although you may not need emotional support, you may meet the other qualifications for palliative care.

Would your loved one benefit from spiritual support?

YES: Recognizing the spiritual dimension of a person’s well-being is an integral part of palliative care. Dealing with a chronic illness can often lead individuals to question the meaning and purpose of life, prompting a search for spiritual support and guidance. In such cases, a chaplain or spiritual counselor may play a crucial role in offering comfort, helping your loved one explore their beliefs, and providing a source of strength during challenging times.

NO: If your loved one and your family do not prioritize or find solace in spiritual support, palliative care can still focus on other essential aspects of their well-being. In such cases, the palliative care team can tailor their approach to meet the specific needs and preferences of your loved one, ensuring a comprehensive and personalized care plan.

Do you or your loved one have a hard time understanding their illness?

YES: Palliative care can provide patient-teaching resources and education about your loved one’s condition. Understanding the illness may help your loved one come to terms with it. It will also enable your loved one and the family to know what to expect, what treatment options are available, and what the prognosis is.

NO: If your loved one understands their illness, the palliative care team may focus on other aspects of their care.

Does your loved one or the family need help with complex decision-making and determination of goals of care?

palliative nurse holding hands with senior patient - how do I qualify for palliative care

YES: It may be challenging to make decisions on complex issues such as treatment options, goals of care, and advance care planning when you don’t fully understand them. Palliative care provides assistance to help patients and their families navigate complex decisions. Guided discussions can be initiated about the prognosis of the illness and your loved one’s end-of-life wishes. These discussions can help determine the goals of care, what treatment options are preferred, and advance health directives such as a do-not-resuscitate (DNR) order.

NO: If you and your family feel confident and well-informed in making complex decisions regarding treatment options, goals of care, and advance care planning, you may not require additional support in these areas. Palliative care is adaptable to individual needs, and if decision-making is not a current challenge, the focus can shift to other aspects of comprehensive care that align with the preferences and priorities of your loved one and your family.

Are you concerned about medical coverage for palliative care?

YES: If you find yourself worried about the financial aspects of accessing palliative services, rest assured that part of the palliative care team’s role is to provide support in understanding and securing medical coverage. They can assist in exploring insurance options such as Medicare and Medicaid, discussing eligibility criteria, and even connecting you with financial counselors who can help ease the financial burden associated with palliative care.

NO: If medical coverage is not a current concern for you and your family regarding palliative care, you can focus on the other aspects of the care plan.

Keep in mind that your loved one doesn’t have to answer “yes” to all the questions above to qualify for palliative care. They may be eligible based on some or all of the questions.

When Should Palliative Care be Consulted for a Patient With a Serious Illness?

caregiver helping elderly woman stand - qualifications for palliative care

A palliative care consultation should be made as soon as your loved one is diagnosed with a serious illness, or when your loved one meets some of the qualifications from the questions above.

A palliative care consultant could be your loved one primary physician or a palliative care provider like Amy’s Eden. They will evaluate your loved one’s medical reports and needs, answer any questions you may have, refer you to a palliative care provider, or start palliative care for your loved one.

It’s beneficial you have this consultation early on in your loved one’s diagnosis, so the right plan of action can be incorporated. This will ensure your loved one maximizes palliative care, finds relief from their symptoms, and improves the quality of their life.

Who Makes up my Loved One’s Palliative Care Team?

Your loved one’s palliative care team would be made up of a multidisciplinary team of healthcare professionals. Who is on the team will depend on your loved one’s health condition and needs. Your palliative care provider will ensure that the necessary professionals are in your care team.

a group of palliative care team

Here are some experts you might find in your loved one’s team.

  • Doctors are responsible for evaluating your loved one’s health condition, determining what treatment options are available, and predicting the prognosis of the illness. They lead the care team and coordinate the care plan.
  • Registered nurses provide hands-on care, and help manage symptoms or all aspects of care for the patient and the family.
  • Nutritionists/dieticians provide nutritional support and ensure your loved one’s diet is appropriate for their condition. They also address digestive and appetite-related issues.
  • Psychologists and mental health therapists help your loved one and the family cope with the emotional stress that accompanies the illness. They help with symptoms such as depression, anxiety, and isolation.
  • Social workers provide holistic support to the patient and family. They can assist with providing resources and training on the illness and helping families navigate complex decision-making.
  • Spiritual counselors offer spiritual support and help your loved one find meaning despite the illness.
  • Grief counselors help your family come to terms with and handle grief once your loved one is approaching the end of life.

This list is not exhaustive. More professionals can be in your loved one’s team when deemed necessary by the palliative care provider, or upon request by your loved one or your family.

How To Access Palliative Care Services

Your loved one’s primary physician may start palliative care upon evaluation of your loved one, or request from your end. They may also refer you to palliative care providers in your area.

how to get palliative care - elder woman and her daughter browsing the web

Other ways to get palliative care include

  • Online directories such as getpalliativecare.org
  • Your loved one’s insurance provider. This could be a long-term care insurance provider, Medicare, or Medicaid.
  • Web search for keywords such as “palliative care provider near me”
  • Hospice centers in your area.

Once you have a list of palliative care providers consider factors such as

  • Their reputation, history, certification, and licenses
  • The extent of care your loved one and the family would receive
  • What their payment policy is like
  • How they handle emergencies and complex health situations
  • Transition to hospice

Asking relevant questions about these factors will help you gauge the quality of their care, and determine if they are the right fit.

In Summary,

Palliative care is beneficial at any point of a serious illness. But often, determining if a loved one qualifies is where the challenge is. We have discussed pointers to determine if your loved one qualifies for palliative care, and why a palliative care consultation should be had early.

If you have some questions about qualifications for palliative care, or you’re looking for the best palliative care provider for your loved one, don’t hesitate to reach out to us.

Amy’s Eden has trained and compassionate caregivers who can provide excellent care to your loved one to improve their quality of life. We can also help you coordinate your loved one’s care among various professionals, so you spend time doing important things like creating meaningful memories with your beloved senior.

Contact us today to find out how we can be an ally in this challenging time.

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