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Hospice and Palliative Care

Michelle Tristani, MS, CCC-SLP

May 9, 2016

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Question

What is the distinction between hospice and palliative care? 

Answer

Essential components of hospice care may be similar to palliative care. These include alleviating suffering of patients and families by focusing on all components of the family and the whole person. Improving quality of life is a goal. Hospice care also aims to transition patients and families from health to illness to death to also bereavement, and to help patients and families in their search for meaning and hope.

There are several levels of hospice care. The four levels of hospice are routine, inpatient, respite, and continuous care. Routine is used when symptoms are not escalating. Inpatient is used when there are many highly skilled needs for periods of symptom crisis; this care is provided at an acute hospital or long term care facility or an inpatient licensed hospice facility. There are many that provide great care throughout the country. Respite is another level of hospice care that allows a reprieve, or respite, for exhausted families to have a break from the stresses of care giving. Continuous care is round-the-clock, short-term care in the patient's home.

The similarities between hospice and palliative care are that both focus on aggressive pain and symptom management with the goal of quality of life, and seek to educate and support families, caregivers, and the medical team. Both address the whole person, including physical, psychosocial, spiritual, and social needs, and can be provided in a variety of settings.

As for differences between palliative and hospice care, some of the distinction is related to reimbursement. Some of this distinction may be related to the location in which the services are provided.  On the palliative care side, a patient or a person at end of life stage can receive or pursue curative disease-modifying or life-prolonging treatments, whereas hospice is more comfort-based than curative. With palliative care, eligibility is not based on life expectancy, whereas on the hospice side, eligibility guidelines are set by Medicare based on the prognosis of life expectancy of six months or less. That does not that mean that hospice is not provided after the six-month point. Hospice services can, in fact, continue beyond the six-month mark and can be applied for another period of time as well. It is not “six months and that is it.” 

Michelle Tristani, M.S CCC-SLP, has provided speech pathology services for 24 years across adult and geriatric settings from acute care to skilled nursing to out-patient. Michelle specializes in progressive neurological diagnoses, specifically, Alzheimer’s and related dementias.  She has delivered a wide scope of trainings including, yet not limited to, cognitive disorders, dysphagia in persons with dementia, medical errors and ethics, management of the pulmonary, medically complex and palliative care patient populations.


michelle tristani

Michelle Tristani, MS, CCC-SLP

Michelle Tristani, M.S CCC-SLP, has provided speech pathology services for 24 years across adult and geriatric settings from acute care to skilled nursing to out-patient. Michelle specializes in progressive neurological diagnoses, specifically, Alzheimer’s and related dementias.  She has delivered a wide scope of trainings including, yet not limited to, cognitive disorders, dysphagia in persons with dementia, medical errors and ethics, management of the pulmonary, medically complex and palliative care patient populations.  Michelle is currently a clinical specialist with Kindred Healthcare, is a speech-language pathologist at St. Elizabeth’s Medical Center in Boston, and is also an Alzheimer’s Association Helpline Counselor.


Related Courses

Connecting Swallowing, Cognition, and Dignity: An Essential Clinical Pathway for Dysphagia in Persons with Dementia
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A comprehensive, systematic clinical pathway to effectively assess and manage dysphagia in persons with dementia is described in this course. Common eating challenges and contraindications of enteral feeding for those with advanced stage dementia are addressed. Environmental modifications, swallow strategies and adaptive equipment that can enhance the safety and experience of oral intake are also discussed.

Behavioral Frameworks for Dementia Management
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This course will focus on cognitive-communication intervention strategies for various dementia presentations and will provide a review of evidence-based treatment. Behavioral frameworks along with their rationales will be introduced and applied across several dementia types and mild, moderate and severe levels of impairment.

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