Palliative Care: What It Is, What It Is Not

Palliative care emerged in the 1980s as a holistic, team approach to supporting patients suffering from serious medical conditions. It is not the same thing as hospice care. While both focus on making the patient more comfortable, the difference is that hospice is called for when the patient has a prognosis of impending death. Palliative care, quite on the other hand, focuses on life.

The difference between the two is significant, but not widely known. In fact, more than 78 percent of adults in the United States are not exactly sure what palliative care is.3 Even some members of the medical community believe that palliative care is just a synonym for hospice. Some doctors understand the difference but don’t recommend palliative care because they’re concerned the patient may interpret it to mean hospice and believe that they’re dying.4

Moreover, more than 50 percent of directors of nursing do not understand the basics of palliative care, according to new study. This research found that the more familiar the director of nursing was with palliative care, the greater the chances that their patients experienced end-of-life care aligned with a higher quality of life focus.5

While hospice patients no longer receive curative treatment for their underlying disease, palliative care is available at any stage of illness and can be deployed in conjunction with curative treatment. It is not associated with any particular age, illness or stage of illness, and is appropriate for anyone suffering from a serious illness, whether chronic or acute.

Team Approach
Palliative care is provided by a team of professionals, usually in concert with the patient’s primary physician for a specific condition. This team is developed to meet the special needs of each patient and therefore can vary significantly. Examples of palliative care team specialists include trained palliative care doctors and nurses, social workers, psychologists, dietitians, nutritionists, massage therapists, pharmacists, chaplains and even art or music therapists — whatever is most appropriate for the patient. Even if the primary physician is not technically a member of the palliative care team, he supervises the patient’s care and plays an active role in ongoing treatment.

The healing scope of the palliative care team is broader than that of traditional doctors. Their focus is on preventing pain, alleviating suffering, improving quality of life and helping both the patient and his loved ones cope with the stress and burden of caregiving. The team works to make the patient become as independent as possible, emphasizing what the patient actually wants instead of what a traditional medical approach might dictate that he needs. This approach gives patients more control over their treatment plan.

For example, an aging parent diagnosed with cancer may be worried about who will care for his mentally incapacitated adult son to the degree that he forgoes scheduled treatments to stay home with the dependent. This scenario may call for a social worker who is able to procure resources to help care for the son and provide transportation to and from chemotherapy sessions for the father. A palliative care team addresses physical, mental and social conditions, and studies have revealed that curative treatment can also be more effective when accompanied by palliative care.6

Access
Because palliative care is not that well known, access is an issue. Most of the time it is recommended by the treating physician and frequently provided by on-site teams in a hospital setting. However, palliative care can be provided wherever the patient is located, including outpatient clinics, long-term-care facilities, hospices and even at home.

Palliative care also can be recommended via other sources, such as health and mental health agencies, day care and senior centers, schools, courts, child welfare and family service agencies, correctional systems, agencies serving immigrants and refugees, substance abuse programs and employee assistance programs. While the foundation of the program is to provide pain and symptom relief, these types of organizations may be engaged due to the patients’ lifestyle, socio-economic factors, immigration status and/or living environment. Social service agencies are frequently able to identify these factors and refer patients who would benefit from palliative care before their conditions are exacerbated and require more costly treatment.7

Palliative care is generally covered all or in part by Medicare, Medicaid and most insurance plans. However, Medicaid coverage can vary depending on the state program.8

3 Health Affairs Blog. March 10, 2015. “Effective Public Engagement To Improve Palliative Care For Serious Illness.” http://healthaffairs.org/blog/2015/03/10/effective-public-engagement-to-improve-palliative-care-for-serious-illness/. Accessed April 14, 2015.
4 Journal of Hospice and Palliative Nursing. October 2012. “Opportunities and Challenges for Palliative Care Professionals in the Age of Health Reform.” http://www.nursingcenter.com/lnc/cearticle?tid=1429239. Accessed April 8, 2015.
5 NYmag.com. “Many Nursing Homes Fall Short at Palliative Care.” March 24, 2015. http://nymag.com/scienceofus/2015/03/many-nursing-homes-fall-short-at-palliative-care.html.  Accessed April 8, 2015.
6 Pharmacy Practice News. March 2015. “Palliative Care a ‘Foreign’ But Vital Role for Pharmacists.” http://www.pharmacypracticenews.com/ViewArticle.aspx?d=Clinical&d_id=50&i=March+2015&i_id=1155&a_id=30832. Accessed April 8, 2015.
7 National Association of Social Workers. “NASW Standards for Palliative & End of Life Care.” https://www.socialworkers.org/practice/bereavement/standards/default.asp.” Accessed April 8, 2015.
8 GetPalliativeCare.org. “Frequently Asked Questions.” http://getpalliativecare.org/whatis/faq/#how-do-i-know-if-palliative-care-is-right-for-me. Accessed April 8, 2015.

All-Inclusive Resorts: The Key to Vacationing on a Budget?

How often have you given yourself a limit as to how much you’ll spend while on vacation, only to find you spend much more? One way to control this phenomenon is to book your next vacation at one of the increasingly popular all-inclusive resorts.

An all-inclusive resort offers one price for many of your main expenses, including accommodations, meals, daily activities and nightly entertainment. Some places even include gratuities, bar drinks and transportation to and from the airport.

Club Med pioneered the concept of the flat-fee resort more than 60 years ago. Since then, hundreds of luxury hotels and cruise lines have honed the idea to create a popular option for vacationers. However, be aware that even all-inclusive resorts may charge extra for things like spa treatments and motorized water sports. Some packages may charge an optional daily beverage fee, as the inclusive fee may not include alcoholic beverages or even sodas. You also may incur charges for Internet access, and all-inclusive resorts seldom foot the bill for activities enjoyed in the local community.6

Some travelers may not mind paying the extra fees since so much is already included, but keep an eye on your bottom line or you could end up going way over budget. Instead of keeping tabs on the small daily charges, add them to your running tab for the entire vacation, as that’s the number that will help keep your ancillary spending in check.

Many travelers enjoy the simplicity of an all-inclusive vacation, knowing they don’t have to carry cash around the resort or check prices at every juncture. It also can be much easier than researching local restaurants to figure out where to go for each meal.

For 2015, several media outlets have picked their top recommendations for all-inclusive resorts. The following is a diverse sampling.

Generations Riviera Maya, Mexico — Generations features 144 suites on a secluded beach with a collection of infinity pools, swim-up suites and hot tubs. The all-inclusive package features butler service and customized gourmet experiences allowing guests to complete a culinary preference questionnaire before they arrive.7

Hyatt Ziva Rose Hall, Jamaica — The Hyatt’s first all-inclusive resort in Jamaica, this adults-only retreat features beach butlers and poolside food trucks. Exotic cuisine choices include a Japanese teppanyaki grill and Brazilian churrascaria, plus the all-inclusive fee includes free rounds at two local golf courses.8

Riu Palace Antillas, Aruba — An adults-only resort for active beach enthusiasts, featuring windsurfing, snorkeling, kayaking, stand-up paddle boarding and scuba lessons. You can also get beach pavilion massages, go nightclub dancing and gamble at an onsite casino. Note that the all-inclusive fee does not include gambling funds.9

Secrets Resorts & Spas, Mexico — The “Spoil Yourself and Repeat” package features up to four spa treatments a day, plus complimentary green fees, nine dining options and six bars. If you choose this spot for your honeymoon, the resort will grant you a free night on your anniversary each year.10

Blackberry Farm, Walland, Tennessee — If you’re looking for an all-inclusive domestic resort, consider the combination of downhome activities and luxury amenities at Blackberry Farm. With a view of the foothills of the Great Smoky Mountains, enjoy hiking, biking, horseback riding, canoeing, fly fishing, gardening, farming and even truffling. There are cooking demonstrations, whiskey and wine tastings, a full-service spa along with golf and tennis. Most activities are charged separately but meals and accommodations are included in the singular price.11

The Ranch at Rock Creek, Philipsburg, Montana — Billed as an all-inclusive luxury ranch resort offering “a slice of raw western adventure paired with unprecedented comfort and amenities,” this Montana retreat offers an interesting vacation alternative. Vacationers can enjoy fly-fishing, massage treatments, horseback riding and regionally inspired cuisine. Accommodations feature “glamping,” or glamorous camping, options: Canvas tent-cabins featuring 810 square feet with two rooms separated by a curtain, and rustic yet luxurious wood cabins featuring private baths and comfortable beds with luxurious bedding. The resort’s Rod and Gun Club offers a variety of activities ranging from fishing to horseback riding to pistol shooting, while the Granite Spa offers rejuvenating treatment packages. The all-inclusive fee (plus 20 percent “ranch fee”) includes room, board and your choice of two daily, on-property, guided activities with all gear and equipment, as well as access to the fitness center, pool and hot tub.12

1 Wendy Lustbader. Yes! Magazine. Feb. 16, 2015. “Will the Elder Boom Spur a Caring Revolution? Ai-jen Poo’s Inspiring Vision.” http://www.yesmagazine.org/issues/together-with-earth/will-the-elder-boom-spur-a-caring-revolution-ai-jen-poo. Accessed Mar. 18, 2015.
2 Worklife and Wellness UC Davis. “Adult and Elder Care.” http://worklife-wellness.ucdavis.edu/family_care/adults_elders/.  Accessed March 18, 2015.
3 U.S. Census Bureau. March 25, 2014. “Facts for Features: Older Americans Month: May 2014.” http://www.census.gov/newsroom/facts-for-features/2014/cb14-ff07.html. Accessed March 18, 2015.
4 Family Caregiving Alliance. “Selected Long Term Care Statistics.” https://www.caregiver.org/selected-long-term-care-statistics.  Accessed March 18, 2015.
5 Wendy Lustbader. Yes! Magazine. Feb. 16, 2015. “Will the Elder Boom Spur a Caring Revolution? Ai-jen Poo’s Inspiring Vision.” http://www.yesmagazine.org/issues/together-with-earth/will-the-elder-boom-spur-a-caring-revolution-ai-jen-poo. Accessed March 18, 2015.
6 Kaitlin Wells. MarketWatch.com. June 8, 2014. “10 things all-inclusive vacations won’t tell you.” http://www.marketwatch.com/story/10-things-all-inclusive-vacations-wont-tell-you-2014-04-17?page=1. Accessed March 18, 2015.
7 The Huffington Post. “10 Best Caribbean All-Inclusive Resorts for 2015.” Feb. 17, 2015. http://www.huffingtonpost.com/fodors/10-best-all-inclusive-res_b_6349578.html. Accessed March 18, 2015.
8 Ibid.
9 Ibid.
10 Ibid.
11 Luxury Travel Magazine. Dec. 23, 2014. “Travel Channel Names Top 10 All-Inclusive Resorts of 2015.” http://www.luxurytravelmagazine.com/news-articles/travel-channel-names-top-10-all-inclusive-resorts-of-2015-22867.php. Accessed March 25, 2015.
12 Ibid.