10 Older Adults 275spiritual and psychosocial support from diagnosis to the end of life and
bereavement. Palliative care:■ provides relief from pain and other distressing symptoms;
■ affirms life and regards dying as a normal process;
■ intends neither to hasten or postpone death;
■ integrates the psychological and spiritual aspects of patient care;
■ offers a support system to help patients live as actively as possible
until death;
■ offers a support system to help the family cope during the patients
illness and in their own bereavement;
■ uses a team approach to address the needs of patients and their
families, including bereavement counselling, if indicated;
■ will enhance quality of life, and may also positively influence the
course of illness;
■ is applicable early in the course of illness, in conjunction with other
therapies that are intended to prolong life, such as chemotherapy
or radiation therapy, and includes those investigations needed to
better understand and manage distressing clinical complications
(WHO, 2015).The final point is the differentiating feature as hospice meets all the prior
points, but no longer focuses on curative care. Hospice care in the United States
is part of the Medicare benefit and therefore covers more services while pal-
liative care is typically focused on pain management and is covered through
one’s medical insurance.
One of the goals of palliative care is that individuals should be helped to
experience a respectful death (Reith & Payne, 2009). By definition a “good death”
entails anticipating death and understanding what can be expected; being able
to retain control of what happens; being afforded dignity and privacy; having
control over pain relief and other symptom control; having a choice and con-
trol over where the death occurs; having access to information and expertise of
whatever kind is necessary; having access to any spiritual/emotional support
required; having access to hospital care in any location, not only the hospital;
having control over who is to be present and who shares the end; being able
to issue advance directives which ensure wishes are respected; having time to
say good bye and control over other aspects of timing; and being able to leave
when it is time to go, and not having to have life prolonged pointlessly (Reith &
Payne, 2009). Typically, when hospice is elected, patients agree to avoid resusci-
tation and hospitals in favor of remaining at home for their deaths.
The philosophy of hospice is to promote quality of life and the dignity of
the individual while providing supportive compassionate care to the patient
and family. The focus is on alleviating unpleasant symptoms rather than on
cure of the life-threatening disorder or disease. Even when the patient is in
an institutional setting, hospice tries to create a homelike environment for the
patient and attempts to support the patient’s family. One of the goals of hos-
pice care is to focus on the quality of life so that positive reassurance and com-
fort can be provided through ongoing interactions with the patient and family.
Clukey (2007) found that hospice caregivers (including family) and dying