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The literature has two approaches to this.  The first is to list actual conditions that may qualify for PC.  Cancer, kidney failure, Alzheimer’s disease, ALS, and MS were identified as qualifying conditions by the Vermont Assembly of Home Health and Hospice Agencies (2019). The Daily Caring website list (February 25, 2019) includes Parkinson’s, COPD, and severe arthritis.  But most research articles delineate more specific criterion such as multiple hospitalizations or emergency room visits over the previous year (Vermont Assembly of Home Health and Hospice Agencies, 2019), recurrent infections, wounds that will not heal, multiple falls, and a need for care coordination (Geriatric Review, 7th Edition).  Mehta (2012) adds that those with a failure to thrive and those “advanced dementia patients with nutritional and severe functional impairment should be considered for a palliative medicine evaluation”. The Center to Advance Palliative Care (2019) includes multiple hospitalizations and weight loss on the list of patients that should be referred to and qualify for palliative care. (Palliative care for clinicians, 2019. The Center to Advance Palliative Care.  Retrieved from https://getpalliative care.org/resources/clinicians on May 7, 2019.) Also included are clients experiencing a decline in their ability to complete activities of daily living and situations of serious chronic illness with difficult to control physical or emotional symptoms or distress of the patient and/or family.  In addition, the Center to Advance PC includes situations when prognosis or goals for care are not certain, or when there are requests for care that are incapable of producing positive results.  Those with repeated ER visits for the same symptoms/issues, ICU admission from a nursing home or multiple ICU admissions during a hospital stay would also be recommended for PC as are those cases where the patient, family, or caregiver wants hospice services but has not been referred. 

 

Patients with dementia and their advocates must be proactive in requesting PC services.  The first step is to talk to your physician about palliative care.  One thing is certain – PC can only be obtained through a physician referral.  The following should help with your discussion with your doctor (Center to Advance Palliative Care, 2019):

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 Tell your physician that you’re thinking about PC. 

1.  Explain what quality of life means to you, such as

   • Time with family

   • Relief from pain and other symptoms

   • Ability to make your own decisions

   • Continuation and maintenance of values and religious/spiritual beliefs and practices that are important to you.

2.  Ask the doctor to explain your illness and any treatments and decisions that will need to be made.

   • Discuss what treatments you do and do not want.

   • Setting in which you would like to be treated (home v. hospital)

   • Ask for time to discuss future care planning.

3. Ask where services can be obtained.

4. Provide the doctor with a copy of any legal medical paperwork you may have, such as a living will or health care proxy.

 

Sources:

Fox S, Fitzgerald C, Dening K, Irving K, Kemohan W, et al.  Better palliative care for people with dementia:  Summary of interdisciplinary workshop highlighting current gaps and recommendations for future research.  BMC Palliative Care, 2018;17:9.

 

How and where to get palliative care:  Start the conversation.  Vermont Assembly of Home Health and Hospice Agencies, 2019.  Retrieved May 7, 2019 from http://startthecoversationvt.org/palliative-care-hospice/palliative-care.

 

NHPCO Clinical Practice Guidelines for Quality Palliative Care, 4th Edition (2018) from the Center to Advance Palliative Care, 2019.