Hospice and Palliative Care - VA Sierra Nevada Health Care System
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VA Sierra Nevada Health Care System

 

Hospice and Palliative Care

What is palliative care?
Palliative (pronounced pal-lee-uh-tiv) care is a medical specialty provided to people with advanced, life-limiting illness. Palliative care focuses on enhancing comfort and quality of life, as well as reducing suffering. The Palliative Care team of doctors, nurses, chaplains, social workers, and psychologists aim to support patients and their families to live as well as they can while addressing physical, psychological, emotional, social, and spiritual needs from an interdisciplinary team perspective. 
Unlike hospice care, which focuses on end-of-life, palliative services are provided during any phase of a serious illness, including active treatments such as chemotherapy. There is no limit placed on palliative care based on life expectancy. This type of care assists patients with an improved sense of well-being, independence, access to information, and active participation in developing the plan of care.

What is hospice?
Hospice care is a type of palliative care that is offered to patients with life-threatening illness when: 1.) life expectancy is six months or less, and 2.) the patient accepts a "palliative approach to care," meaning that the primary focus is on comfort and quality of  life, rather than life prolongation or cure.
However, some therapies that are directed toward life prolongation are allowed in hospice. It can be difficult to determine if or when hospice care is appropriate. It is not always easy to determine life expectancy. It is important that, to the extent possible, care provided is consistent with an individual Veteran's preferences.
Hospice care is available for all enrolled Veterans meeting clinical eligibility criteria through the VA and may also be available through Medicare and Medicaid or MediCal. Hospice care is often provided in the home setting but is available in nursing homes and in dedicated inpatient hospice programs as well.

If you are considering hospice care for yourself or a loved one, consider talking with your primary provider or other clinicians about your options and choices.

Services Available

At VA Sierra Nevada Health Care System, specialized palliative care is available through our inpatient consultation team or outpatient palliative care:


Inpatient Consults: If you are in the hospital, your physician, nurse, case manager, or social worker can refer you for a consult from one of our hospice and palliative medicine board-certified physicians or other team members.

We can assist with: Symptom management, Discussing options and planning for care, How best to support patient and families with stress associated with illness. 

                                                          
Outpatient Care: If you are interested in being seen by our palliative care team, please talk with your treating clinician about this, or call the Palliative Care Coordinator.

Referral to Home Hospice: Local community home hospice agencies are available. Your primary care provider or specialist provider can place a consult and refer you to the Palliative Care Coordinator for assistance in receiving services in your home.

CLC Inpatient Hospice Unit: Located in the Reno VA community living center, our inpatient unit is available for acute management of pain and other symptoms. We provide:

  • Physician coverage
  • Skilled nursing care
  • Specialized pain management
  • Social work and grief/bereavement support
  • Psychological counseling
  • Multi-denominational pastoral services and spiritual support
  • Registered dietician
  • Registered pharmacist
  • Recreational activities
  • Volunteers

Bereavement Support: Support is available to veterans and their family or friends who have experienced the loss of a loved one or who are anticipating the loss.

  • Individual/Group Support:
    When: 2nd and 4th TUESDAY of every month at 11:00am to 12:00 Noon
    Where: Chapel (2nd floor)
    Contact: Chris Davis, MSW, CSW-l, at (775) 326-2643 or
                 Kirstin Hudson, MSW, CSW-l, at (775) 785-7108
  • Individual Support:
    Contact: Sara McGill, LCSW, at (775) 785-7118

Hospice and Palliative Care FAQs

Who is eligible for hospice care?
All enrolled Veterans who meet certain clinical criteria are eligible for care. As a general guideline, appropriate patients have a limited life expectancy and have goals of care focusing on quality of life. Enrolled Veterans may be referred for hospice care by their VA providers.

Where is hospice care given?
Hospice care can be delivered at home or in nursing homes. For eligible Veterans wishing and able to receive care at home, VA Sierra Nevada Health Care System arranges this with community hospice agencies. Where inpatient care is needed, such care is usually delivered in one of our Community Living Centers (CLCs). We currently have a dedicated hospice unit at our CLC, located within the Ioannis A. Lougaris Medical Center in Reno.

Are hospice and palliative care the same thing?
Not quite, although there are similarities. Both focus on trying to improve patient and family quality of life. Hospice care is appropriate for people with limited life expectancies, where the focus of care is on quality of life. Palliative care also focuses on improving quality of life and relieving distressing symptoms. However, palliative care may be appropriate at any stage of illness. Often, it is delivered right along with care directed toward life-prolongation or cure. Palliative care may also be helpful in working with patients, families, and other clinicians to sort out options of care and to clarify patient and family goals of care. Palliative care specialists may provide consultation either for outpatients or inpatients in hopes of helping patients and families struggling with the burdens of illness.

Must a patient have a DNR (Do Not Resuscitate order) to elect the hospice benefit?
In the past, many hospices required a hospice patient to have a signed DNR to enroll in hospice care. This requirement has been discontinued.

After 6 months on the hospice benefit, am I no longer eligible for hospice care?
In reality, a patient is eligible for hospice as long as he or she has a life-limiting illness with a prognosis of 6 months or less to live if the disease process proceeds on its expected course. There is no absolute time limit.

An unfortunate recent trend is very late referrals to hospice. As a result, the median length of stay for some patients is too short to allow them and their loved ones to gain the full benefits of hospice care.

Who do I contact if I have questions about Hospice or Palliative Care?
For Hospice or Palliative Care, please contact:


Sara McGill, LCSW, at (775) 785-7118.

Home Hospice Care - FAQs

What is Home Hospice Care?
Hospice provides care for people with limited life expectancies, who wish the focus of their care to be on enhancing their quality of life. Most hospice care is provided at home, although within the VA hospice care may be provided as an inpatient service, if necessary. For eligible Veterans home hospice care is provided by community hospice agencies with which we have agreements at VA expense, or, if a dually eligible Veteran so chooses, via other insurance, most commonly Medicare.


What services are available?
Care is provided by an interdisciplinary team, consisting of nurses, social workers, and other clinicians. This team will work closely with your physician to provide care for the Veteran and support for the Veteran's family. Frequency of home visits varies depending on the Veteran's needs, but typically this means one to three visits per week.


How do I arrange for this care?
Hospice does require the physician certification of the appropriateness of the patient for hospice care. However, hospice is always an elected benefit; the patient determines whether or not this approach to care is consistent with his or her needs and expectations. 
If interested in pursuing hospice care, discuss this with your VA provider (physician, nurse practitioner or physician assistant). If hospice care looks appropriate, your provider can refer you to our hospice coordinator, who can facilitate referral to a community agency.


Do hospice patients have to forego a continuing relationship with their primary care provider?
No. Hospice programs encourage an ongoing relationship between the primary care provider and the patient.

Are hospice patients denied treatment(s) because they are terminally ill?
If the purpose of any treatment is to manage pain and/or control symptoms and is consistent with the patient's wishes, it may be included in the plan of care.

Does hospice end when the patient dies?
Hospice programs provide bereavement services for loved ones following the death of the patient. Most hospice programs also offer bereavement support to those in need even if their loss is unrelated to a patient who received hospice care.  

Contact Info

Location

  • Sierra Nevada Health Care System

Contact Number(s)

  • 775-785-7118

Hours of Operation

  • Monday - Friday 8:00am - 4:30pm