Therapy and Palliative Care – Kristin B., Physocal Therapist
In the past, palliative care services have been offered almost exclusively in hospice houses and private homes and only included comfort measures that were aimed at preventing pain and suffering during terminal disease processes. But in recent years there have been more and more skilled nursing facilities offering comprehensive programs to patients in their end stages of life. These programs include skilled nursing care as well as the option for therapy services to be provided. As palliative care is becoming a part of skilled services, it is important to remember that each facility will have their own set of policies and procedures, but there some universalities to working with patients who are receiving palliative care services.
First, palliative care doesn’t always mean–no therapy. As patients and their families make decisions about which services they would like to receive, there is often an option to still receive therapy services as the patient may tolerate them. These services may include skilled treatments aimed at maintaining current functional level or they may primarily include treatments to promote comfort and positioning such as passive range of motion. It is important to ascertain the intentions of the patient and family before proceeding with patients who have been placed on a palliative care program.
Another consideration is whether or not a patient is still their own responsible party. Often in cases of palliative care, the patient is declining rapidly and may have selected a durable power of attorney or healthcare proxy to make their decisions for them. In cases of working with patients who are nearing end of life, it is important, always, to determine if a patient is making their own decisions, or if a third party decision maker needs to be involved while determining the needs of the patient.
Additionally, as therapists, we are hard-wired to push our patients to progress functionally. As a therapist treating a palliative care patient, however, the focus is different. We are not pushing the patients to gain, we are pushing them to maintain their independence and physical function. We are helping them determine strategies and coping mechanisms to make things less difficult in their everyday life. This is a change in mindset that must occur before having a successful patient/therapist relationship with a palliative care patient.
Finally, it is important to be aware of the fact that palliative care patients and their families are coping with very difficult decisions and struggles, and while not all therapists can be trained grief counselors, it is always important to be a good listening ear and to be prepared with resources to refer patients and families to.