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Palliative Care Out-Patient Services

Next Reply: Re:Palliative Care for Patient unable to swallow
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Post Palliative Care for Patient unable to swallow
Author: dduffy
Date: May 13, 2010 12:46 pm
Patient in hospital for pneumonia and recent hx of stroke who is now unable to swallow. He does not want a feeding or PEG tube and wants to go back to board and care facility to live out rest of his days. He's concerned about being "hungry" during his final days. Would he be appropriate for Palliative Care and what can be done to abate his hunger? Does not want SNF care either.
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Re:Palliative Care for Patient unable to swallow (by SharolHerr on 05/14/2010)
It sounds like this patient is appropriate for hospice care and meets medicare criteria for hospice based on the CVA criteria and inability to maintain adequate nutrition. Having hospice following would support the patient physically and manage symptoms and address the psychosocial needs of the patient and family. The patient may or may not experience hunger but good oral care is absolutely critical to comfort. There is no evidence that IV fluids would alleviate hunger and there is lots of literature about benefits and burdens of artificial nutrition and hydration and end-of-life care. I would encourage you to check some of them out. You will also want the MSW/discharge planner to explore if the residential home will be able to accept the patient with his current care needs. Sharol Herr, RN, BSN, MSEd, CHPN; Nurse Clinician/Education Coordinator; Mount Carmel Health Palliative Care Leadership Center; Columbus, Ohio.

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