Hospice and palliative care

What is palliative care?

Palliative care provides pain and symptom relief, emotional and spiritual support for patients and their families when the patient is diagnosed with a serious illness. The goal of this care is to improve quality of life for both the patient and the family without an intention to cure the illness. Palliative care can be given alongside treatment aimed at the underlying illness. In advanced illness, the patient may no longer have treatment options or has chosen not to pursue treatment because the side effects outweigh the benefits.

Palliative care can be provided in those health or care facilities where the facility staff are trained and attentive to the patients’ palliative care needs – this could be at a hospital or a clinic/community health centre. Palliative care can begin at an early stage of the patient’s illness by addressing pain and symptoms and the need for emotional support. This can occur alongside care that has a curative intent. There are community-based workers linked to public health care facilities where patients receive care – these community-based services can also provide palliative care in the patient’s home.

Hospice care is a community-based service provided by non-governmental organisations that focuses only on palliative care. This care is most often provided in the patient’s own home but may also be provided in dedicated hospice in-patient facilities. Patients are usually at an advanced stage of their illness when they are referred to hospice.
 

Who qualifies for palliative care?

Any person, of any age, who has a severe, life-limiting, or life-threatening condition qualifies for palliative care. Palliative care is provided for patients with many different conditions or types of illnesses, as well as their families.

Should a patient be accepted into a palliative care programme, the care and support of the palliative care team will help the patient and their  family deal with the challenges of living with a life-limiting or life-threatening condition.

Palliative care could include the following:

• pain and symptom control,
• psychosocial support and advice,
• spiritual support,
• emotional support,
• bereavement support, and
• loan of equipment (for example wheelchairs, urinals etc).
   

How to join a palliative care programme

A patient in the public sector may be referred to a palliative care programme by a healthcare worker at a hospital or community health centre (CHC). The healthcare worker will get the patient an appointment with a palliative care team. This appointment may take place while the patient is in hospital, at a visit to the CDC/CHC, or at the patient’s home. A point person for the palliative care team will contact the patient and/or the family before the appointment.

Patient Journey through palliative care

7 Benefits of palliative care

• Professional care and treatment of pain and symptoms.
• Helping the patient have more control over their care by improving their understanding of their treatment options.
• Improving communication between the patient, their family, and their healthcare providers.
• Improving the quality of care the patient receives, while also reducing the costs of care.
• Helping to reduce or eliminate lengthy hospital visits.
• Helping the patient to remain comfortable at home and live as actively as possible.
• Making it easier for the patient to stay in touch with their family and friends.
   

Types of care

1. In-hospital palliative care – Palliative care is offered in many of our district, secondary and tertiary hospitals throughout the province. A team of health care workers who are trained in palliative care will be involved in the care of the patient, and will assist with communicating with the patient’s family while addressing the palliative care needs of the patients as listed above.
2. In community health centre/day hospital/clinic – Palliative care is offered in several of our primary healthcare facilities (CDCs/CHCs). The patient will be booked to see a healthcare worker (HCW) who is trained in palliative care. The HCW will work with the hospital team and the community-based team to address the palliative care needs of the patient.
3. In the home – As mentioned above, community-based services (CBS) are offered throughout the province. Together with the primary healthcare facility and hospital team or hospice team, the CBS team will work to address the palliative care needs of the patient.
4. Intermediate care facilities – the Western Cape has many facilities where a patient can be admitted when they need more care than can be provided at home but do not require hospital admission. A patient may be admitted to one of these facilities when discharged from hospital but not well enough to return home (‘step-down’ care).
5. Care for children - Palliative care for children and youths has many similarities to palliative care for adults. The World Health Organization (WHO) defines palliative care appropriate for children and their families as follows:

• Palliative care for children is the active total care of the child's body, mind, and spirit, and also involves giving support to the family.
• Palliative care begins when the life-threatening or limiting illness is diagnosed, and continues regardless of whether or not a child receives treatment directed at curing the illness.
• Healthcare providers will evaluate and alleviate a child's physical, psychological and social distress.
• Effective palliative care requires a broad multidisciplinary approach that includes the family, and makes use of available community resources; it can be successfully implemented even if resources are limited.
• Palliative care can be provided in tertiary care facilities, in community health centres and even in the child’s own home.
• Paediatric palliative care is initiated at our tertiary children’s hospitals – Red Cross Children’s Hospital and Tygerberg Hospital.
• To find out more about children’s palliative care, please visit any of the following websites:
• Patch South Africa – https://patchsa.org/
• Paedspal – https://paedspal.org.za/
• CHOC – https://choc.org.za/
   

Bereavement 
Bereavement support is a very important part of palliative care. After a patient has passed away, the palliative care team provides support to the family and friends. They will continue to provide support to the loved ones until such time as the support is no longer needed.

Any primary healthcare facility will be able to assist you.

Information about hospice and palliative care

eHospice brings together the expertise and experience of the global hospice and palliative care community, and helps reduce the isolation felt by many people receiving or providing end-of-life care. The Hospice Palliative Care Association of South Africa (HPCA) forms part of this initiative. eHospice https://ehospice.com/south-africa/

To access our palliative care referral forms, use the links below:

• Metro home-based care referrals
• Rural home-based care referrals
• Intermediate care referrals (adults)
• Intermediate care referrals (children)