What’s the difference? Palliative vs Hospice Kidney Care
Sometimes doctors push patients toward dialysis at the first sign of kidney trouble, but is that the best path for everyone? Today, I want to take a transparent look at two alternative paths: palliative and hospice kidney care.
“Hospitals often tell patients they must start dialysis or they are going to die. That’s not really a fair choice, is it? … You may have access to trained palliative and hospice care professionals who can listen to your story and help you decide the best way forward.”
Why not dialysis?
Hospitals often tell patients they must start dialysis or they are going to die. That’s not really a fair choice, is it?
For younger people, kidney dialysis can be an essential, life-saving treatment. Doctors should make every effort to preserve kidney function, but dialysis may eventually be necessary for advanced kidney failure. It can help support a longer life.
For some older adults, however, dialysis doesn’t sound so good. It’s terribly time-consuming and uncomfortable. Some patients already have cancer or other severe conditions. Kidney function naturally declines as you age, so an 85-year-old adult may realistically die of other causes before their kidneys fail.
As you can imagine, this is a conversation that can’t happen in five minutes. Fortunately, you may have access to trained palliative and hospice care professionals who can listen to your story and help you decide the best way forward.
Palliative kidney care
Hardly anyone knows what “palliative” really means. It sounds technical and intimidating when really, it’s the exact opposite! Palliative care is designed for patients with serious chronic diseases who want to focus on quality of life. Sometimes we also call it “supportive care.”
For kidney patients, palliative care may focus on managing disease with medications instead of dialysis. Many drugs can help balance blood pressure (BP) and blood sugar and help preserve whatever kidney function remains. For instance, SGLT-2 inhibitors can be used by patients with a GFR as low as 25.
Palliative care is a specific sub-specialty typically found in a hospital setting. It can include a one-time conversation or an ongoing relationship with regular coaching and guidance. A palliative care team can include specialists, doctors, nurses, social workers, nutritionists, and others for emotional and practical support.
Patients can be on palliative care for a long time; they don’t have to be close to death. It simply helps patients and families decide the best treatment options to prolong optimal quality of life.
Hospice kidney care
A doctor may refer patients to hospice if palliative care is no longer working. At this point, there’s no need for further tests and invasive treatments. Hospice is designed to keep patients’ final days peaceful and comfortable. Ideally, it allows them to pass away peacefully at home.
The rules around hospice can vary by state and medical institution, but usually, it becomes available when doctors determine a patient is close to death (within six months). The doctor can renew or cancel hospice care if it is still needed after six months.
Nurses, nurse practitioners, and doctors can provide hospice in the hospital, a nursing home, a hospice facility, or at home. They will often have pre-approved medications to ease symptoms like pain and shortness of breath — patients don’t have to wait for a prescription.
Autopsies are not typically required for hospice patients, which offers further dignity and respect after death.
How to decide
Patients may no longer be able to make medical decisions for themselves after a certain point, so it’s essential to clarify their wishes early on with relevant lawyers, doctors, and family members. This helps them live their final days with dignity and respect, without unwanted treatments.
Sometimes the medical standard of care is what we call “aggressive support.” Emergency doctors will do everything they can to save a life. But what about an 89-year-old man with metastatic cancer and dementia? He probably wouldn’t want to be intubated and put in the ICU. Both palliative and hospice care should put directions like a do-not-resuscitate (DNR) on file with the hospital.
You can ask for a referral if your doctor hasn’t mentioned palliative or hospice care options. Medicare, Medicaid, and the Department of Veterans Affairs may cover palliative and hospice care options.
- Supportive care for patients who want to prolong quality of life
- Patients may not want intensive treatment
- Can continue to provide “curative” treatments
- Can continue for several months or many years (does not require end-of-life)
- Reserved for patients at the end of life
- Focuses only on symptom relief
- Can be provided at home, in the hospital, or in special facilities
- May be renewed or canceled after six months
For more information on palliative and hospice care, check out this useful resource from the National Institute on Aging.