What is Palliative Care

Palliative care is person-centred holistic care which supports your physical, psychological, emotional, and spiritual wellbeing. It helps to improve or maintain your quality of life when diagnosed and living with a life-limiting illness. Palliative care also supports your family or significant people in your life by facilitating open and honest conversations to ensure that treatment options and care decisions align with your preferences and values. Palliative care provides symptom control so you have the added reassurance of knowing symptoms associated with your condition can be managed in a timely manner. Palliative care is supportive care offered throughout the progression of all phases of your illness. It will help to improve your ability to participate in your daily activities and hobbies.

This is often the first thought people have when they hear the words ‘palliative care’. However, palliative care takes a holistic approach, focusing on improving the quality of life for you and your family throughout your illness. A prognosis on life expectancy is very difficult to determine at the outset of any diagnosis, so whilst your illness may not be curative, it may be managed for a very long time.

Palliative is not synonymous with end-of-life care only, it is much more than this. Palliative care isn’t just for end of life; it’s about living your best life and remaining involved in all decisions as your illness progresses. Palliative care is about living well and planning for the future. Irish Hospice Foundation’s ‘Think Ahead Planning Pack’ helps you discuss and record your wishes and preferences. Visit thinkahead.ie for further information.

Palliative care provision is the responsibility of a multidisciplinary healthcare team. This team will provide care that is tailored to meet the individual needs of the person and their family. Depending on where your care is being provided, your team may include members of Hospital, Primary and Community care teams that are made up of Doctors, Nurses, Social Workers, Carers, Pharmacists, Speech and Language therapists, Occupational therapists, Counsellors and other professionals. Specialist Palliative Care (SPC) teams become involved when complex symptom management is required. ese teams can be hospital or community based. Many Community Palliative Care Teams are based at your local hospice, which provide additional services like symptom control admissions, outpatient services or day-care services. Palliative care is provided at different levels depending on your illness. As your illness progresses and if your symptoms become complicated you may need more specialised care from a specialist palliative care team.

Within a healthcare team, there are three levels of palliative care provision with increasing specialisation from Level 1 to Level 3.

Level One

Level 1: This is a Palliative Care Approach and is provided in any location – at your home, in hospital or in a nursing home by all healthcare professionals as part of their role. Care at home is usually provided by your Primary Care Team. Level 1 includes managing basic symptoms and providing educational supports for you and your family. Example: Being linked in with your GP or Public Health Nurse on the Primary Care team will provide you with signposts to other healthcare professionals and information resources for you and those closest to you. 

Level Two

Level 2: This is Palliative Care which can be provided in any location – at your home, in hospital or in a nursing home using a non-specialist palliative care approach. Level 2 Palliative Care is provided by your GP/PHN/RGN and Carer who have additional knowledge, training and experience of the palliative care principles and use this as part of their role. If you feel more unwell, you should continue to speak with your healthcare team about managing your symptoms and issues that affect your quality of life. Example: Your healthcare team will support you in learning how to manage symptoms you may experience, focusing on reducing distress to increase the amount of comfort and control you feel.

Level Three

Level 3: This is Specialist Palliative Care and is provided in any location – at your home, in hospital, or in a nursing home – by specialist palliative care teams that are made up of healthcare professionals who work solely in palliative care and have extensive knowledge and skills in this specialty. As with Levels 1 and 2 palliative care, this can be provided to you at home, in the community or in a hospital. You may be discharged from a Level 3 specialist care if your needs become less complex; you can be referred again should you need it.

Example: The Specialist Palliative Care Team will visit you in your place of care and complete a symptom control assessment. They will then link in with your healthcare team regarding any changes to medication or treatment that is needed and will do a follow-up assessment to determine their level of involvement at this stage.

Most of your palliative care needs will be met at Levels 1 and 2. End-of-life care can be provided at Levels 1, 2 and 3.

Palliative care is for anyone, at any age, who is living with a life-limiting illness. The term ‘life-limiting illness’ refers to any disease, condition or illness that is progressive and cannot be cured. Palliative care focuses on improving and maintaining quality of life for people who are facing the challenges associated with all life-limiting illnesses.

If you have been told you have a life-limiting illness, you can access palliative care in Ireland, and you can have palliative care at any stage of your illness at the level required.

Ideally, Level 1 palliative care should be offered to you and begin at the time of your diagnosis and continue throughout your life-limiting illness. In the past, palliative care was associated with the treatment of patients who had a cancer diagnosis. However, it is also available if you have other types of advanced life-limiting illnesses such as Parkinson’s disease, motor neuron disease, dementia, heart failure, stroke, renal, respiratory conditions or other.

Palliative care can be integrated into care plans early in the course of your illness and can be provided in conjunction with other treatments intended to prolong life, such as dialysis, chemotherapy, and medication.

Providing palliative care at an early stage in a person’s illness can support better management of symptoms and complications as well as in planning for future care.

No. Palliative care is provided in hospitals, in residential centres, nursing homes and/or your home.

In hospital: your healthcare team may manage your treatment or refer you to the Specialist Palliative Care Team. This initial consultation will determine your future care needs whereby you may be referred for ongoing specialist palliative care follow-up in hospital, or the team will inform your GP and Primary care team to support your needs when you are being discharged.

In a residential care setting or nursing home: the staff there and/or your GP are able provide palliative care. They will refer you to the Community Palliative Care Teams to be involved in your care if you are experiencing more complex symptoms.

In your own home: your GP or healthcare team can arrange for a referral to the community-based Specialist Palliative Care Team to complete an assessment to improve the symptoms you are experiencing. is assessment may be offered to you through hospice day services or with a Specialist Palliative care Consultant in the outpatients Department. This might involve you attending day services where available at your local hospice or a home visit from the Community Palliative Care Team. These visits may be required more often as you near end of life. The Community Palliative Care Team will arrange, if possible, free night nursing care to support you and your family in your final days. This provides reassurance and respite for your families and loved ones caring for you at home. See hospicefoundation.ie/nnc for details.

Most palliative care services are free for all patients and their families in Ireland. Where people have private medical insurance, their insurer may be asked to contribute towards the cost of their care. Depending on the stage of your illness, you may be entitled to a medical card, which is applied for with the support of your consultant, GP or social worker, who facilitate the application process to the HSE. Be sure to check in with your GP and local primary care team about what other free services may be available in your local area.

No. End-of-life care is an important part of palliative care provision and usually commences when a person is in their last year of life, whereas palliative care is much broader and can last for longer.

End-of-life care offers treatment and support for people who are near the end of their life to ensure their comfort and dignity. The aim is to allow someone to be as comfortable as possible in the time that they have left and making sure their preferences or wishes are respected as part of the care that they receive.

Palliative and end-of-life care also includes supporting your family, carers and those who are important to you