Meet Julie Hirsch, RN, a devoted nurse for 24 years and the Palliative Care Lead at VNA Health.
In fact, Ms. Hirsch helped establish the VNA Health Palliative Care program in 2009, which cares for patients wherever they are: at a clinic, at a hospital, or at home. So what is Palliative Care?
To better understand how palliative care works, let us start at the beginning.
Palliative Care is one of the most misunderstood terms in health care.
First, “palliative” is not an easy word to say or spell. Second, Palliative Care in the United States is a “young” medical subspecialty.
Finally, and the most difficult misunderstanding, is that most people identify palliative care as “the step right before hospice care,” so then that means “the end of life.”
While hospice is palliative in nature, the reality is that over time, Palliative Care has grown into its own medical specialty, uniquely different in its philosophy and practice.
In the United States, Palliative Care has evolved over time. It began in the midst of the 1970s hospice movement in which a more “patient-centered approach” was provided to offer the patient peace, comfort, and pain relief when a cure was no longer possible and death was imminent.
It was not until 2006 that Palliative Care was recognized as an independent medical subspecialty.
Today, the primary shift in Palliative Care is that it can be provided to patients at any stage of illness or condition, and in coordination with curative treatments to alleviate the side effects of medications and treatments, and help the patient feel well so that they may live well.
The most common health conditions that Palliative Care can address include:
» Cancer
» Congestive Heart Failure (CHF)
» Kidney Failure
» Liver Failure
» Chronic Obstructive Pulmonary Disease (COPD) or other lung diseases
» HIV/AIDS
» Spinal Cord Injuries
» Brain Diseases (such as stroke, ALS, or Parkinson’s)
» Multiple Sclerosis (MS)
» Alzheimer’s and other Dementias
Usually patients choose to begin Palliative Care when they get a formal assessment of their condition.
Palliative Care focuses not just on the difficult symptoms of an illness, but on the overall benefits and effects of potential treatments, as well as the emotional, physical, and financial stresses for someone dealing with a serious, perhaps life-threatening illness.
Ensuring patients’ dignity, coordinating care, and shared decision-making are critical components.
Dr. Michael Kearney, VNA Health’s Palliative Care associate medical director, has been at the forefront of our local Palliative Care movement in Santa Barbara County.
“Palliative Care is focused on what the patient’s needs are,” shares Dr. Kearney. “Yes, the diagnosis or prognosis is important, but that is not our focus. It is about helping the patient feel better, to manage their physical and non-physical symptoms. If they feel well physically, psychologically and spiritually, then their quality of life improves.”
Dr. Kearney’s first experience with palliative care and hospice care was as a medical student in the 1970s.
“Palliative Care as a medical specialty did not yet exist. Nobody had come up with the term ‘palliative care.’ People talked about palliative treatments, palliative radiation, palliative chemotherapy, and palliative surgery. Those are all treatments that were aimed at improving the patient’s quality of life, which were not curative in their intent, but were palliative in their intent.”
Originally from Ireland, Dr. Kearney worked at St. Christopher’s Hospice in London, which he described as a place of healing.
“I was really very inspired by what I saw there,” he said, “so much so, that I decided that this is how I want to practice medicine.”
Dr. Kearney has spent more than 35 years as a physician of palliative care and hospice care.
He trained and worked at St. Christopher’s Hospice in London with Dame Cicely Saunders, the founder of the modern hospice movement. He eventually worked as medical director of Our Lady’s Hospice in Dublin, and later with Professor Balfour Mount at McGill University in Montreal.
Dr. Kearney came to Santa Barbara in the early 2000s, and has been the associate medical director of Palliative Care for VNA Health for 15 years.
Dr. Kearney works closely with the VNA Health Palliative Care staff — an integrated team of clinicians, therapists, and caregivers — all focused on caring for the patient and their family.
“Our real strength is in the nursing core of the team, especially for home-based Palliative Care,” shares Dr. Kearney. “Also at VNA Health, the teams are focused on the patient, and their family and caregivers. Our patient is the center of our circle of care.”
“To me, being a Palliative Care Nurse is the most private, special time that someone can let you into their lives that no one else can experience,” shares Ms. Hirsch. “What is most special is that you’re guiding them or you’re with them during this part of their life journey. We make a handprint and then we’re out of their lives, but that doesn’t erase our effect or their effect on us either.”
Ms. Hirsch continues, “One reason I’ve always liked nursing is because I feel nursing deals with how patients react to a disease.”
Each Palliative Care plan is personalized to the patient and their needs. Care for patients can include education about the disease, a discussion of options, and spiritual care.
Improving communication between health care providers and family caregivers can help the patient make better informed decisions about their health.
In coordination with the patient’s primary, attending or treating provider, VNA Health’s Palliative Care team will visit patients in their homes and offer tailored treatment plans focused on improving quality of life. Patients who are seriously ill often do better when they can stay in their own homes, and received personalized Palliative Care.
VNA Health’s Palliative Care is the first local and leading home-based palliative care program.
The VNA Health Palliative Care team consists of nurses, case managers, chaplains, social workers, and the primary medical team, who work together to meet the needs of the patient.
VNA Health offers comfort and dignity in all stages of care, including coming to terms with an illness and ensuring that one’s family is also coping and accepting the new diagnosis. Beyond pain and symptom management, palliative care is about helping the patient heal.
Dr. Kearney’s colleagues have described him as more than a Palliative Care doctor: “He is a healer.”
When illness is advanced, the journey to healing does not always mean free from illness. Instead, Dr. Kearney defines healing as a “becoming more completely who we are, and coming to peace with one’s situation…of coming kind of even closer to one’s loved ones and one’s family…and coming into a sense of forgiveness and acceptance that will help the patient feel well.”
Ms. Hirsch agrees as she believes that healing comes from acceptance. “Healing has many different meanings. It can be about how you live the best life that you have for the time that you have, and enjoy that time with your loved ones.”
A Partnership of Care
The VNA Health Palliative Care program provides support and care for persons with a serious, life-limiting or life-threatening illness, condition, or injury so that they may live as fully and comfortably as possible.
VNA Health supports the belief that through appropriate care and the promotion of a caring and supportive community, patients and family/caregivers experience an improved quality of life.
If you or anyone you know is experiencing stress and pain due to a severe illness, talk to your physician and discuss your options for Palliative Care. Call 805.690.6212 for more information about VNA Health Palliative Care.