Palliative care units (PCUs) provide specialist inpatient care. A palliative care unit is a department specialized in the treatment and care of palliative care patients.
It is usually a ward within, or adjacent to, a hospital, but it can also exist as a stand-alone service. In some countries, palliative care units will be regular units of hospitals, providing crisis intervention for patients with complex symptoms and problems; in other countries, PCUs can also be freestanding institutions, providing end-of-life care for patients where home care is no longer possible.
The aim of palliative care units is to alleviate disease- and therapy-related discomfort and, if possible, to stabilize the functional status of the patient and offer patient and carers psychological and social support in a way that allows for discharge or transfer to another care setting.
PCUs admit patients whose medical condition (physical, psychological, social, and spiritual) necessitates specialist multi-professional palliative care. Patients can be admitted to these units for specialist care for a few days or for a number of weeks; medical, nursing, psychosocial, or spiritual problems can determine the priority. These units may also provide day hospice facilities, home care, support for appropriate patients cared for in care homes, and bereavement support, together with advice services and education.
Essential services should be available 24 hours per day and 7 days per week.
If possible, there should be 24-hour telephone advice for health care professionals and 24-hour telephone support service for known outpatients and their carers.
Demand
It is estimated that 50 palliative care beds are needed for 1,000,000 inhabitants. With an optimal size of 8-12 beds per unit, this would correspond to
5 PCUs per million inhabitants. Recent estimates have upgraded the number of palliative care and hospice beds needed to 80-100 beds per 1,000,000 inhabitants.
Requirements
PCUs require a dedicated core team of nurses and physicians. PCU nursing staff should encompass a ratio of
at least one nurse per bed, and preferably 1.2 nurses per bed.
PCUs require physicians with special training, with a ratio of at least
0.15 physicians per bed.
In a setting where children are being cared for, there should be at least one nurse on each shift with a special pediatric qualification.
PCUs require an extended team of relevant associated professionals, such as psychologists, social workers, spiritual care workers, or physiotherapists. These professions should be included in the team or work in close liaison with it. There should be dedicated input from these professionals, or at least ready access to them if warranted.
Palliative care units should offer a homelike atmosphere with quiet and private areas. They should be separate areas with a capacity of 8-15 beds. The units should be equipped with single or double patient rooms, facilities for relatives to stay overnight, and rooms for social activities, such as kitchens or living rooms.
Radbruch L, Payne S and the Board of Directors of the EAPC. EAPC update. White Paper on standards and norms for hospice and palliative care in Europe: part 2. European Journal of Palliative Care, 2009; 16(6).