This is the fifth in a series of articles about palliative care.

Palliative care can help improve your quality of life and ability to function when a serious medical condition and/or the treatments you are getting for it have resulted in symptoms that significantly disrupt your life.

Three common sites at which to get such care are the hospital, a nursing home (nursing or skilled nursing facility), and your own home. This column provides some comments about the last two from two board-certified palliative care practitioners.

Dr. Kevin Doyle, medical director at Granite Mountain Home Care and Hospice, noted, "I do palliative care consultations in the hospital, but the lion's share is in the patient's home, often shortly after they have been discharged from the hospital. My typical house call visit is two hours. I go out and sit down with them - and in most cases, their family. Seeing people in their homes is very helpful - in the home I can see them in their normal surroundings. When they are in the hospital, they are often at their worst, and it can be harder to get a feel for who they are in their normal lives."

Before going to a patient's home, Dr. Doyle will get an OK from the patient for the hospital and doctors to release their medical records to him. He reviews the records to be sure that he has a good understanding of the medical picture before he walks in the door. Of course, the medical records tell only part of the story; the consultation is used to complete the picture.

With a two-hour block of time, Dr. Doyle explained, he can learn about the patient's goals - what they want to be able to do again - and the symptoms they are experiencing that are preventing them from doing those things or that are degrading their quality of life. He can also help them understand all their treatment options: "Often, patients are just following a course of treatment that one specialist laid out; they may not realize that there are other options."

In one case, Dr. Doyle recounted, a woman was on a complicated regimen of many drugs to manage her pain. He was able to switch her over to one drug and eliminate all the rest. He worked with her over time to adjust the dosing to get the best results, simplifying her care and improving her quality of life.

Dr. Sam Downing, medical director at Good Samaritan's Prescott Home Health and Hospice, talked about palliative care for people with Alzheimer's, living either at home or in a long-term care facility (nursing/skilled nursing/assisted living): "Just because somebody has dementia doesn't mean that they don't have pain or mobility problems or other issues. Now, some Alzheimer's patients have very few palliative needs, except that they wear their caregivers out, so we end up palliating the caregivers."

He continued, "Some people with Alzheimer's realize that their cognitive functioning is declining. They often become despondent and depressed. But that's where the emotional palliation becomes important: dealing with someone's depression or anxiety or frustration and anger around their conditions."

How do you create a plan based on the values and priorities of someone who is no longer in a position to explain these to you? Dr. Downing said, "We can figure out what their life choices indicate their priorities and interests have been along the way -- family or jobs or working in their garage or tinkering with their car, and so forth. Then we can put together a care plan that reflects those priorities." Perhaps patients can take part in relevant activities or outings and/or display and share meaningful mementos from their lives. These actions can help them and their caregivers honor who they truly are - not simply focus on their disease or limitations.

To arrange a palliative care consultation, ask for a referral from your primary care doctor. Or, if you would like to set up an appointment with Dr. Doyle, he can be reached through Granite Mountain Home Care and Hospice at 445-2522. Dr. Downing, whose availability is severely limited, can be reached through Good Samaritan's Prescott Home Health and Hospice at 778-5655.

Next week's column will discuss hospital-based palliative care.