When treatment ends, care continues

In today’s world, caring for a person does not end with treatment — it continues even when a cure is no longer possible. Palliative care is precisely this continuation — support that preserves dignity, alleviates pain, and offers human presence in the most difficult moments at the end of life. According to the World Health Organization (WHO), around 56.8 million people worldwide need palliative care each year, but only a small fraction actually receive it. In Europe, the number of people in need is about 4.4 million annually. In Bulgaria, however, access to quality palliative care remains a significant challenge. We discuss the topic with Dr. Anna Savcheva, director of VITA Hospice, which has been providing care for the elderly for seven years.

– Dr. Savcheva, how would you describe the current state of palliative care in Bulgaria?

Palliative care is a specific segment of healthcare that aims to provide dignity and the best possible quality of life for people with incurable illnesses. In Bulgaria, the right to palliative medical care is enshrined in the Health Act — patients with incurable diseases and a poor prognosis require medical supervision, health care to relieve pain, and moral support. The goal is to maintain quality of life by reducing or eliminating the symptoms of the disease and its psychological and social impact.

Unfortunately, palliative and hospice care in Bulgaria is underdeveloped because there are no public resources to fund it, and patients and their families are forced to find solutions on their own.

– What are the most common misconceptions or negative stereotypes about hospices in Bulgaria?

There is a prevailing belief in our society that a person is placed in a palliative care or hospice facility when their relatives no longer wish to care for them. Some poor practices in certain residential homes have also contributed to a lack of trust in these institutions. People fear that their loved ones will not receive the care and attention they need.

Hospice care typically involves a team of specially trained professionals — including nurses, caregivers, doctors, physiotherapists, psychologists… Each team member works with the patient and/or their family to provide the necessary medical, emotional, and spiritual support.

It is important to understand that stopping active treatment aimed at curing a disease does not mean ending all care. A good example is the approach for a cancer patient. If the treating team determines that the disease no longer responds to chemotherapy, treatment is discontinued, and the patient may choose to receive hospice care, where other medical support continues as long as it is beneficial.

– How long has VITA Hospice been providing palliative care, and what are its advantages compared to other facilities?

VITA Hospice opened in 2018 and has been providing palliative and hospice care for seven years. Our team consists of a doctor, nurses, caregivers, and a rehabilitation specialist. One advantage of our hospice is that it is located in the same building as VITA Medical Center, which allows access to consultations with all specialists, laboratory tests, and imaging diagnostics whenever needed. The hospice also has a centralized oxygen supply system for patients with respiratory insufficiency.

– What do patients’ relatives prioritize when seeking your services?

Relatives want their loved ones to receive proper medical care to manage and alleviate symptoms, maintain good quality of life according to the patient’s condition, and, not least, to receive warm, compassionate attention.

– What are the main challenges facing hospices in Bulgaria today?

There are several key challenges. First, the lack of a state policy for the development and funding of integrated health and social services.

Staff shortages are also a serious problem. Caring for these patients is demanding and responsible work, requiring not only specialized training and knowledge, but also empathy and a compassionate approach.

– What qualities are most important for people working in palliative care?

Those working in palliative and hospice care must have the necessary knowledge and skills to serve this type of patient — both medical and psychological training. Patience, compassion, and responsible conduct toward patients are essential.

– What should a sustainable national strategy for palliative care include?

Caring for the sick and elderly is the responsibility of society as a whole, not just family members. There should be a unified state policy in this area, with standards and regulations guiding the work and institutions responsible for monitoring compliance. Funding for these services should be provided, at least partially, by public resources.