Team-Based Palliative Care Gains Ground

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)
Team-Based Palliative Care Gains Ground

Still somewhat misunderstood by the general public, palliative care programs are becoming increasingly popular thanks to readmission penalties and accountable care organizations. A recent New York Times article called attention to the highly successful combination of palliative care and care teams that perform house calls.

Since palliative care focuses on improving quality of life for severely ill patients, it’s logical to involve social workers, chaplains, geriatric specialists and home care nurses in addition to physicians. This expanded form of palliative care likely will grow popular with patients, caregivers and those responsible for controlling costs.

For example, a palliative team is prepared to offer practical help so patients can remain at home. It also can provide support for family caregivers and expert help with pain management and depression. As for costs, a 2007 Kaiser Permanente study found terminally ill patients that received interdisciplinary home care were less likely to be admitted to the hospital or visit the ED than those receiving standard home care.

The article notes that in cases where insurance doesn’t cover this type of palliative care, some hospitals are financing it themselves. The University of California, San Francisco says it sees sufficient improvement in quality and costs to make this a sound investment, according to Dr. Steven Pantilat, who leads the organization’s palliative care program. Dr. Timothy Ferris of Partners HealthCare ACO in Boston is seeing similar benefits and calls home care nurses “the eyes and ears and stethoscope in the patient’s house.”

Team-based, at-home palliative care also is being recognized as an effective option for those who don’t fit hospice criteria. For instance, after being told that clearing her four clogged heart arteries would be unacceptably risky, a patient of Pantilat’s didn’t know how long she would live, but she knew she did not want to spend more time in the hospital. She received care from her daughter, as well as home visits from a spiritual counselor. She was comfortable and in fine spirits until her death, seven months after leaving the hospital.

Pantilat noted that hospital readmission likely would have been without palliative care and added that her pain would not have been as well controlled. “Avoiding even one hospitalization would have paid for all the palliative care she received,” he said.

Working with hospitals on palliative care programs is another area where innovative home health agencies can expand their services and recommit to their core mission to help patients stay in their homes.

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