In just the past few months, you may have been hearing more and more about palliative care. Whether as a consumer who is reading about or seeing this in the news or as a healthcare worker whose hospital may experience an increased demand. Arguably, palliative care has never been more important and so many are relying on it during this time. You may ask why. Palliative care is specialized medical care for those living with serious illness, and focuses on both the patient and the family. Palliative care teams are well versed in having difficult conversations around goals-of-care and end-of-life, and so many of these conversations are needing to take place, especially as new hotspots emerge throughout the US.
What is palliative care?
The Center to Advance Palliative Care (CAPC) defines palliative care as specialized medical care for people living with a serious illness, and is care focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family. It is a team-based approach that includes physicians, nurses, social workers, mental health professionals, and chaplains, and the care team works together to provide that extra layer of support. It focuses on the needs of the patient and the family, not just the diagnosis. Patients can receive this at any age and any stage during a serious illness, and can be provided in conjunction with curative treatment.
Palliative care areas of focus include:
- Symptom management
- Pain management
- Navigation of treatment options
- Advance care planning
- Referrals to community resources
- Comfort measures that support quality of life
It is not uncommon for people to think palliative care and hospice are one in the same. Hospice focuses on the end-of-life, specifically the last six months of life. It’s also referred to as comfort care, meaning there are no curative treatments provided during this time. As mentioned above, palliative care and curative treatment can happen together, but can also be provided to those who are not receiving curative treatment.
Since many think these two are one in the same, especially consumers, a CAPC study showed that once a consumer is informed about what palliative care is, more than 8 out of 10 consumers would likely consider palliative care for themselves or loved ones. Consumers also felt the two most important things to convey around palliative care is that it relieves suffering and helps provide the best quality of life.
In this same study, CAPC also polled physicians, and found that nearly all physicians are very comfortable discussing palliative care with their patients. While comfortable discussing this, they are not always talking about or referring their patients to palliative care. When asked if they talk to their patients and their families about palliative care, 28% selected nearly always, 44% talk about it often, 27% sometimes, and 1% never. When asked if they refer their patients to palliative care, 16% nearly always, 46% selected often, 37% sometimes, and 1% selected never.
Home-based palliative care
While many consumers think palliative care always happens in a hospital setting, there are home-based or community-based palliative care options. Home-based palliative care still incorporates the multidisciplinary members of the care team – physicians, nurses, social workers, mental health professionals, and chaplains – but care is given in the comfort of the patient’s own home.
One trend we’re seeing is that more hospitals are offering community-based palliative care programs. Why is this? It has a proven track record for lowering hospital and ED visits and acute care costs. It also provides care to patients no matter where they are in the care continuum – hospital, home or SNF. And provider organizations are recognizing the value, with nearly two-thirds of programs offering in-home programs coming from hospitals and hospices. One economic research group found that within two decades, home-based palliative care could reduce societal healthcare costs by $103B.
When should someone be offered palliative care?
Palliative care should be offered when someone is diagnosed with a serious, long-lasting disease or a life-limiting illness. Some of these illnesses include, but are not limited to:
- Congestive Heart Failure (CHF)
- Chronic Obstructive Pulmonary Disease
- Kidney Disease
- Alzheimer’s Disease
- Parkinson’s Disease
- Amyotrophic Lateral Sclerosis (ALS)
Benefits of palliative care to the patient
There are numerous benefits the patient may or may not realize they will receive by incorporating the physical, psychosocial and spiritual components of palliative care.
- It truly puts the patient, their goals and their desires first
- Full alignment with and amongst the care team
- Helps the patient understand and match treatment plans to their goals
- Relieves the pain and symptoms of their chronic illness
- Allows the patient and caregivers to engage in advance care planning
- Reduces the likelihood of receiving aggressive, unwanted treatment
- Improves the quality of life
- Helps relieve the stress often experienced by the family
- Provides that extra layer of support when it is most needed
Impact of palliative care on healthcare organizations
Many organizations have realized the value of palliative care, not only for the patients, but also from a clinical outcomes perspective. And while we continue making the shift from fee-for-service to value-based care, the outcomes recognized by many organizations truly supports this shift, as palliative care can improve care quality while lowering costs.
In CAPC’s case for palliative care, they highlight how palliative care can have a positive impact across all care settings:
- Inpatient – 48% reduction in readmissions; 28% reduction in cost/day
- Outpatient – 50% admissions reduction; 35% reduction of ED visits
- Skilled Nursing – 43% reduction in hospital/ED transfers
- Home-Based – 36% reduction in total costs
In another study, a 30,000 member Medicare Advantage plan and health system in Ohio, who implemented a community-based palliative care program, members who received care showed:
- 20% reduction in total medical costs ($619/enrolled member/month)
- 38% reduction in ICU admissions
- 33% reduction in hospital admissions
- 12% reduction in hospital days
The future of palliative care
Today, there are about 7,600 physicians who are board certified in hospice and palliative medicine. There is already shortages in this area, and expected to get bigger as we watch 10,000 people age into Medicare daily, as well as the growing population of people living with serious illness. While we feel that palliative care has really shined during this time, there are high burnout rates and impending retirements as many in the field skew on the older side. In order to combat shortages, researchers make these five recommendations:
- Legislation to better support palliative care
- Education funding to expand training
- Research to better understand workforce needs
- Better reimbursement for the interdisciplinary team
- Burnout prevention
Palliative care is truly a benefit for everyone involved. As we continue the push towards value-based care, we are hopeful that changes will be made to increase support and access to this important care.