Understanding the Scope of Palliative Care

Palliative care is commonly approached by providers as a solution to initiate at or near the end of a patient’s life. Often, the focus of care for chronic and complex illnesses becomes how to mitigate the disease process itself, but not always how to manage its impact on activities of daily living. In other words, “fixing” a disease process sometimes overshadows living with a disease, until the negative effects can no longer be ignored, and the cure is acknowledged as unlikely. The fundamental root of palliative care is to change that.

A new understanding of palliative care

Increasingly, it is becoming understood that initiating palliative care does not have to equal deprioritizing curative care. If you’re confused by this statement, or just trying to understand more about this growing specialty, you’re not alone. In a recent survey conducted by the National Hospice and Palliative Care Organization (NHPCO), one of the greatest barriers to providing palliative care services was referrals, and the largest referral challenge was “referring provider understanding.”

Indeed, implementing palliative care as an organizational strategy is only just beginning to take hold as a widespread practice. The Center to Advance Palliative Care (CAPC) notes that in the span of 15 years, the percentage of hospital systems with greater than 50 beds who have a palliative care program rose from 25% to 75%.

The basics: what is palliative care?

Palliative care is a medical specialty for improving quality of life for patients who are living with a serious or life-limiting diagnosis. For example, it may benefit patients with a diagnosis of heart failure, cancer or end-stage dementia, among others. Palliative care can be initiated at any stage of an illness. The patient’s long or short-term prognosis does not matter.

Patients who are enrolled in palliative care receive support from a specially trained team of doctors, nurses, and other healthcare specialists. This team works with the patient’s existing healthcare providers to ensure symptoms and problems related to the diagnosis are managed in the best way possible. Research has shown that patients who receive palliative care have better outcomes than those who do not.

What does palliative care look like in action?

A typical first day of palliative care services involves an initial assessment of the patient. During this visit, a palliative care nurse practitioner performs an exam, and evaluates the patient’s symptoms and need for pain management. They also attend to holistic care needs by discussing goals of care with the patient and their family and addressing emotional and social needs. Based on this first visit, they create a plan of care.

After the initial assessment, follow-up visits are conducted 1-2 times per month and as needed. In-home visits with Contessa’s palliative care program can last anywhere from 30 minutes to 1.5 hours, depending on the patient’s needs. Along with managing pain and other symptoms, the nurse practitioner or registered nurse will also coordinate with a social worker for any other resources or emotional support the patient may need.

Throughout this process, the entire palliative care team works behind the scenes to collaborate with the patient’s other healthcare providers to ensure care coordination and reduce the risk of complications and hospital admissions- by as much as 50%. This care coordination also serves to help patients transition to end-of-life care with hospice care in the future if needed.

Which patients should be considered for palliative care?

Palliative care can help patients with a broad range of healthcare needs. It is especially helpful when introduced at the time of diagnosis. Palliative care has a role in:

• Chronic, serious illnesses such as heart failure, stroke, respiratory disease, Parkinson’s disease, kidney disease, cancer, dementia, and many other conditions
• End-of-life care or terminal illness, even if the current treatment is intended to cure the condition
• Providing a bridge to hospice care, by offering support and comfort measures until treatment is no longer curative and a patient’s lifespan is limited to 6 months or less
• Improving quality of life, by helping to control symptoms such as:
• Pain, fatigue, nausea, vomiting, confusion, trouble breathing, loss of appetite, and other physical symptoms
• Anxiety, depression, or stress related to organizing care, making decisions about care, and discussing difficult topics with loved ones
• Helping to match a patient’s treatment to their wishes, by creating goals of care that consider their unique needs

The option of palliative care in the home

Contessa’s Palliative Care at Home program, together with our parent company Amedisys, brings this option to patients where they most prefer to receive their care: in the comfort of their own homes. Although palliative care services can be delivered in many settings, including hospitals, nursing homes, and outpatient palliative care clinics, the home offers a unique opportunity.

In this setting, palliative care can treat patients in the environment most conducive to supporting their personalized goals of care. In a patient’s home, our palliative care team, consisting of palliative care nurses, nurse practitioners, doctors, community health workers, and social workers, can better see how social determinants of health impact the patient’s well-being.

Through this lens, they can better understand any unique challenges that patients, their families, and other caregivers face on a day-to-day basis. And they can remove barriers to medical care by eliminating the need for transportation to clinic visits and ensuring symptom management is addressed promptly and at home, rather than in the emergency department or a hospital bed.

With a broader understanding of palliative care, it is easy to see why Contessa’s Palliative Care at Home program is an option that is invaluable to our full suite of Comprehensive Care at Home options, a choice that more and more hospital systems are choosing to partner with us for. As palliative care continues to grow in the future, Contessa and its partners are poised to offer a robust palliative care solution to those who need it most.