Healthcare has always had numerous sectors and specialties and most of those integrate well for a broad based continuum of care for the patient. In the past 10 years, a new specialty has emerged and it continues to grow, as more and more people understand it.
Palliative care is a specialty that has been a focus recently as more and more people are living with chronic and serious illnesses. The realities that the patient and the families must face are often beyond their capabilities and palliative care pulls in the right healthcare professionals to support those needs.
Physicians, nurses, therapists, dieticians and other types of professionals work together as a team to support those needs. Palliative care is not considered "end of life" care and is appropriate at any age—and for a multiple of diagnoses. It may be congestive heart failure, Alzheimer's, cancer, kidney disease, ALS, etc. and the care is often used in addition to treatment on an ongoing basis. The fact that palliative care can be provided at the same time as curative treatment and isn't dependent on diagnosis is what differentiates it from hospice care. The main purpose is really to help provide the highest quality of life and to relieve suffering, pain and stress.
One of the issues recently recognized is that most people in the United States do not have any knowledge about palliative care. In a recent survey published by The Regence Foundation, only 24% of respondents were either very familiar or somewhat familiar with the "palliative care" term. However, once it was explained, 92% stated they would consider using the care if it was needed for a loved one.
In 2000, there were only 600 palliative care teams and according to a recent survey by the Center to Advance Palliative Care in March, 2011, there has been a 138% increase to over 1,500 programs. The west, midwest and northeast all have a 68-73% prevalence of hospital-based programs while the south is reporting only a 51% penetration. Of U.S. hospitals that are larger than 50 beds, 63% offer palliative care. Larger hospitals are more apt to have palliative care than smaller facilities.
The issue of reimbursement is an area that is bringing about much discussion. When palliative care is in a hospice setting, private insurers normally provide the care as a service similar to Medicare while state Medicaid programs vary by state. In a hospital-based setting doctors and advanced practice RNs (in some states) are reimbursed for some initial consultation and follow-up along with some services under Medicaid hospice benefits. Some services are now being absorbed by hospitals but the director of the National Palliative Care Research Center in NY recently shared (http://www.modernhealthcare.com/article/20100531/MAGAZINE/100529913#) "that palliative-care programs can save a hospital more than $2,600 per patient per admission for patients discharged and almost $7,000 per patient per admission for patients who die in the hospital." Palliative care is certainly something up for discussion by Congress to look at a new Medicare benefit but it doesn't look like it is going to happen anytime soon.
The American Hospital Association recently awarded Circle of Life Awards to three organizations with excellent palliative care programs along with four others that received Citations of Honor. The three top recipients and their programs included:
Gilchrist Hospice Care, Hunt Valley, MD - Integrated palliative care with geriatric care across their continuum of services and settings, including long-term, hospice, physician groups, assisted living and acute care.
St. John Providence Health System, Detroit MI - Hardwired the evaluation process for palliative care to every entry point into their system for every patient. Clinical, psychosocial and spiritual needs are all evaluated throughout the continuum, including post-discharge.
The Center for Hospice & Palliative Care, Cheektowaga, NY - The program includes a sophisticated palliative care institute for patients and their families with serious illnesses. The team supports strong collaboration, physician leadership and clinical research, which are monitored closely for outcome measures and survey data from all stakeholders.
As palliative care continues to grow at a rapid pace, resources have become available to help organizations set up programs, purchase tool kits and participate in educational workshops or webinars. For some of those available resources, please utilize the list below.
Resources for your use:
www.getpalliativecare.org (includes options searchable by state)
www.capc.org - Center to Advance Palliative Care
www.careinginfo.org (non-hospital based)
www.nhpco.org - The National Hospice and Palliative Care Organization
www.aahpm.org - American Academy of Hospice and Palliative Medicine
www.hpna.org - Hospice and Palliative Nurses Association
www.npcrc.org - National Palliative Care Research Center