Understanding palliative care - Haymarket Media Group

Evercare
Improving care, curbing costs
The benefits of palliative care programs reach into fiscal
realms as well. Research shows that because palliative
care works to prevent and relieve suffering, fewer
people receiving the services require hospital visits and
stays. Palliative care also helps ease the transition
between care settings, which can further drive patient
satisfaction while steering them to the most appropriate
healthcare resources throughout their illness course.
Even if a patient does require hospitalization, the costs
for those receiving palliative care consultation are significantly
less than for those who don’t. Live discharge costs
for palliative care patients who receive intensive care are
roughly $183 less per day than those who receive usual
care. Care for end-of-life palliative care patients who
receive intensive care and die in a hospital is approximately
$446 less per day than those non-palliative care
patients, according to a 2007 study published in the
Journal of the American Geriatrics Society.
“Complex patients with advanced illness and multiple
comorbidities are among the most expensive cases
in healthcare,” confirmed Mark Leenay, M.D., MS,
chief medical officer, Evercare Hospice and Palliative
Care, citing a study published in the February 2007
issue of the American Journal of Cardiology.
“There’s no correlation between the prevalence of
severe chronic illness and total Medicare spending,”
continued Dr. Leenay. He did point out, however, the
high correlation between Medicare spending and days
spent in the hospital in the last six months, and an even
stronger correlation between Medicare spending and
doctor visits in the last six months of life.
According to the 2006 Dartmouth Atlas of Health
Care, if the resource utilization of efficient providers and
systems was implemented nationally, it would reduce
spending for those with severe chronic illness by 30%.
The most physically, emotionally and spiritually fulfilled individuals
are those who are able to stay focused on the things they love
– and those who are chronically or terminally ill are certainly no
exception.
Palliative care should embrace each individual’s needs, while
encouraging them, whenever possible, to stay engaged in their
favorite activities or interests. More specifically, palliative and
hospice care should be shaped by a deep commitment to celebrate
who a patient is as a complete person, emphasizing not just
what they need while they are ill or in their end stages of life, but
what has been meaningful to them throughout their life.
For 89-year-old Virginia Frizzell, it was the company and comfort of
a volunteer and her therapy animals — a horse and a dog — that
helped create an enriching hospice experience (see her photo on
page 2). Despite being very weak from incurable pancreatic cancer,
Frizzell was able to live independently with the support of in-home
care and spend quality time with friends and family.
Finding its stride
Although palliative care is still underutilized, there’s no
question the benefits, both to the patient and families and
to the healthcare system, have led to greater penetration.
A 2007 survey of 4,103 hospitals by the American
Hospital Association revealed more than 30% have a
palliative care program. The amount jumps to 70% for
hospitals with more than 75 beds. VA hospitals reported
almost 100% palliative care penetration.
Still, Meier and Connor stressed there’s a well-documented
need for evidence-based palliative care
research to promote more wide-spread support, access
and implementation of the program across the care
continuum.
The National Consensus Project for Quality
Palliative Care states that further promotion and
support of palliative care in the U.S. can be driven by
ongoing health professional education in palliative
care principles and practice; increasing access to
palliative care specialists across the care continuum;
and promoting timely access to hospice services to all
eligible patients.
Some of those goals are currently being addressed
by the Joint Commission. Later this year, the agency
will be implementing palliative care standards as part
of its new Health Care Services Certification Program.
“The proposed standards emphasize the importance
of patient-centered care and teamwork in focusing
on the front line of service delivery,” noted Chuck
Mowll, executive vice president, Business Development,
Government and External Relations, The Joint
Commission.
The standards, expected to be launched in August,
cover important aspects related to program management,
providing care, managing patient information,
and improving performance.
Meeting the needs of individuals — while focusing on what’s important
4 UNDERSTANDING PALLIATIVE CARE
Pain by
numbers
33-88: Percentage of
nursing home residents
with ongoing pain that
impairs mobility and
robs quality of life 1,2
50: Percentage of
patients who report
moderate or severe
pain at least half the
time in their last three
days of life 3
65: Percentage of caregivers
of dying patients
who cite inadequate
control of suffering 3
References
1. Miller SC, Mor V, Teno J.
Hospice enrollment and
pain assessment and management
in nursing homes.
J Pain Symptom Manage.
2003;26:791-799.
2. Teno JM, Weitzen S,
Wetle T, Mor V. Persistent
pain in nursing home residents.
JAMA.
2001;285:2081.
3. Leenay M, Opening a
Dialogue: Advance Care
Planning. 2007
“A large part of what we do is spend time one-on-one with
patients, reflecting on their lives to get a better understanding of
what will help them most as they approach this final phase,” noted
Anne Kidd, the hospice social worker who coordinated Virginia’s
home services and regularly monitored her overall condition and
well being.
Knowing Frizzell’s love of horses and riding, Kidd contacted the
volunteer coordinator for their hospice program to determine
whether a horse visit could be arranged. They immediately
reached out to another volunteer who jumped at the chance to
bring her horse, Cody, to Frizzell’s home.
“Because Virginia wasn’t able to travel much, we knew we’d need
to bring the horse to her,” Kidd explained. The joy in Virginia’s face
as she connected with Cody was unmistakable, she added. “It was
so wonderful for her, so rewarding and calming. In fact, Virginia
told us: ‘This is the best day of my life.’”