1. Home Based Palliative Care
A case for access to patient centered services
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2. What is Homebased Palliative Care?
Palliative care seeks to improve quality of life for patients and to support families, as they face serious or terminal illness. The focus is on the prevention and relief of suffering through an interdisciplinary team approach to care. This can include medical, physical, emotional, and spiritual assessments and interventions.
In home based palliative care models, patients receive care in their home or facility with the goal of preventing unnecessary ER visits and avoiding unwanted (re)hospitalization. Goals of care can be established earlier in the disease trajectory.
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3. All Hospice is Palliative Care but not all Palliative Care is Hospice
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4. Hospice vs. Outpatient Palliative Care
Timing -generally considered terminal or having a life expectancy of months or less to be eligible
Payment – reimbursable through Medicare, Medi-Cal and private insurance
Treatment – comfort care is the focus rather than curative, life prolonging therapies
OUTPATIENT PALLIATIVE CARE
Timing -No time restrictions. Palliative care can be appropriate whether a patient is terminally ill or not. It is generally agreed that palliative care is for those with advancing illness
Payment – Services are not reimbursable by Medicare, new legislation (in CA) allows for Medi-Cal to reimburse, private insurance is negotiable
Treatment- can concurrently receive curative treatment alongside symptom management and end of life care planning
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5. Differences in Palliative Care Delivery
HOME BASED PALLIATIVE CARE
In the patients residence (home or facility)
Specialized Care
Interdisciplinary Team
Case Management
Care Coordination
Community need (only 18% of California hospitals offer outpatient palliative care)
OTHER PALLIATIVE CARE
Inpatient Palliative Care – Hospital Based programs (In 2012 the U.S. had more than inpatient palliative care programs)
Outpatient Palliative Care Clinics – Typically associated with and subsidized by a health system
Medical Groups – Developing Innovative New models
Integrated Care Systems – Kaiser, The VA
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6. Why a Palliative Care Program?
Access to expanded services for patients in the community
Improved patient outcomes, quality of life
Increased patient and family satisfaction
Reduced utilization of unnecessary services
Generates cost savings for the system
Hospice programs have the knowledge to ensure success in Palliative Care
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8. Barriers to Implementation
Financial – difficult to break even
Studying the problem too long – needing more data
Trying to get buy-in/agreement from all stakeholders
Tackling everything at once –scope too large
Measuring nothing/everything
Assuming that the status quo is OK
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9. Next Steps: Timeline 6 months – 1 year
Establish leadership team
Identify community partners
Develop program policies and procedures
Identify interdisciplinary team and staffing
Determine scope of services
Develop training and education materials
Define goals and measureable outcomes
Identify funding sources (managed care, Medi-Cal, grants, etc.)
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11. References California Healthcare Foundation
Coalition for Compassionate Care
Dartmouth Atlas of Healthcare
Jama Internal Medicine
TriCentral Palliative Care Toolkit
Center to Advance Palliative Care
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