Page 20 - Delaware Medical Journal - April 2017
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Community-Based Palliative Care:
Important Link in the Continuum of Care
Loretta Higgins, MSN, ARNP
The term palliative care can be a mouthful for most people. Try saying it three times fast! In addition to creating a sense of a mouthful of marbles, patients and providers
are not familiar with the concept of palliative care. To palliate means to ease or eradicate suffering. Palliative care attempts to relieve suffering, whether
it be physical, psychological, social, or spiritual in nature. A palliative care team is an interdisciplinary team aimed at providing patients and their families with a comprehensive, holistic approach to their serious illness. Palliative care teams utilize physicians, nurse practitioners, nurses, social workers, and chaplains. According to the Center to Advance Palliative Care (CAPC) and the American Cancer Society, “Palliative care referral
is appropriate at any age and at any
stage in a serious illness, and can be provided together with curative treatment. Palliative care can be provided in any care setting: hospital, nursing home, rehabilitation centers, and at home, with or without adjunct home health agency assistance.”
Even as the wave of palliative care has been crashing down around us, patients, families, and a majority of health care
palliative medicine program was established in 1975 at the Royal Victoria Hospital in Montreal by Balfour Mount, who also coined the term palliative care. Since the early days of palliative care,
this model of patient-centered care has suffered an identity problem. It is not skilled care, and it is not hospice care. Unfortunately, the majority of patients with serious illness do not qualify for skilled care or hospice care and, therefore, are ineligible to receive the services required to maintain independence, functional ability, and overall symptom management. In approximately 90 percent of these cases, patients report needing help with aspects of care that are not covered by traditional health insurance. Enter community-based palliative care. Palliative care teams provide a safety
net of support for these patients via in- home evaluation by physician or nurse practitioner, ongoing coordination of care between community providers, non- skilled assistance with activities of daily living, and social supports, including meals and transportation.
While a large majority of patients continue to die in hospital or nursing home settings, the bulk of care for patients with serious illness takes
place in the home, over time, by family caregivers, neighbors, or friends. The average caregiver is a female in her 40s who is also working outside the home and caring for her own children and family. These uncompensated caregivers provide, on average, 20 hours of care
per week to loved ones with serious illnesses. This caregiving dilemma is
in part how palliative care came into existence. Community-based palliative care can offer educational, psychological, and respite assistance for these family caregivers, in an effort to minimize caregiver fatigue and burnout.
Current health care trends are moving from providing patient care in an inpatient setting to a population health, community-based setting. Community- based palliative care serves as a bridge between the acute care setting and the post acute care setting. Care focuses
on providing relief of burdensome symptoms, education regarding disease progression, advance care planning, goals of care, and caregiver issues. Any of these issues could be the impetus for a patient or care giver to call 911 and begin the inpatient cycle.
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Del Med J | April 2017 | Vol. 89 | No. 4
