Page 27 - Delaware Medical Journal - April 2017

PALLIATIVE CARE
POSITIVE OUTCOMES WITH DELAWARE PALLIATIVE
■ 89-year-old Mrs. T is homebound and unable to get to the physician’s office for care. Her physician referred her to Delaware Palliative so that she can be seen by a medical provider in her home. Admitting diagnoses and conditions include dysphagia, dementia, hypertension, and chronic arthritic pain. She is essentially non-communicative. In the months prior to admission to Delaware Palliative, Mrs. T had experienced frequent and multiple emergency department visits and hospitalizations for upper respiratory infections with mucus plugging. In consultation with Mrs. T’s primary care physician, the Delaware Palliative nurse practitioner was able to obtain a portable suctioning unit for the home, and has educated the caregivers in its use. Instruction has also been provided in early signs of respiratory infection. Additionally, the patient has been treated at home for a rash, pressure ulcer, and chronic urinary tract infection. Mrs. T’s daughter has formed an excellent relationship with Delaware Palliative and calls as soon as she observes a change in her mother. Home assessments, early interventions, including medication prescription, caregiver education, and support has prevented further emergency department visits and hospitalizations for five months.
■ Ms. G is a middle-aged woman living with ALS and arthritis. Her goal is to live independently in her home for as long as possible. She was referred to Delaware Palliative for the support needed to realize that goal. Ms. G continues to visit her specialists and actively engages with the ALS support community. The Delaware Palliative social worker has worked closely with the ALS Society, the physician, and the patient’s daughters to assure Ms. G has the transportation, equipment, and in-home caregivers she needs. Outpatient therapy is no longer feasible, so home physical therapy
was ordered by the primary provider. Eventually, the ALS is going to progress to a point where hospice care may be the most appropriate option for Ms. G. Transitioning to hospice for this patient and her daughters may be more easily accomplished and accepted as a result of their involvement in the palliative care program.
Delaware Palliative has admitted and cared for more than 400 patients since the start of the program in 2014. The most commonly seen diagnoses include cancer, dementia, end-stage renal disease, congestive heart failure, and chronic respiratory diseases. Referrals are made by general and specialty physician practices, cancer care treatment centers, inpatient palliative teams, discharge planners and case managers, home health agencies, care navigators, and nursing facilities. As Delawareans are hearing about the services, more patients and families are seeking assistance by calling Delaware Palliative directly or by speaking with their physicians.
Patients at any age and stage of serious

palliative services. Medicare, Medicaid,
and some Medicare Advantage health insurance programs cover palliative services. Patients are responsible for co-pays, deductibles, and visits not covered by their insurer.
Delaware Palliative wishes to partner with community providers at all levels and in all settings to improve the quality of life for Delaware individuals and their families. Consider making a referral to Delaware Palliative if your patient:
• Has a serious, life-limiting illness that

health care outside their home;
• Is experiencing exacerbations that cause them to call 911 and go to an emergency department;
• Has complex social services needs that threaten their ability to age in place;
• Has had a need for facilitated exploration and decision-making conversations regarding end-of-life care wishes.
Delaware Palliative Referral Line: 1-800-838-9800
CONTRIBUTING AUTHOR
■ TRACY TULL, RN, MSN, CHPCA is Vice President of Compliance and Education and Delaware Palliative Program Coordinator for Delaware Hospice.
Del Med J | April 2017 | Vol. 89 | No. 4
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