Palliative Care: The Next Frontier in Patient-Centered Care and a Value Proposition for Seniors Housing
The focus of modern medicine has been centered squarely in the curative camp for a long time. As Atul Gawande put it in his recent New Yorker article, modern medicine is a practice in “rescue medicine,” meaning the goal of treatment is to immediately and summarily save the patient. Unfortunately, in life, some diagnoses are not so easily remedied. Though in today’s world, a cancer diagnosis is by no means a death sentence, neither is it a free pass. Patients diagnosed with serious illnesses are not always capable of being “rescued;” nor do they necessarily want to give up their autonomy over their own health and quality of life to the health care system. In most cases, patients have their own set of goals for the future, some of which may have nothing to do with medical treatment. Nonetheless, those goals are complicated because of illness and may be omitted from the care plan.
Enter palliative care.
According to the National Hospice and Palliative Care Organization,
“Palliative care is patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information and choice.”
You may be surprised that the definition of palliative care does not refer to care given at the end-of-life. Palliative care is not hospice, though many–even many in the medical profession—have difficulty making this distinction. Indeed, palliative care usually begins at diagnosis and can act as an additional layer of treatment alongside life-prolonging and curative care. A team usually comprised of a primary care physician, nurse, spiritual guide (e.g., a priest, a rabbi, etc.), and/or a social worker work together to uphold the patient’s wishes while prioritizing quality of life. A palliative care team provides a number of services, such as acting as a patient advocate, coordinating care, symptom management, and providing counseling for patients and family members. Patients receiving palliative care can have a range of diagnoses such as cancer, Alzheimer’s disease, congestive heart failure, COPD, and many more.
As stated above, palliative care does not imply that the patient necessarily ceases life-prolonging medical treatment, as is the case with hospice. Some physicians out of a desire to not appear as “giving up” may hesitate to prescribe palliative care as an additional consultative service to their patients, but evidence suggests outcomes actually may be improved because of palliative care. Attitudes are changing. As health care delivery continues to evolve into a more patient-centered model, palliative care is growing in popularity.
As noted in a recent NIC blog post about the high-need, high-cost population, the Centers for Medicare and Medicaid (CMS) is actively looking for opportunities to lower overall Medicare spending on this population. A study published in JAMA Internal Medicine in 2008 confirmed that the presence of a palliative care team in a patient’s treatment plan resulted in lower hospital costs, therefore suggesting palliative care aligns with CMS’s goals and could increase in popularity if regulations are put forth to promote this additional layer of consultative treatment. Other policy efforts to grow the use of palliative care and similar services include a 2015 final rule from CMS that allows providers to bill Medicare for advanced care planning and the Medicare Care Choices Model, a pilot in which over 140 hospice providers will be able to bill Medicare for palliative care services while patients receive concurrent curative care.
Palliative care could be part of the value proposition of seniors housing.
Much of palliative care is delivered in the home, which for seniors housing residents, means inside an independent or assisted living community. And, while the majority of seniors housing residents may not be receiving palliative care, many may be eligible. Consider the percentage of assisted living residents with a dementia or COPD diagnosis, diseases commonly treated with palliative care. Many seniors housing providers already provide a number of services that could be incorporated into a palliative care treatment plan, such as working with family members to understand the progression of disease or providing assistance with advanced directives. Indeed, seniors housing providers can highlight their existing services that align with palliative care, further underscoring the value proposition seniors housing communities poses to residents.
According to Hal Friedman, Senior Director for Seasons Hospice and Palliative Care’s program in Maryland, palliative care is more commonplace in nursing homes where a high concentration of residents with comorbidities reside. Staff in these settings as compared to staff in assisted living, he explained, are also more familiar with palliative care and, therefore, are more inclined to refer families and residents to palliative care. Meanwhile, compared to patients living independently in the community, within “the assisted living setting, you’ve got more eyes and ears on the patient, so if they see a change in the resident, they would call the palliative care team.” He added that assisted living operators see the value in palliative care, but the practice is not currently commonplace in Maryland.
Seniors housing can join the larger discussion.
Palliative care is evolving as a treatment option for patients with complicated illnesses, which means the seniors housing and care industry has a unique opportunity to add its perspective. One group pioneering the effort to expand access to palliative care is the Coalition to Transform Advanced Care (C-TAC), which recently launched the Campaign to Transform Advanced Care. The campaign is a blend of policy efforts, caregiver support, and coordination with other coalitions. Marian Grant, policy advisor for C-TAC, explained that there are a number of ways seniors housing and care stakeholders can join the conversation: “They can educate their staff and residents on the benefits of palliative care, explore incorporating it into the health services they offer, and promote activities like advance care planning and the completion of advance directives or POLST [Physician Orders for Life-Sustaining Treatment] forms.” Grant added that “Palliative care’s focus on improving the quality of life for those with serious illness and their loved ones is aligned with the philosophy of seniors housing.”
Because of changing attitudes in health care delivery to treat the whole patient and move away from “rescue medicine,” seniors housing operators may identify many opportunities to create additional value for residents by incorporating palliative care elements into their business models or by supporting resident access to this type of care. CMS initiatives and consumer demand for palliative care services will also drive this treatment option into the mainstream. As Grant points out, “Patients and families are so grateful once they receive these services, it will reflect well on this industry for providing them.”