Palliative care program: Formalizing what we’ve done all along

December 11, 2015

With the launch of an “official” palliative care program this October, Housecall Providers is once again breaking new ground in healthcare. No blueprint exists for rolling out such a program.

“Palliative care has been mostly used in the hospital setting, so we are adapting this emerging field to fit with our mostly geriatric, frail patient population and primary care practice,” said Mary Sayre, RN, primary care program director.

The Housecall Providers in home palliative care team: from left, nurse Katie Kusmaul, chaplain Kate Jaramillo, social worker Kirk Porter and nurse Kelly Ambrose.

The Housecall Providers in home palliative care team: from left, nurse Katie Kusmaul, chaplain Kate Jaramillo, social worker Kirk Porter and nurse Kelly Ambrose.

Palliative care is yet another innovation from Housecall Providers. In 2009, the nonprofit unveiled its own hospice program, and in 2012, a transitions team was created to support patients who were hospitalized or at high risk of being so. In both cases, there were no instructions on how to integrate these services with a primary care practice.

Housecall Providers a national resource

“We are continually being asked to share our experience and expertise with the greater community,” says Executive Director Terri Hobbs. “Healthcare administrators and professionals want to know how we have been so successful and I truly believe it’s because we have put the needs of the patients always at the forefront of our program design.”

Such is the case with the new palliative care program. Palliative care focuses on the relief of suffering and finding the best quality of life as chosen by the patient or family. It has been an integral part of Housecall Providers practice since its founding 20 years ago. However, leadership realized, a more structured program was in order.

“Our clinicians provide complex care, but sometimes the needs of the patient exceed what the clinician would normally be able to provide in a normal clinic setting,” Sayre continued.

Why palliative care

The goal of the team is to partner with the primary care provider to improve symptom management of the patients and offer psychological, social and spiritual support to those who have increased needs beyond what a monthly house call or other health support services, such as home health, can offer. The program will also fill the gap between primary care and hospice.

Initially, all of the 30 or so patients who were enrolled in the palliative care program had taken advantage of the support offered through the nursing, social work and chaplain services.

Who is a palliative care patient

Identifying patients who are appropriate for palliative care seems to be the relatively easy part. “Multiple trips to the hospital are a telltale sign of health instability,” says Sayre. “Also, increased calls to the care coordinators, several requests for our transition team to visit the home and conflicted goals of care are other indicators.”

Currently, Sayre is unsure how many patients the team will be able to handle at one time; the model is a new and untested one. Only time will tell. But, with Housecall Providers’ strong record of successfully launching new initiatives, it will likely become the new model of care for home-based medicine around the country.

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