Thought Leadership

Acclivity Health’s Chief Innovation and Advocacy Officer explains why patients and families shouldn’t hesitate to seek hospice care.

As seriously ill patients near the end of life, it is often suggested that hospice care become part of their health care plan. Unfortunately, patients often enroll in these services too late to reap the full benefits. Dianne Gray, Chief Innovation and Advocacy Officer at Acclivity Health, says this is often due to a stigma that surrounds hospice care.

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Over half of all hospice referrals today come from hospitals that often wait too long to refer a patient into hospice care. Whether they believe a referral suggests they are abandoning the patient or they anticipate higher profits from an extended stay, too often hospitals prevent patients from receiving hospice care in time to make it meaningful.

Independent physicians and specialists often don’t have the time or experience to handle hospice care coordination efficiently. However, when physician groups align with hospice organizations in a formal community structure called a Connected Care Community, these doctors can remain on the front line of their patients’ care.

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Today’s doctors are trained to keep patients alive, but not always to prepare them for death. From developing a care plan to delivering the news to supporting their patients’ medical, emotional and spiritual needs, most doctors are uncomfortable starting the conversations required to develop the most appropriate end-of-life care plans.

As Baby Boomers retire and age, we have an older generation that has grown up expecting continuing gains to their longevity. But longevity doesn’t mean everyone who lives longer lives in good health. In fact, according to the National Centers for Disease Control and Prevention, about 60 percent of adult Americans have a chronic disease, and 40 percent have more than one1. Our medical community needs to ensure that the sickest and most vulnerable in this generation will receive comprehensive, high-quality, person- and family-centered care that honors their dignity and choices and is consistent with their goals and values.

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Less than 40 years ago, when you went to the Emergency Room at your local hospital, you had no idea what kind of doctor you’d see. Staff physicians in the hospital took shifts in the ER, so you might have an obstetrician casting your broken wrist or a psychiatrist treating your heart palpitations. Beginning in 1979, Emergency Medicine was recognized by the American Board of Specialties. Over the next decades, EM specialists became thoroughly integrated into the continuum of care, so that today, patients coming into to the ER can expect treatment and a proper diagnosis from the right physician. 

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Eighty percent. That’s how many Americans would like to die at home. But despite the fact that 70 percent of Americans die from chronic illnesses1, giving them time to anticipate their deaths, over 50 percent still die in hospitals or nursing homes.2  Of the Medicare patients who died in 2016, only 48% received hospice services at the time of death3, even though every patient was eligible for six months of hospice care.

Prior to 1950, the majority of Americans did die at home. At that time, many chronic and advanced illnesses were untreatable, and all physicians could offer was palliative care. Over the next few decades, innovations in medicine enabled doctors to prolong life with medical and surgical interventions and for hospitals to treat patients with ventilators and IV anesthesia. As seriously ill patients lived longer, medical institutions recognized advanced illness management as an effective way to maximize their profits.

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What Is Palliative Care?

Palliative care is a discipline of skilled medical care designed to relieve suffering and improve the quality of life for patients and families living with serious, advanced, or life-defining illnesses.  It can be available to patients of any age with serious illnesses of all types, at any stage of illness, providing care in all locations.  It is typically supported by insurance plans.  We believe that despite having a serious – possibly terminal – diagnosis, there is the potential of experiencing meaningful quality of life.  Though maintaining an understanding of the reality of a serious illness, the focus is on clarifying a patient’s values, wishes, hopes, and dreams, and creating the optimal care environment that allows them to move beyond potential pain and suffering and realize opportunities for joy in life.  It’s about living, not dying.

How is Palliative Care Different from Hospice?

Hospice care is team-based service designed to help those with a limited life expectancy. An interdisciplinary team including a nurse, social worker, chaplain, physician, and volunteers. In most circumstances, hospice is provided to patients with less than six months to live, and who are willing to forego further curative treatment.

Hospice care includes skilled palliative services, but palliative care does not require participation in hospice, and doesn’t have the restrictions of a limited prognosis. It’s quite common for patients with a palliative plan of care to continue to receive curative or disease modifying treatments. Palliative care provides for optimal treatment of symptoms related to underlying disease or treatment; it also provides the opportunity to discuss plans of care, and assure that a patient’s treatment plan is consistent with their wishes and goals.

What Should You Expect?

There are many illnesses that can accurately be predicted to place a potential burden of suffering onto a patient: cancer, progressive neurologic diseases (ALS, Parkinson’s disease, Alzheimer’s disease), congestive heart failure, chronic lung disease, kidney failure, liver disease, just to name a few. Ideally, palliative resources should begin at the time of diagnosis of a life-defining illness.

We are moving into an era in health care in which palliative care is becoming recognized and accepted as a normal part of a treatment course for advanced and serious disease. Most hospitals offer inpatient palliative services, and many communities now have community-based programs: home visit palliative programs, palliative care in nursing homes, and palliative clinics, both free standing and those imbedded in cancer centers.
Anyone experiencing challenges with a serious, chronic, or advanced disease should ask their doctor about palliative services. When curative therapies are no longer effective or desired, and life expectancy is realistically measured in months, that’s the time to request hospice services.

John Mulder, MD

Medical Director, Trillium Institute
Chief Consultant for Hospice and Palliative Care, Holland Home
Medical Director of Palliative Care, Metro Health