Hospice and palliative care are not necessarily “one size fits all” care models. What may be considered palliative with one patient may not be appropriate for another seriously ill patient with a different diagnosis. The standardized approach to hospice and PC can deter referral sources from making timely referrals. I have had many pulmonologists say to me that they will not refer their COPD patients to hospice as they know that they will be prescribed Roxanol and Ativan upon admission – just “to have on hand” – and these medications are contraindicated for COPD. I have heard cardiologists say that they don’t refer as they feel they lose touch with their heart failure patients while they continue to fine tune their medication to optimize comfort and function.
If the standard palliative approach is not meeting the needs of patients and referral sources, then maybe it should be changed. In the past, partnering with specialists in my community, I developed several diagnosis-specific hospice programs. For a COPD specialized program, we did not prescribe opioids until indicated by the pulmonologist, instituted proactive sputum checks to look for infection, educated on the proper use of nebulizers, and focused on managing patients through respiratory crises including the proper use of the ER, among other services. For a heart failure specialized program, we trained on listening for specific heart sounds to report back to the cardiologist, supported a sodium-restrictive diet, covered outpatient cardiac rehab, and worked to proactively manage edema, among other services. These efforts made the patients more comfortable, increased length of stay, increased referrals tremendously, and broadened the understanding of what true palliative care can be, including within our own organization.
As the post-acute care market becomes more and more competitive, and as organizations are challenged to embrace the totality of the care continuum for seriously ill patients, the approach of diagnosis-specific care programs, whether through hospice or non-hospice palliative care, becomes more relevant. Focusing on the unique needs of a diagnostic group – perhaps one that is currently underserved or has many unmet needs – can be a way to differentiate and grow your organization, build partnerships with specialists in your community, empower your clinicians, and better meet the needs of families.
“Elegant, Expert Care: The Emergence of Neuropalliative Services” by Kristin Easterling, posted by Hospice News on September 11, 2023, and accessible at https://hospicenews.com/2023/09/11/elegant-expert-care-the-emergence-of-neuropalliative-services