PCA was designed to provide both health system AND home-based palliative care solutions. When a home-based service is offered during the inpatient discharge plan, patients become aware that they will not be neglected or their needs forgotten once discharged. In an effort to significantly minimize patients’ anxiety or worry, PCA staff collaborates with existing inpatient health care teams to jointly coordinate a plan of care that reinforces the treatment goals that began inside the hospital. The PCA clinician(s) will establish rapport with both patient and caregiver so that there is a seamless transition from hospital to home. In this way, palliative care uses a transitional model of effective chronic disease management, keeping a patient from unnecessary readmissions for 30 days after discharge and beyond.
PCA can provide health systems the following palliative and transitional care solutions:
While there is no disputing that palliative care can enhance a hospital’s breadth of services while lowering costs and increasing quality care, there are still a rather small percentage of national hospitals and outpatient providers who deliver palliative care the way that it was intended. Part of the reason for this is that it is still in a relatively experimental stage of development. Medical personnel and patients alike have only recently been introduced to the benefits of palliative care. Because of its overall perplexity in the medical world, palliative care must be fully understood before it can be adopted and utilized. While there seems to be many ways that ‘palliative care’ can be defined, PCA prefers the following definition to describe its service philosophy and provision:
“Palliative Care is specialized medical care for patients with serious illness designed to improve quality of life. It emphasizes pain and symptom management for patients as well as consultative support and care coordination for patients and families who are in the process of making decisions about their treatment and goals of care.” (Source: Realizing the Full Benefit of Palliative Care, 2013)
Unlike hospice, palliative care can be delivered to patients simultaneously with curative treatment and at any stage of their illness. It important for providers and medical staff to recognize that palliative care is very distinct from “hospice”. Its philosophical foundation is rooted in comfort for a patient with a serious or chronic illness but not necessarily as an ‘end-of-life’ service. It can therefore be offered as another layer of supportive care during a time when patients truly need the guidance and supervision of a unified team.
Hospitals are widely recognized for helping people get over illnesses and remain healthy following an inpatient stay. However, the costs that are involved in getting patients healthy can be astronomical. What is often overlooked is the importance of receiving the right type of care while inside the hospital. While it’s been shown that palliative care can reduce costs while increasing quality, it is often not made available. In fact, a study* done in 2011 of cost savings for hospital patients who receive palliative care compared to those receiving typical inpatient care clearly demonstrated cost savings for three hospitals who participated in the research.
For patients discharged, the saving averaged more than $1600 per patient. As was previously thought, the main reason for the cost savings centered on shorter ICU lengths of stay for patients receiving palliative care. Decreased ICU days for patients who receive palliative care ultimately allows a hospital to care for additional patients across the board. In this way, ICU costs are lowered and inpatient bed availability is increased for additional patients who require intensive care.
The general public is largely unfamiliar with palliative care, but when provided with a definition, most people are in fact very supportive of the service. In fact, 63% of patients surveyed said they would be very likely to utilize palliative care if it was offered.* This is very attractive to health systems seeking to provide the best care for their patients. As Medicare seeks to incentivize hospitals whose patient satisfaction scores that fall into a desirable range, hospitals will look to find more services that increase care quality.
*(Source: Realizing the Full Benefit of Palliative Care, 2013)
Patient satisfaction and a higher quality of care go hand in hand with each other. Patients report a higher degree of satisfaction through a greater sense of caring, respect and understanding between themselves and their hospital providers. These patients also indicated that the increase in quality represented a greater sense of control, believing that their wishes were taken seriously. Patients who are given care through palliative means can be comforted knowing that they will participate in an open dialogue about diagnosis, prognosis and treatment plan. Patients are allowed to be fully engaged with the provider regarding all aspects of their care.
To fully adopt a palliative care mindset, a hospital can endorse the process by recognizing and addressing one major factor. Palliative care is only successful if it’s offered with permanent intent. In other words, although favorable as an inpatient program, its success will ultimately be measured by its sustainability. When a patient is discharged, the palliative philosophy must translate into the patient’s home environment. If the building blocks erected by the inpatient provider team aren’t addressed beyond the hospital walls then the work done to prevent recurring health crises, including re-hospitalization will be compromised.
The answer can be as simple as three letters: PCA. For patients suffering with chronic or serious illness, the PCA team will provide transitional care alternatives that will lower hospital costs by giving patients the best opportunity to be well. PCA team members can follow patients as they transition from the hospital setting into their own residence. In this way, the palliative work that was initiated inside the hospital can be augmented by the community based clinical team to help ensure that a patient receives continuity of care in the comfort of home.