EXECUTIVE SUMMARY
Palliative care services have been on the rise in the past decade as an increasingly aging population is in need of these services. Palliative care and case management can work well together.
- Both case management and palliative care have a team-based approach to improving quality of care.
- There is greater need for both palliative care and case management due to the increasing complexity of medical care and medical challenges.
- People with advanced diseases are living longer and are in need of services that provide the benefits of hospice without the prognosis of having less than six months to live.
Case managers likely are going to hear a great deal more about palliative care in coming years. Case management’s team-based approach to improving quality of care increasingly is being used for patients with life-threatening illnesses.
Within the past decade, palliative care services have multiplied by 148%, studies show.1,2
“The evolution of palliative care in the last five years has been tremendous,” says Ellen Wild, RN, CHPN, palliative care nurse coordinator for the Mayo Clinic in Rochester, MN.
“A lot of this is because of the complexity of medical care and people’s medical issues,” Wild says. “Fifteen to 20 years ago, when people got sick from advanced cancer, heart disease, and lung disease, there often were limits in treatment and people didn’t live long with the diseases they had.”
Now, people with advanced diseases are living longer and often are not eligible for hospice care under Medicare, for which patients qualify with a prognosis of less than six months to live. “People have more complex diseases now and it’s often not just one medical event, but a combination of things, that lends itself to palliative care,” Wild says.
Palliative care is both a philosophy of care and expert, holistic, interdisciplinary care for people with serious, life-limiting illness, says Lynn Borkenhagen, DNP, CNP, ACHPN, assistant professor of medicine at the Mayo Clinic College of Medicine. Borkenhagen also is a hospice and palliative care nurse practitioner who works with the Mayo Care Transitions/Palliative Care Homebound Program.
“What we do is add a layer of support to the care teams already involved with the patient, so patients do not have to give up their long-time physicians or nurse practitioners,” Borkenhagen says. “We come on board and augment the care they’re receiving now.”
Worldwide, only 14% of people who need palliative care receive it, and a growing number of people are in need of palliative services as populations age and chronic illnesses are on the rise, according to the World Health Organization (WHO).
“The evolution of case management in nursing and primary care has taken place for similar reasons: People have more comorbidities, complex illnesses, and care has become more complex,” Wild explains.
“In order to keep people from being in the hospital and to give them the best care, they’ve instituted care teams and case-managing nurses to fill that gap,” She adds. “This also is true in primary care and palliative care.”
Including palliative care services is absolutely critical in care coordination, says Walter Rosenberg, MSW, LCSW, manager of transitional care, health, and aging, at Rush University Medical Center in Chicago.
“Goals of care discussions are something we integrate in our program,” Rosenberg says. “In our care continuity calls, we’ve recently mandated that somebody from the Rush palliative care team be on those calls, whether the person is heading to palliative or hospice care or not.”
Four out of five adults needing palliative care have cardiovascular diseases, cancer, and chronic respiratory diseases, a WHO 2015 fact sheet reports.
“Palliative services are, for the most part, concentrated in acute care,” says Diane E. Holland, PhD, RN, clinical nurse researcher in the department of nursing and an associate professor in nursing at the Mayo Clinic College of Medicine. Holland has focused on palliative care in her research.
“Yet, there is an understanding now of the benefit of palliative care services further upstream when a patient has a known condition that can be life-limiting,” Holland adds. “There is very much a growing interest in establishing palliative care as part of primary care.”
Holland’s research has shown that most palliative care services are in hospitals, limiting their availability to rural patients. Also, discharge plans that fail to coordinate transitions from hospitals to home often result in poorly managed care and costly medical errors.1
Case or care management, using technology, can help bridge the palliative care gap. “When a patient is introduced to acute care palliative care resources and then sent home, the primary care provider might not have any education about palliative care,” Holland explains. “Palliative care is different from end-of-life services.”
Since case managers focus on improving patients’ quality of life, palliative care services are a good fit, Holland says.
“There is some evidence that connections to palliative care actually prolong people’s lives,” she adds.
Palliative care is an undervalued service, Rosenberg notes.
“These are tough conversations to have, and we see a lot of families who are struggling with [end of life] terms,” he says. “We have conversations about what it feels like for patients and their caregivers to have discussions about end of life care, and it’s critical to include this in all transitional care programs.”
Case managers can continue conversations with patients, their families, acute care, and primary care providers about palliative care, Holland says.
“It’s also helpful for case managers to have knowledge about a patient’s [advance care planning] preferences and why the person wants to move forward with treatment,” she adds.
REFERENCES
- Holland DE, Vanderboom CE, Ingram CJ, et al. The feasibility of using technology to enhance the transition of palliative care for rural patients. CIN. 2014;32(6):257-266.
- Meier DE. Increased access to palliative care and hospice services: opportunities to improve value in health care. Milbank Q. 2011;89(3):343-380.
Case management’s team-based approach to improving quality of care increasingly is being used for patients with life-threatening illnesses.
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