Coordinating Palliative and Therapeutic Care in Long-Term Care Settings
A person-centered approach to medical care requires that providers and family members prescribe and encourage care that is, in their opinion, in the best interest of older individuals. This approach also dictates that each older adult’s personal wishes, values, and financial situation be considered and integrated into care decisions. As older adults in long-term care settings often have multiple comorbidities and are nearing the end of life, it is important to ensure that coordinated, efficient palliative care is considered and available. Careful attention to skilled care and therapeutic care outcomes is also necessary to maintain residents’ quality of life.
Articles in this issue of Annals of Long-Term Care: Clinical Care and Aging®(ALTC) discuss strategies to improve access and delivery of palliative care in nursing facilities and explore factors contributing to improved patient therapeutic outcomes.
According to recent studies, less than half of nursing homes in the United States have a framework or protocol regarding comprehensive palliative care. This estimate, among other factors such as the increasing population of older adults, makes the provision of palliative care one of the greatest challenges across the country. In this month’s ALTC ECRI Strategies column, Victor Lane Rose, MBA, NHA, FCPP, CPASRM, examines how palliative care is currently delivered in care facilities and discusses practical steps facilities can take to increase quality of and access to palliative care. His column explores topics such as surrogate decision makers and how to measure performance and drive improvement.
Continuing in the theme of improving palliative care, one of the feature articles in this issue by Kelly E Baxter, MS, APRN, ACHPN, and colleagues, describes a yearlong pilot project. Her research concentrated on enhancing care transitions and reducing hospital readmissions from skill nursing facilities (SNFs) by creating a transition team for discharged patients receiving palliative care and extending palliative care into partner SNFs. The extension of palliative care services and consultation was achieved by having a palliative care nurse trained in conversation skills follow discharged patients to subsequent facilities. With improved conversations between inpatient and community-based providers through case conferencing, nurses were able to identify patients who may benefit from more intense palliative care interventions and then expedited this transition when necessary. Hospital readmission rates decreased among community-based facilities. The project design demonstrates opportunities in which hospitals and community partners may collaborate in order to enhance the delivery of palliative care and subsequently reduce unnecessary care transitions and potentially avoidable hospital readmissions.
Patients’ financial and insurance situations may at times play a role in the quality and consistency of patient care—especially when care spans across different settings. Different sources of insurance for skilled nursing care may have varying policies about duration and continuation of care that could influence patients’ attainment of therapist-guided goals. Samson Barasa, MD, and Donald A Jurivich, DO, sought to explore whether there may be a link between SNF insurance policies and patient outcomes at 3 large metropolitan nursing homes that accept the following major forms of insurance: Medicare, County Care, and commercial insurance. Patients’ insurance payment source was examined as the primary risk factor for attaining SNF goals. Secondary risk factors considered included patients’ age, gender, SNF admitting diagnosis, comorbidities, and functional status at SNF admission. Authors’ results represent the first known observation of the association between patient SNF insurance policies and health care outcomes.
In this issue, authors demonstrate how readers can optimize palliative care and skilled nursing care in their facilities by providing guidelines, performance measures, and real-world intervention strategies as well as highlighting what patient characteristics, such as insurance source, that needs to be considered before action can be taken toward improvement.
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