To begin this discussion on palliative and hospice care, Dr. Marc Rothman, Chief Medical Officer, introduced a panel of three Kindred executive clinicians:
- Dr. Mark Fox, Division Vice President of Medical Affairs and Regional Medical Director of the Mid Atlantic Region for Kindred at Home
- Dr. Amy Moss, Division Vice President of Medical Affairs and Regional Medical Director of the South Central Region for Kindred at Home
- Dr. Amjad Riar, Division Vice President of Medical Affairs and Regional Medical Director of the North Central Region for Kindred at Home
First the panelists were asked: What is the difference between palliative, hospice and end-of-life care?
As you may already know, palliative care is the management of physical, emotional, social and spiritual suffering. It also involves directed treatments related to chronic, life-threatening or terminal pain and disease. Most important, palliative care means improving the quality of care through communication and informed decision making. It is a HOLISTIC approach.
Palliative care is NOT a single treatment algorithm and not limited to end-of-life care or restricted to pain management, nor is it only appropriate for cancer-related diagnoses.
"It has been the biggest battle with healthcare providers to separate the differences between hospice and palliative care," explained Dr. Riar. He then clarified that hospice is an insurance-provided service and palliative is a way of improving quality of life.
Traditionally, where life-prolonging care ends, hospice care begins. More recently, palliative care is being utilized for hospice care and even bereavement.
The national average hospice care length of stay during 2015 was less than seven days. Ideally, that time would be 180 days to get the full benefits of that special care.
"I have yet to meet a family that said we should have waited," Dr. Fox said. "Instead they say, 'why didn't we come to you sooner?'"
But it isn't just the patients and families who don't understand hospice and palliative care. According to Dr. Riar, some physicians use palliative care for the wrong reasons or at the wrong times.
Dr. Moss used this metaphor to help everyone keep it straight: "Palliative care is the overarching umbrella, and hospice is a spoke of that umbrella."
She also explained that we don't have to give up something to gain palliative care and, in fact, we gain a lot. She added that it isn't about restriction of access to care, but rather the alignment of the two.
Palliative care defines a team, but when that patient goes home, the team often doesn't follow. "This is where Kindred can be different," Dr. Fox said. Dr. Moss said that in her inpatient palliative care facility, 76% of patients discharge alive and into services like home health.
Dr. Fox also described a common misconception that some people think palliative care means giving up, which makes some patients reluctant to accept. He used his own parents as an example, saying that they lived much longer than they could have because he improved their quality of life with palliative care.
Dr. Rothman, who moderated the panel, added that there are many proven benefits for patient, family and clinic when palliative care is brought in early. He said he hopes that as a company Kindred can take the lead in educating the public about palliative care and help to improve the understanding of the benefits of palliative care throughout the country.
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*Each year the Kindred Clinical Impact Symposium focuses on a topic to enhance clinical practice in the post-acute continuum and to maintain Kindred as a leader in clinical excellence. This eighth symposium focuses on pain management across the continuum. At this week's symposium, held in Louisville, Kentucky, national speakers discuss these topics broadly, while internal speakers bring it home to Kindred attendees from across the country.