The COVID-19 outbreak — and associated morbidity and mortality — has underscored the need for clinicians to navigate difficult, often emotional conversations with patients and families about their goals and wishes for the care they receive, including end-of-life and hospice care. Providers that specialize in hospice and palliative care excel at navigating these sensitive conversations and undergo specific training to develop those skills.
Palliative care providers are adept at communicating with patients and families to ensure that they receive care that is consistent with their goals and wishes. The need for goal-concordant care continues even in times of crisis, according to a report from the journal Caring For the Ages, particularly in the post-acute and long term care settings.
“This global health crisis has increased the need to swiftly identify a resident’s preferences for medical treatment. Health care providers who specialize in palliative care, a medical specialty focused on advance care planning and symptom management in serious illness, have been eager to bring their skill set and resources to the frontlines, especially to the post-acute and long-term care setting,” wrote researchers Melissa McLean and Victoria Nails. “Interventions such as initiating discussions to address goals of care and using therapies to relieve distressing symptoms (physical, social, and/or spiritual) are concepts inherent in [palliative care], and they are vital to the care of older adults with COVID-19.”
Nalls is the director of education for hospice, palliative and serious illness care provider Capital Caring Health, and McLean is a nurse practitioner and medical director of community-based palliative care for that organization.
The hospice and palliative care patient populations are among the most vulnerable to coronavirus disease (COVID-19) infection. Understanding the risk points can be key for providers to minimize the potential risks of COVID-19 on aging and seriously ill patients.
Currently 72% of hospitals in the United States with 50 or more beds have a palliative care program. This is up from 67% in 2015 and 7% in 2001, according to the Center to Advance Palliative Care (CAPC). These institutions care for 87% of all hospitalized patients nationwide. Large nonprofit hospitals in large cities are the most likely to provide palliative care.
Data on the availability of community-based palliative care services are limited, but CAPC numbers show that at least half of the in-home providers of those services in the United States are hospices.
Core aspects of palliative care can provide a foundation for responding to a COVID patient’s needs, including alleviation of symptoms, multidisciplinary teams, patient-centered care, and support for patients’ families.
The expansion of telehealth during the pandemic has allows palliative care medical staff, nursing staff and social workers to extend their reach into the post-acute and long term care space, even as in-person visits become more difficult as organizations work to prevent the spread of the virus.
In addition to performing direct consultations with patients and families, palliative care providers have been mobilizing to educate their counterparts in other medical fields on how to manage these conversations to ensure goal-concordant care.
“Multiple evidence-based resources to prepare and educate both patients and health care professionals have been created, and they are freely available during this pandemic,” the researchers indicated. The impact of COVID-19 has been devastating in [post-acute and long term care], and serious illness conversations and advance care planning have never been more critical. How the COVID-19 pandemic will impact the long-term delivery of health care remains unclear, but one thing is certain: incorporating PC concepts into the care of individuals with chronic, life-limiting illnesses across all health care settings empowers both patients and families, allowing them to have more information and perhaps a plan for when the unimaginable occurs.”
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