VA Study Finds 95% Increase in Palliative Care Utilization When Patients Have Access to Social Workers

Patients are more likely to receive palliative care if they can access social workers through their primary care providers, Veterans Health Administration (VA) research has found.

Researchers analyzed records for 43,200 veterans with prior hospitalization who had received primary care at a VA site between October 2016 and September 2019. They found a 95% increase in hospice or palliative utilization among veterans served by VA providers participating in the agency’s Social Work Patient Aligned Care Team (PACT). The average age among the veterans was about 65.

“This cohort study found significant increases in use of palliative care for recently hospitalized veterans whose primary care team had additional social work staffing,” the authors wrote in the story. “These findings suggest that social workers may increase access to and/or use of palliative care.”


Prior research found that the program had also resulted in reduced hospitalizations and emergency department visits.

A subset of the VA’s PACT program funded social work positions for three years in locations serving rural veterans, including outpatient clinics co-located in a medical center as well as stand-alone, community-based offices. After the three-year period, the sites could choose to fund the positions from their own budgets.

The researchers took into account the number of veterans who had received a palliative care encounter during the 30-day period after an acute inpatient hospital stay at either a VA hospital or VA-paid stay at a community hospital. They included VA hospice encounters in the outcome but not enrollment in a home hospice program, nursing home hospice center or Medicare-paid hospice.


The social workers received training in the VA’s Social Work Practice Model, which emphasizes comprehensive assessment of patients’ psychosocial needs followed by ongoing case management and treatment planning.

“Health care social workers have the skills to overcome barriers to palliative care, including educating patients, helping them understand their options, and eliciting preferences for care,” authors wrote in the study.

The barriers to palliative care largely mirror those affecting the general population, such as poor understanding of those services among patients and reluctance among clinicians to make referrals, the researchers indicated.

But differences do exist between the VA and the health system at large. For instance, the VA allows patients to receive hospice care concurrently with other medical treatments. The agency in the early 2000s also launched several initiatives to expand veterans’ access to hospice and palliative care.

“As health system leaders consider where to invest resources, social workers present a patient-centered approach to increase the use of a service that can improve outcomes and decrease readmissions,” the authors wrote. “Increasing access to palliative and hospice care may partly explain how primary care social work staffing can decrease unplanned emergency and inpatient care.”