Palliative care providers may have untapped areas of potential when it comes to improving access and quality through services that address social determinants of health.
Though social determinants can take time and resources to build into palliative care programs, they come with a strong return on investment, according to Dr. Yaquta Patni, wound care and geriatric care physician at Innovative Geriatrics.
Addressing social determinants of health (SDOH) in palliative care patients can be an uphill strain on providers’ in today’s current reimbursement climate, Patni said at the Hospice News Palliative Care Executive Webinar Series.
“What we’re doing right now with specifically SDOH in the palliative care space does take time, and it is not reimbursed,” Patni told Palliative Care News. “Hopefully, people will realize that what we’re doing is very important for the final outcome for our patients, our communities and in general for the health of the people that we serve with chronic illness.”
Tapping into untapped social determinants of palliative care
Health literacy challenges and transportation needs represent two of the biggest categories of non-medical and social needs that palliative care programs often overlook, Patni indicated.
Palliative care providers should focus on community-based, local data available in their service regions to determine how best to orient messaging of their social determinant services. Communication on how and what is included in this realm is important to bridge knowledge gaps among palliative populations, Patni said.
Keeping both health literacy and transportation needs in mind is key, she stated.
“SDOH can also be very community based and very location-specific. The most important ones that we see are definitely [related to] transportation. The other thing that we see as a big problem is health literacy,” Patni said. “The literacy level of our patients is the core that we target, because that determines everything. It determines what they’ve understood so far about their medical problems, how they take care of themselves, what barriers they have because of that low health literacy. That has become one of the biggest things that we do and then we go into transportation, money problems and all the other things that SDOH comprise.”
Building social determinant services that are “adjacent” to palliative care and focus on psychological and spiritual support can also be a driver of quality, as well as opportunities for providers, according to Dr. Michael Fratkin, palliative care specialist at the Humboldt Center for New Growth and consultant at Fire & Water.
“[Palliative care providers] are living in the realm of the psycho-spiritual determinants of health,” Fratkin told Palliative Care News during the webinar series. “They’ve made it clean, whereas they work in parallel to, but not overlapping with, the clinical default medical care delivery system, which gives them a sort of more focus on meaning, a sense of well-being support, context, [care] setting, ceremonies, architecture, art, all the other elements. They’re a counterpoint to our fragmented, dysfunctional, overly physically-centered health care delivery system.”
Social determinant services that address loneliness and isolation are other “under the radar” elements in palliative providers’ social determinants of health programs, according to Dr. Jennifer Ritzau, vice president of medical staff services at HopeHealth.
An isolated patient can often have less access to care without caregiver or family member support, Ritzau said. Loneliness and isolation can sometimes carry more significant impacts on utilization than some other common social determinants of health such as economic status, especially among historically underserved populations, she indicated.
These issues are increasingly coming to the forefront of disparities among underserved populations such as LGBTQ+ communities, Ritzau stated.
“Increasingly, in our world, sadly, many people are alone. I think especially LGBTQ elders end up alone,” Ritzau said. “One of the things that feels like the tip of the iceberg for my team is loneliness and hopelessness. [These are] as hard as some of the other [social determinants of health] such as financial and legal things. There are resources for some of those, but when somebody really has nobody, that one’s harder to solve sometimes. You and your team can’t be there 24/7. It is really hard to walk out of that house or facility, close the door and know that nobody’s coming back until you do a week and half or so later.”