Though regional variations exist, some palliative care delivery challenges are nearly universal for providers across the globe.
Palliative care providers worldwide stand to benefit from sharing “lessons learned” to address common pain points.
A frequent issue among many palliative care providers around the world is that not enough seriously ill patients, families or referral sources understand the nature of their services, according to Dr. Timothy Ihrig, CEO of Ihrig MD & Associates.
Expanding care collaborations with clinicians across the health care spectrum is among the common approaches that can boost access and awareness around palliative care, he stated. Increasing goals of care conversations among patients and families is another.
“It was a grand slam if we just learn how to care differently, whether it’s supportive questions, your own vernacular …,” Ihrig told Hospice News at the ELEVATE conference in Chicago. “We can recognize when change begins to happen so we can offer relevant care choices based on what your body is capable of doing, what’s sacred to you. We put all that together, it’s a win-win-win situation for the patient, family members, providers in your system. Hopefully, that sparks a revolution of thought and questions [that] that some of us will engage in on this together.”
Recent research in Ireland underscores the point. Nearly 4 in 10 adults in that country said they did not want to think or talk about palliative care, the study found.
Common problems: workforce and reimbursement
Regardless of geography, palliative care providers are challenged globally to find a sufficient workforce as well as secure payment for their services.
Though the world’s base of palliative providers has grown in recent years, their numbers are insufficient to keep pace with the volume of patients and families in need of serious illness care.
The availability of palliative care services has increased in 47% of European countries, according to a recent World Health Organization (WHO) report. About 4.4 million people in European countries have a need for palliative care, the report found.
“Early delivery of palliative care reduces unnecessary hospital admissions and the use of health services,” WHO researchers wrote in the report. “A number of significant barriers must be overcome to address the unmet need for palliative care.”
Countries in European regions lack the regulatory structures that support palliative care expansion, according to WHO. Not enough have policies in place that address health care needs among seriously ill populations, the organization stated.
“Only eight European countries have national laws that include palliative care,” WHO researchers said in the WHO report. “Although 63% of western and 26% of central and eastern European countries have a standalone national palliative care plan, many countries do not have national health policies and systems that include palliative care.”
Only 14% of an estimated 56.8 million people worldwide who need palliative care actually receive these services, according to a separate 2020 WHO report. Many of these individuals live in low- to middle-income countries, the organization indicated.
A main challenge among palliative care providers is finding sufficient reimbursement for the full scope of their interdisciplinary services, including in the United States. Payment streams lack what’s needed to support the palliative workforce of clinicians, social workers and spiritual care providers.
While reimbursement can be challenging, palliative care services offer cost-saving opportunities for health care providers across the continuum.
A big lever providers can pull when working to expand reach is illustrating how palliative care can reduce hospitalizations and other urgent and intensive care services, according to Ihrig. Demonstrating that providing palliative care to seriously ill patients can be a cost-saver is key, he said.
Ihrig is an Oklahoma-based hospice and palliative care physician who previously served as a content expert for the Accountable Care Learning Collaborative (ACAC), an organization with an aim to increase collaboration and address quality and access challenges in the accountable care landscape.
ACAC was instrumental to the development of the Pioneer Accountable Care Organization (ACO) project that took place between 2011 and 2015 piloted by the Center for Medicare and Medicaid Innovation (CMMI). The ACO project analyzed quality improvement and cost savings measures across 32 health care organizations in the United States.
Among the project’s results were a roughly 98% patient satisfaction rate and a 70% per capita reduction in health care expenditures, according to Ihrig.
“That was a premise for this ACO pioneer project … to figure out how to care for these elderly, ill and very expensive people,” Ihrig said. “Challenge the assumption that is the mantra in modern health care – that elderly ill are expensive because they’re elderly and ill. Wrong. They’re elderly and ill because of what we do to them. After a certain point, this does not potentiate increased life expectancy or life quality.”
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The needle is moving forward in some countries toward improved palliative care access.
One example includes a more than $2.1 million infusion from the Canadian government to improve the quality of home-based palliative care across the country.
The country’s ministry of health recently awarded the funds to the Canadian Home Care Association (CHCA) to develop a three-year program aimed at improving the quality and availability of those services.
“Canadians nearing the end of their lives deserve to be treated with respect, compassion, and dignity,” Mark Holland, Canada’s minister of health, said in a statement. “This Government of Canada funding will help the Canadian Home Care Association get more health workers and caregivers the tools and resources to provide quality palliative care to Canadians.”
Dubbed the eiCOMPASS project, the funding will support the development of professional tools and training that will better equip health workers and caregivers with palliative care skills and knowledge. The project aims to encourage the adoption of the Canadian Interdisciplinary Palliative Care Competency Framework, beginning with a network of providers across 12 home-based palliative care settings.
“eiCOMPASS aims to address a significant human resource challenge among palliative care practitioners. Increasing care complexity and rising demand for home-based palliative care requires home care providers to continuously enhance and develop new skills and knowledge,” CHCA CEO Nadine Henningsen said. “Through this project, home care provider organizations will have access to competency-based training and tools that will guide and support the implementation of high-quality, compassionate and culturally safe palliative care services.”
Providing home-based palliative care visits is essential to care for underserved rural regions throughout the world, according to Dr. Deepak Sudhakaran, community and palliative medicine professional at Pallium India.
Similar to the United States and other countries, India’s swelling aging population is outpacing the supply of palliative professionals able to provide serious illness care.
Additionally, patients that live in rural pockets may lack access to family caregivers who can assist with medical transportation and other health or psychosocial needs, according to Sudhakaran. These factors make community-based palliative care services a priority for those in need of support.
“Home visits are a crucial part of our work to attend to patients who are unable to make the journey to our centers,” Sudhakaran said in a recent BMJ article.
