Palliative care is often delivered in the hospital setting or in the home, but a number of organizations have set up clinics to deliver those services.

These locations often assist patients by offering a variety of services beyond symptom management. While they offer an alternative to home-based services, they present their own unique benefits and challenges.

One of the agencies that uses the clinic model is Hospice of Northwest Ohio, which serves both Ohio and Michigan. Their palliative care subsidiary, Sincera — Supportive Care and Symptom Relief, launched in 2008 and recently opened a location in Oregon City, Ohio. At Sincera clinics, patients of any age who have chronic, serious illnesses can receive expert palliative care services.

Creating the clinic-based model was a challenge, according to Richard Russell, president and CEO of Hospice of Northwest Ohio.

“Physicians and other providers are accustomed to home-based care,” Russell told Palliative Care News. “Palliative care has historically been an at-home service, but we realized the growing need to expand our service, allowing our providers to serve more people. Changing the mindset of the referring physicians and providers to use this clinic-based service is probably the biggest challenge.”

One of the benefits of the clinic-based model is improved access to care. Patients come to the clinic when they need to and can be attended to by the appropriate personnel. For Russell, this is the main focus of the clinics.

“Providers are able to see and support more patients and families to meet their complex needs,” Russell said. “This option is for those who continue to be able to access community services or who would prefer to be seen outside the home.”

Similar to other palliative care programs, Sincera’s clinics use an interdisciplinary model, including nurse practitioners, registered nurses, social workers, chaplains and volunteers under the direction of board-certified palliative care physicians. The program currently works with 180 physicians in its service area. Sincera also partners with Hospice of Northwest Ohio to provide aid and support for caregivers as well as advance care planning.

All patients with chronic, serious illnesses can receive expert palliative care services at the Sincera clinics, Russell indicated. Qualifying patients may suffer from heart disease, cancer, lung disease and neurological conditions. The clinic’s efforts are paying off, with 94% of patients showing improvement, according to the Hospice of Northwest Ohio website. 

One of the difficulties of creating a clinic-based palliative agency is finding space, and Sincera’s community partners are especially important in this regard. First, the clinic-based model presents challenges in its need for physical space and the associated costs. However, Sincera’s community partners, such as the Toledo Clinic Cancer Center, provided space for the palliative care clinics.

“We have been very fortunate to have strong community partners that recognize the need for high-quality palliative care services and who have willingly worked with us to allow us to utilize their existing clinic space throughout the community,” Russell said. “These partnerships allowed us to quickly establish these clinics without the need for significant investment in brick-and-mortar facilities.”

Sincera’s palliative care clinics receive reimbursement from insurance companies as well as from Medicare and Medicaid. For low-income families, care is still a priority, Russell said.

“As with all our programs, care is provided regardless of the patient’s ability to pay. Again, community support is critical for funding,” Russell told Palliative Care News.“ Mission-driven organizations like Hospice of Northwest Ohio use community support to assist these programs so that we can meet the needs of patients and families in the community.”

For organizations interested in creating a clinic-based palliative care model, Russell has the following advice:

• Evaluate the community need. Be sure your target area can support a clinic.
• Identify a community partner. You’ll likely need to share space with another physician/health group, at least initially. It’s a good idea to choose a specialty group whose patients are likely to need palliative support.
• Plan to start small, perhaps operating one day a week.
• Make sure you have enough administrative support to keep the burden on the providers low.

In addition to the clinic-based care, Sincera also offers home visits for patients who are unable to travel. Regardless of whether services are provided in the home or onsite, Russell said, “We deliver the same high-quality palliative care regardless of setting.”