Some palliative care providers have fueled stronger referral efforts in skilled nursing facility settings as a way to reach patients sooner in their serious illness trajectories. Measuring the impacts of these efforts has come with various challenges.
Timely identification of potential palliative needs in nursing homes is critical to supporting rising demand for serious illness support in these settings. But many patients lack support due to insufficient awareness and education around palliative care, according to Dr. Kathleen Unroe, geriatric and palliative care physician, researcher and a professor of medicine at Indiana University. Unroe is also co-founder, CEO and chief medical officer of the virtual support care provider Probari Inc.
Misunderstandings around the difference between palliative care and hospice are among the most significant barriers preventing wider examination around quality impacts, Unroe indicated in a recent GeriPal podcast. More standardized palliative patient assessments and stronger integration of these services across the care continuum is needed, she indicated. Greater research efforts could also go a long way, Unroe added.
“There [are] a lot of misconceptions around palliative care,” Unroe said during the podcast. “We need to enhance capacity in the nursing home [and] the level of knowledge and understanding of what palliative care can offer to kind of make some of those other steps move through a little faster. We have to work on the business model part of it and the evidence-based part of it, and then we can get more palliative care providers in there. But they need to know they’ll be impactful. They need to know they’ll be welcomed, accepted and that they will have enough residents there to make it make sense.”
A small but growing body of research has found that integration of interdisciplinary palliative care teams can help ease burnout at nursing homes amid prolific clinical staffing shortages, according to Dr. Cari Levy, professor of medicine at the University of Colorado and board certified hospice, palliative and geriatric medicine physician.
The most successful models integrate colocation of interdisciplinary palliative care staff at skilled nursing facilities and involve developing strong referral partnerships with these professionals, Levy stated. Providing basic palliative care training to non-clinical staff has also led to improved outcomes.
Despite the progress, not enough is known about the impacts of palliative care integration in skilled nursing settings, with several barriers preventing wider research efforts, according to Connie Cole, nurse, researcher and assistant professor at the University of Colorado’s Division of Geriatric Medicine.
Many unknowns exist when it comes to palliative referral processes, evidence-based patient screening protocols and symptom management in skilled nursing facilities, Cole said. Staffing issues have stymied progress of evidence-based clinical studies, she stated. Greater integration of technology in care delivery may help with more meaningful examination around the effects of palliative care services among seriously ill patient populations in skilled nursing settings, according to Cole.
“[Staff turnover] is a big problem in nursing homes, and that’s why we need to do something to integrate [palliative care] into workflow,” Cole said during the podcast. “Perhaps the [electronic health record (EHR)] identifies someone [who] has palliative care needs and automatically shoots an email to the provider. There’s different ways that we can sidestep around some of that turnover and also sidestep some of the shortages that we see with it.”
