Massachusetts-based Mercy Medical Center recently launched its new facility-based palliative care unit, an initiative several years in the making.
The Andy Yee Memorial Palliative Care Unit opened in May and is located on the fifth floor of the Mercy Medical Center, which is part of Trinity Health of New England. The 5,000-square-foot unit has eight patient beds and includes overnight family rooms, a reflection space and a consultation area. It was established in part through a $250,000 grant from the City of Springfield, Massachusetts’ American Rescue Plan Act funds and roughly $1.5 million in philanthropic support from more than 260 donors.
The journey to establish the hospital-based palliative care program began in 2022, which now has an interdisciplinary team of nurses, a chaplain, a social worker and a pharmacist. The unit’s name memorializes local restaurateur Andy Yee, who died of cancer at age 59. A main goal is to expand the palliative care program to serve more seriously ill patients and their families, according to Dr. Philip Glynn, director of medical oncology at Mercy Medical Center.
Glynn oversees the new palliative care unit and recently sat down with Palliative Care News to discuss the most significant challenges and opportunities of developing a sustainable program.
What were some of the reasons that led to the launch of the new palliative care unit? Why was this an important initiative to explore?
About 25 years ago, the opportunity to get involved in palliative care came up when I was the director of a hospice program that integrated an oncology practice. If there was a patient I took care of, I wanted to be involved in every part of the illness and the end-of-life care as well. I took care of Andy for several years and when he was a very prominent figure in our community, a very generous and charismatic guy. But as he approached death, it was clear that his symptoms were complex and management at home was going to be really difficult.
Our hospitals have very large intensive care units where Andy received care, but having a dedicated, special space for palliative care would have given his family more access. They wanted to be very involved in allowing others to have access to specialized care in a hospital setting.
Palliative care programs have been increasing dramatically over the last couple of decades. There are different paths, and ours started from recognizing the need for palliative care in the hospital. It was physician- and family-driven. We started as an inpatient consultation service about two years ago, and it took quite a while to get all the financing figured out, get everything structured and get the facility built. This was a product of multiple people having a shared vision of what it would look like to [provide] palliative care in the hospital.
What were some of the operational, financial, staffing and care delivery considerations involved with a facility-based palliative care program?
We’re very grateful for the financial resources and support to do this, as it was built with 100% philanthropic support. Financially, these palliative care programs can really be a challenge.
We began just after the COVID pandemic, and the hospitals’ resources needed to go to lots of places at that time. The financial piece became so important. We had a huge network of family and friends helping us with philanthropic support, grant writing and advocating at local government agencies.
The staffing piece of it is actually ongoing in my mind, because there are a lot of people working in palliative care who may not be the most comfortable providing it. We want to remain flexible so that nurses, in particular, or maybe even some of our hospitalists, can become comfortable with this care.
We’re sharing this experience with them to make sure that we generate this culture of care and help people see the purpose behind it. With that understanding of why, a lot of those other staffing issues become readily resolvable. People gravitate and want to be part of that palliative care service when they see the impact they’ve had on patients and their families. They like being part of a more global health care unit.
It’s actually a good operational tool for nurses as far as allowing people to rotate through a cycle that they normally would not have. For some newer or younger nurses coming in just over the last couple of weeks, they’ve said that they feel more comfortable with palliative care. That innate attraction is exactly the sort of thing that’s going to create the right kind of culture of the service that we’re offering. That perpetuates among those same people who will become part of this culture and the next role models for new personnel.
What advice would you give to other organizations seeking to unveil facility-based palliative care units?
Get moving! If your hospital is seeing this as an unmet need, then create your business and action plans, create your team and find a space that is going to be peaceful and welcoming. That sounds simplistic, but it involves a lot. You have to incorporate administrators, social work case managers, physicians and specialists. There are a lot of people who need to buy into it.
Studies have shown that the vast majority of patients who are facing serious illness want this kind of service. These are patients who are already in the hospital and this is not a service line that is going to shrink. Over the next 15 years, it’s estimated that there is going to be a doubling in the population of patients over the age of 85. So, get started.
From another advice standpoint, hospitalists are great at doing patient consultations and that’s a really important part about the organizational structure. A palliative care team has to have the time, place and ability to communicate. So, a driving force for me was that I hated having private family conversations in a hallway. Now that there’s a dedicated space, it shows that people care about the nature of this conversation. It’s also having the time to communicate with the patient and coordinate all the elements of their care. These are hospital-based patients with multiple diagnoses who have three or four specialists, and part of that palliative care team’s job is to bring all of those care specialists together to communicate based on what the patient’s goals of care are. It’s tying things together and that requires time and a proper space.
What are the future goals of this program? Do you have plans to launch a similar program in other locations?
The immediate future goal goes back to the team development and cultural aspect of this. Making sure we get the people to provide services, that’s goal number one.
The other goals on track are to collaborate with hospice services, which we do right now but could always be better at. It’s thinking about how we are communicating and collaborating with extended care facilities and being really critical about reducing readmissions, hospital mortalities and making sure patients are being discharged to facilities they’re comfortable with or getting proper services at home. We want smooth transitions into high-quality facilities demonstrating financial stability. There’s so much data around cost savings based on a patient’s diagnosis, we just need to document that.
One of our projects right now is coordinating with other national entities to collect data around the patient experience. We want to know more about how we are affecting hospital mortality rates, about how people are being discharged into the home or their extended community settings, or about how we can reduce readmissions. We’ll be looking at that type of data.
We’re also looking at doing a palliative care study and examining electronic medical records. From a palliative care standpoint, it can be a great resource to look at screening for admission, how many times a patient was admitted to the hospital in the last few months and what led to earlier engagement. How and what led to better symptom management and family support? What was the discharge disposition? All of these become important elements of improving consumer investments.
I also have a personal interest in maximizing telecommunications before a discharge with patients while they’re in the hospital. We can use TVs that are in every patient room in today’s world to have virtual family meetings. The telehealth conversation must be continued. We’ve jumped through lots of hoops over the last couple of years with COVID and all these regulations that got kind of complicated. But the technology is not. People can come in and make this happen from a technology standpoint.
