Dartmouth Health Addresses Rural Hospice, Palliative Care Disparities 

End-of-life care disparities proliferate across rural and remote regions, often due to insufficient clinical home-based resources. Dartmouth Health is seeking to address the significant barriers with a new scalable, research-backed teaching model designed for the next generation of rural hospice care professionals.

Access is among the greatest challenges for seriously and terminally ill patients in remote or rural regions, according to Tammy Tarsa, president and CEO of Dartmouth Health Home Care.

Tarsa also serves as co-CEO of the newly launched Dartmouth Health at Home. The program is designed to improve outcomes and transitions of care among rural-based patients through a suite of home-based services, including palliative and primary care.

“We need to think beyond simply asking whether a service exists, and instead ask how we can help a patient access it,” Tarsa told Hospice News in an email. “We need a workforce and a reimbursement system that recognizes the realities of rural care. It takes people and resources to bring care to a patient’s home, and the additional mileage, travel time and staffing needs associated with caring for patients in rural communities has to be accounted for.”

Dartmouth Health serves patients and their families in New Hampshire and Vermont. The health system’s network includes the Dartmouth Hitchcock Medical Center. The academic center provides medical education in primary and advanced specialty care and serves as a hub for research in these services. Dartmouth Health’s network also includes hospitals, medical clinics, specialty care centers and home health services. The organization was founded in 1797 with the launch of Dartmouth Medical College.

The new Dartmouth Health at Home program is supported by a $20 million philanthropic gift. The program aims to reimagine rural healthcare delivery by expanding access and helping to ensure safe, effective transitions of care from hospital and ambulatory care settings into the home.

“When access is difficult, patients don’t always receive the care they need when they need it. Unfortunately, that can impact patient outcomes,” Tarsa said. “This program will prepare the next generation of clinicians and researchers, embedding students directly in the work so they graduate ready to lead the future of care for our aging population.” 

The Dartmouth Health at Home program will examine the potential for home-based models to help lower costs for patients, healthcare providers and payers. The program will feature professional expertise from the Dartmouth Health Institute for Health Policy & Clinical Practice.

Among the goals of the new program is to provide medical students with experience in rural home-based care settings, according to Dr. Jennifer Hunt, chief academic officer at Dartmouth Hitchcock Medical Center. Hunt is also the dean of the Geisel School of Medicine.

“We can create the models, test the models and implement the models to be scaled nationally,” Hunt said during a recent Dartmouth Health webinar. “It’s very important from the education side, that this allows us to train the next generation of students who will be in the rural setting and will be caring for the elderly in ways that we can’t even imagine today.”

Hospice care utilization trends differ between rural and urban patient populations, according to a study by researchers from The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine and Dartmouth Hitchcock Medical Center.

Rural-based seniors are less likely to receive hospice at home compared to urban-based patients, the research found, which was recently published in the Journal of the American Medical Association (JAMA) Network. Nearly one-quarter, or 23%, of older adults in rural communities navigate barriers to home-based hospice such as a lack of unpaid family caregiving support, according to the research. 

Geographic location matters when it comes to the availability of hospice and palliative care professionals, according to Tarsa. Patients may have a provider, but they may lack reliable transportation or live in rural areas that require clinicians to travel far distances or traverse difficult terrain. The additional time and cost of rural, home-based visits can make hospice care inaccessible for some individuals and financially unsustainable for providers, Tarsa indicated.

Improving outcomes and access in rural regions requires a collaborative approach, she stated.

“We need a shift in mindset,” Tarsa told Hospice News. “Many patients want to remain at home, and we should be asking what it would take to make that possible. That requires collaboration and innovation. It’s asking the questions and then answering the questions in a way that may be very different than how we may have answered in the past.”