How One Home Health Agency is Leading on Palliative Care

Demand for palliative care is on the rise, presenting a huge opportunity for home health agencies that have figured out how to provide these services, given regulatory and other constraints. This year, the Center to Advance Palliative Care (CAPC) named four palliative care providers as new leadership centers to meet this growing demand and help boost the number of people providers reach.

Presbyterian Healthcare Services (PHS) was recently named one of the four new Palliative Care Leadership Centers (PCLC) by CAPC, a national, member-based organization that supports health care organizations to implement this type of care. PHS is a Southwest network of eight hospitals, over 100 clinics, medical groups, home health agency and a health plan.

The latest announcement brings the total number of palliative care providers with this unique distinction up to 11 nationwide.

This year’s initiative is to bring palliative care—a type of care that is not commonly provided in many settings, including home care—into the community through home health agencies and other medical settings.

Unlike hospice care, palliative care can be provided for a person at any stage during a serious illness, including long-term and chronic diseases, whatever the diagnosis. With the goal of improving quality of life for the patient and the family, palliative care needs are high, but the number of providers and care settings where it’s offered are still slim.

Presbyterian Healthcare at Home—PHS’ home health agency—currently reaches about 200 people daily for palliative care and will be the only center located in the Southwest. Under its designation as a leadership center, Presbyterian Healthcare will train four health care organizations per year to expand these services elsewhere. CAPC and Presbyterian will have a long-term relationship to advance and expand access to palliative care. Since 2004, PCLC’s have trained more than 1,000 health agencies and care organizations on palliative care programs.

“The key is not the resources we receive, but the resources we are eager to share, which is really what we’ve been asked to do as a leadership center,” Nancy Guinn, medical director of Presbyterian Healthcare at Home—Presbyterian’s home health agency—told HHCN. “[We will be] available, along with the other 10 leadership centers, to educate and mentor other palliative programs that might like to really focus on community palliative care, which is our specialty. We will work with palliative care centers to create a curriculum, and then we will be available to support and mentor them for the subsequent year after their training.”

This type of care is not offered everywhere, and the most recent efforts—until now—have been to implement palliative care programs within hospitals. PCLCs have been instrumental in bringing about care changes within acute settings, and CAPC is betting that a community focus will help bring about a similar impact in home health care.

“When you look at the data on the number of hospital palliative care programs in the United States, 90% are trained by a PCLC,” Diane Meier, MD, director of CAPC, told HHCN. “It was a very powerful and effective social change strategy, and we’re hoping it will have the same effect on the community setting.”

New Model Needed

In addition to offering palliative care for patients in their own homes through Presbyterian’s home health agency, Guinn and her team have expanded their reach to five primary care settings. This expansion is something that Guinn thinks will likely spread throughout health care systems as demand for palliative care rises.

“Palliative care focuses on what the quality of life is, both for the patient and the family,” Guinn said. “The work that we’ve done, particularly to offer palliative care inside primary care settings and patient centered medical homes, is something that is innovative. It allows for us to see people regardless of their diagnosis. There’s a tendency to link palliative care to diagnoses such as cancer, but this care is very important for people who have many other diagnoses, including congestive heart failure, lung disease or dementia.”

Offering this type of care is also innovative in home health, as agencies are typically limited in their ability to provide it.

“[Home health agencies] don’t offer palliative care because under statute, they are limited to serving patients who are homebound and have a skilled need,” Meier explains. “Most of the time that means they deliver care for a time-limited episode. It is not a long-term relationship.”

She notes that as demand for palliative care increases, payment model changes are needed to ensure home health agencies and insurance companies will be able to pay for it.

“The model has to be able to be responsive to needs beyond the single episode of care,” Meier told HHCN. “It does mean getting outside the traditional comfort zone of what a certified home health agency does, because of the extreme statutory limitations on home health agencies. That’s what we’re looking to find and why we chose the PCLCs we chose because they had figured out how to pay for it, primarily by working with risk-bearing entities that shared the goal of improving value for this patient population.”

Presbyterian has been able to successfully create a palliative care program and will work with CAPC to create a curriculum to teach other health organizations how they can offer this care as well.
“I think it’s going to be really valuable to offer these services at home in the future,” Guinn told HHCN. “It will happen because there is a need and we are working to address that need. CAPC is very aware of the need for this care throughout the country and their decision to focus on community care and outpatient care is a sign of a movement to address those needs.”

As the health care system adapts to changes from the Affordable Care Act that shift away from fee-for-service models, palliative care could get the regulatory boost it needs to reach more patients at home.

“The fee-for-service model will not support community-based palliative care,” Meier told SHN. “The models that will support it are risk-bearing. Some of the Centers for Medicare & Medicaid Services incentives to help people stay at home, such as hospital readmissions penalties, are starting to drive attention to what we can do to help people stay at home safely.”

Written by Amy Baxter