Overcoming Barriers to Growth in Home-Based Palliative Care

Now is a better time than ever for home health agencies, hospice providers and other organizations to invest in and grow their home-based palliative care offerings. Yet certain barriers may still be holding them back.

Although need for palliative care is skyrocketing, common barriers to entry include sustainable financing and quality standards. While restrictive, those blockades are, in some instances, relatively easy to overcome, according to a recent study published in the Journal of Palliative Medicine by the Center to Advance Palliative Care (CAPC).

“For almost all of the barriers uncovered in CAPC’s needs assessment, support resources exist for organizations delivering home-based palliative care,” Brynn Bowman, CAPC vice president of education, told Home Health Care News in an email. “We urge [post-acute care providers] to assess whether there are gaps in available services for patients living with serious illnesses in their communities.”


Home-based palliative care provides specialized treatment for patients with serious illnesses. In addition to decreasing costs, palliative care has been shown to improve provider quality measures.

For the recent study, researchers surveyed 25 home-based palliative care programs from across the country. In addition to being geographically diverse, respondents also varied in terms of organizational type and funding model.

“Our goal was to understand the barriers to scaling home-based palliative care, in order – we hope – to catalyze growth in the field,” Bowman said, noting that palliative care is a booming sector that will only continue to grow.


On a national level, California is largely leading the charge in the delivery of palliative care services. For about a year, home-based palliative care has been a mandated benefit in California’s Medicaid program, Medi-Cal.

Meanwhile, respondents in the study identified sustainable financing as the single biggest barrier in delivering home-based palliative care, with nearly every respondent reporting they couldn’t fund an interdisciplinary team on fee-for-service billing alone.

“That said, there is growing awareness among payers (especially government, given new flexibility in Medicare Advantage) of the value of palliative care, and a large body of support resources for community agencies looking to contract with health plans to pay for palliative care services,” Bowman said.

Additionally, many respondents were in need of clarity about the applicability of national palliative care quality standards to home-based programs.

“This discrepancy speaks to the fact that the field of palliative care had its birth in hospitals, and the majority of programs were historically administered by hospitals and health systems,” Bowman said.

The National Consensus Project released the Clinical Practice Guidelines for Quality Palliative Care, 4th Edition, in October 2018.

Other barriers identified in the study include a need for technical assistance and a feeling of isolation amongst home-based clinicians, both of which Bowman said can be addressed fairly easily.

Overall, home health and hospice agencies would do well to pursue home-based palliative care going forward, Bowman said.

“There are a growing number of opportunities to sustainably finance home-based palliative care, and a plethora of tools to ensure quality program design that achieves results,” she said. “Whether in the context of an ACO, or in partnership with a local Medicare Advantage or other health plan, the quality and cost impact of palliative care means that your palliative care business line is likely to be in-demand.”

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