Coronavirus May Push More Home Health Providers into Palliative Care

Across the country, just 10% of community-based palliative care programs are spearheaded by home health care providers. The coronavirus may change that moving forward.

As of Monday, there have been more 1.9 million confirmed COVID-19 cases in the United States, with many individuals in recovery. But while some see a return to full health, doctors are also starting to notice a growing list of lasting health impacts, including heart, kidney and brain problems.

If secondary and tertiary complications prove common and long-lasting, that may lead to higher demand for advanced illness care, particularly for the senior population. It’s a trend that Capital Caring is already seeing, Dr. Matthew Kestenbaum, the organization’s chief medical officer, told Home Health Care News.

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“Right now, we are seeing from our hospital partners and our community colleagues the importance of palliative care, including advanced care as well as appropriate pain and symptom management,” Kestenbaum said. “The number of palliative care consults we’re being asked to perform in the hospitals and in the community has actually increased. The importance of palliative care is absolutely being shown during this pandemic.”

Falls Church, Virginia-based Capital Caring is one of the largest nonprofit providers of advanced illness, hospice and at-home care for seniors in the Mid-Atlantic region. As one of the country’s original hospice demonstration sites, the company cut its teeth in end-of-life care but has since expanded into various services aimed at aging in place.

Overall, Capital Caring helps treat more than 2,000 people on a daily business across its services lines.

“We have really expanded our services after originally starting out as a hospice program,” Capital Caring President and CEO Tom Koutsoumpas told HHCN. “Our goal is to continue providing care across the continuum in order to help people stay at home. Whether that’s providing advanced illness care [or] home-based primary care — we’re doing whatever we can do to help individuals age in place.”

In addition to his CEO role at Capital Caring, Koutsoumpas is also the co-founder of both the Coalition to Transform Advanced Care (C-TAC) and the National Partnership for Hospice Innovation (NPHI).

Palliative and advanced illness care have arguably never been more in the spotlight than during the current public health emergency.

In fact, one recent op-ed in the Journal of Cardiopulmonary and Acute Care argues that palliative care principles should guide the care that all COVID-19 patients receive.

Broadly, the core aspects of palliative care can provide a foundation for responding to COVID-patient needs, including symptoms alleviation, multidisciplinary teams, patient-centered care and family support.

Capital Caring has been working to strengthen those core principles across its markets.

“We … have been very willing to work with our community partners, in terms of helping to guide symptom management, grief and loss counseling — not only for families of patients who have died from COVID, but for staff who’ve been taking care of them who are just not used to this degree of acuity or loss,” Kestenbaum said.

On its end, Capital Caring started closely following the coronavirus situation in February, then took action in the beginning of March. Its early response strategy included the formation of a dedicated leadership team focused on developing best practices and protocols.

The company also acted quickly to secure as much personal protective equipment (PPE) as possible while simultaneously shifting operations to virtual platforms.

“We’re using Zoom [for virtual meetings],” Kestenbaum said. “We considered a couple options, but … we were able to get that in place in a matter of two or three days. By the third week in March, all hospice team meetings were virtual. Only necessary home visits were being made — and we still did those very quickly.”

Nationally, 33% of palliative care programs are operated by hospice providers, 32% by hospitals, 14% by office practices or clinics, 11% by long-term care facilities and 10% by home health agencies, according to a 2019 report from the Center to Advance Palliative Care (CAPC).

If home health providers don’t have experience in advanced illness or palliative care, they should turn to organizations like Capital Caring for support, Koutsoumpas said.

“Partnering with hospice and palliative care providers in the community is important,” he said. “Encouraging these kinds of relationships can really expand the ability to care for people in the community.”

A handful of home-based care providers have already signaled plans to expand into palliative care.

CareCentrix — a care management company that focuses on home-based care — announced in May it had acquired palliative care company Turn-Key Health for an undisclosed sum.

Paul Kusserow, president and CEO of Amedisys Inc. (Nasdaq: AMED), also recently hinted that palliative care may be in his company’s future.

“We’re primarily in home health and hospice now, but we’re moving forward into personal care and expanding into palliative care, which we believe is becoming increasingly important,” Kusserow previously told HHCN.

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