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Extending the range of
home tele-services that can be
brought to today's patients. |
May 2012
Telepalliative Home Care:
Still-Needed, At-Home Telehealthcare Focus
This installment of the Home Telehealth Community of Care on “telepalliative” home care (palliative care services delivered to the home in part through telehealth- or telecommunications-ready tools) re-visits this same topic posted here nearly 6 years ago, titled “Telepalliative Home Care: An Introduction to the Next Potential Wave of At-Home, Needed Telecare. It was the most visited page (more than 10,000 hits per quarter) of all of our Home Telehealth Community of Care installments in the past 10 years.
On that page, palliative care was introduced as long-term health and comfort care services delivered in the interim between home health and home hospice admission periods for patients living with complex chronic diseases and conditions. And there, we presented views of James Cleary, MD, past president of the American Academy of Hospice & Palliative Medicine, about palliative care’s broad scope for targeted care. He said: “Many of us would only associate palliative care with care of the imminently dying.”
However, he noted: “It is much, much more than this. A patient’s journey with a disease starts from the point of diagnosis, and we need to support him or her through this process. [1]*
The Changing Healthcare Delivery System
Much has changed to help realize this goal voiced by Dr. Cleary—the need for caring for patients living with complex chronic diseases from the time of their diagnosis until the end of their lives. These changes include:
- A monumental growth of: palliative care training programs; and
- More widespread development of Patient-Centered Medical Homes (PCMHs). These entities will provide a team approach to care to patients outside of acute care settings. PCMHs promote disease management, patient education, electronic recordkeeping, and more personalized care—the goals being to reduce emergency room (ER) visits and hospitalizations.
- Passage of federal government legislation to encourage consistent, targeted care to individuals over the long term. Most important of these, are: Accountable Care Organizations (ACOs) required under the recently passed legislation, the Patient Protection and Affordable Care Act. ACOs are expected to provide comprehensive care throughout individuals’ lifetimes and avoid typical lapses in care encountered by patients during transfer from one health setting or more to another. Focuses will be on providing electronic recordkeeping and sharing patient information among caregivers, and providing more personalized care—the goals being to reduce emergency room (ER) visits and hospitalizations.
Efforts for working with and organizing ACOs and PCMHs are still in very preliminary stages to be sure. This is a good time, therefore, for all of us to identify what roles telehealthcare can play for effective palliative care delivery as part of any home healthcare role in PCMHs’ or other long-term or lifetime care programs. The stage for home telepalliative care is being set.
Home Palliative Care’s Place in the Continuum of Care Service Delivery Today
In this installment of the Home Telehealth Community Care, we introduce you to more details about palliative care and its needed, longer-term view of patient care
In our Palliative Care: What is it? segment, we provide details on:
In the Palliative Care: Tools to Help Deliver Services segment, telehealth and other related tools to help make living comfortably with long-term conditions more do-able for patients and their families are introduced.
We identify:
- New Informational and Assistive Technology Systems to Help Elderly Persons Live at Home Independently and Safely
- Assistive Products for Performing Health Routines Over the Long Term
- Products that Assist with Performing Activities of Daily Living (ADLs)
Using some of this information about these tools, new home palliative care programs may be initiated and progress in the near future.
In our Look Homeward segment, one representative of a developing home-based palliative program, Colleen Gallagher, director of special programs at the Natick [MA] Visiting Nurse Association, shares her own and her organization’s experiences of working with home-based patients receiving palliative care, procedures that they’ve used, successes achieved.
And finally in the Coming Home segment, we run a repeat performance of a seminal piece penned (for the earlier installment of our page on home telepalliative care) by True Ryndes, ANP, MPH, formerly with the remarkably innovative San Diego Hospice and Palliative Care organization. In it, he urges clinicians to focus on assisting with patients’ “condition management.”
Thank you for joining us in looking at telepalliative care as a wide-ranging and needed possibility for delivering much improved “lifetime care” for those living with advanced chronic diseases or conditions.
Questions for you, the reader: How did we do? What did we miss?
- Cited in Bergin, M., “Palliative Care more than for end of life,” Wisconsin State Journal, Oct. 16, 2003. {back]
