Palliative Care

Posted on | May 14, 2008 | Comments Off on Palliative Care

Lighting the way to home-centered health careIn recent years I have frequently written about and discussed the need for a "parallel build-out" in order to achieve truly preventative care in the United States. This refers to the challenge on the one hand of better managing our current burden of chronic disease in mostly older Americans, while at the same time creating a new infrastructure for prevention based on home-based, multi-generational lifespan health planning. “Care” and “planning” are the key words in this challenge. How can we make these two worlds intersect?

A smart first step would be to follow the lead and wise insights of this nation’s palliative care movement. Palliative care focuses on supporting the needs of the chronically ill as they approach the final phase of life – and we need this kind of care more than ever. By 2030, a fifth of the U.S. population will be over 65, and many will face the challenges of managing one or more chronic illnesses for a significant number of years, including physical and psychological distress, functional dependency and frailty, and a need for support.

Our traditional care systems, based as they are in curing illnesses and prolonging life, are not particularly well equipped for this situation. There is very little emphasis on improving quality of life, relieving suffering, or providing physical and emotional comfort.

But the palliative care movement addresses this concern. Palliative care is as much a life philosophy and value position as it is a caring revolution – emphasizing an extraordinarily inclusive team effort between care providers, patients and families. The high-level goals of improved quality of life and relief from suffering are achieved through a wise mix of “care” and “planning.”

How would a focus on palliative care benefit the build-out of a preventive, home-centered health care model? Consider the checklist below – which offers a wish-list for a reformed health care system. Then consider this: Palliative care already incorporates each of these five critical elements:

Patients should be able to voice their personal needs and define their long-term and short-term goals.
Evaluation should be thorough on the front end and take into account what patients define as excellent outcomes.
Team approaches should be utilized, and the home serve, as much as possible, as the center of care.
Care should be well planned, based on these expectations, and discussions should be summarized in a formal planning directive, leaving little to chance.
Trusted home health managers, both formal and informal, should be identified, and integrated into the health care team.

Were we to embrace the palliative care approach in a reformed health care system, what would we find? More joy and pleasure; less pain and worry; less hospitalization; fewer nursing home placements; greater patient and family satisfaction; greater caregiver health and well being, and, in the end, a greater likelihood of a life lived to its full human potential.

For more background about the palliative care movement, watch this week’s video, embedded with this blog post, or read the full transcript, below. As always, please let me know how you feel. Has your family had experience with palliative care? What were your impressions?