November 2020
Palliative Care in the Time of COVID-19
Molly Langford, MSN, CRNP
November is National Palliative Care and Hospice Month. This month we honor the millions of professionals working in hospice and palliative care. We should also use this month as an opportunity to raise awareness of the importance of hospice and palliative care to patients living with chronic progressive illness as well as those patients at the end of life. This has never been more important than during the COVID-19 pandemic. The Pennsylvania Department of Public Health reported that as of August 2020, 68% of COVID-19 deaths in Pennsylvania were residents of long-term care facilities who died in the facility.[1] What is not reflected in this number are the additional deaths due to frailty post COVID-19 infection. We also do not yet know the toll that isolation and COVID-19 restrictions have taken on long-term care residents. This highlights the importance of palliative care as integral to the care APPs and physicians provide in the long-term care setting. Multiple studies have continued to show that “Older adults who receive palliative care in nursing homes experience less intensive treatments, fewer hospitalizations, better management of symptoms, and an overall improvement in quality of life greater than those who don’t receive the care.” [2]

The Center to Advance Palliative Care (CAPC) defines palliative care as “specialized medical care for people living with serious illness. This type of care is focused on providing relief from the symptoms and stress of the illness. The goal is to improve the quality of life for both the patient and the family.”[3] This care can be provided at any time and does not limit the type of care received by the patient. It is patient and family centered, focuses on realistic goal setting and advanced care planning, and reflects the patient’s and/or family’s wishes.

In addition to improving patient outcomes and quality of life, palliative care has also been shown to reduce overall health care costs. The Center to Advance Palliative Care notes that “Palliative care has demonstrated that it can achieve the win-win health care scenario: higher care at lower cost. Since palliative care helps ensure that resources are matched to patient and family needs and priorities, it results in substantially lower hospital costs, providing patients, hospitals, the health care system, and clinicians with an effective solution to a growing challenge. By improving care and preventing crises for those at highest risk, palliative care reduces the need for burdensome and costly acute care services.”[4]

One of the challenges of providing effective meaningful palliative care is reimbursement to providers and nursing homes. When done well, providing palliative care can be time consuming and the reimbursement under Medicare Part B does not always cover the services rendered. In a January 2010 article, Haiden Huskamp, et al suggested a separate Medicare benefit for nursing home residents that would cover palliative care.[1] Ten years later, we are still waiting for this new Medicare benefit.

Caring for patients in long-term care has also come with unique challenges. COVID-19 has added additional challenges. What has not changed is the continued need for providers to support our patients and families in what matters most to them. We should all embrace the theme of this year’s Hospice and Palliative Care Month “It is about how you live.”

Any views or opinions presented in this article are solely those of the author and do not necessarily represent any policy or position of PAMED, PMDA, AMDA, its affiliates and members.
[1] https://www.health.pa.gov/topics/disease/coronavirus/Pages/LTCF-Data.aspx
[2] Lazare, J. Palliative Care Consultation in Nursing Homes. https://www.todaysgeriatricmedicine.com/
[4] Mittelberger, James, The Case for Palliative Care. https://www.capc.org/the-case-for-palliative-care/
[5] Huskamp HA , Stevenson DG , Chernew ME , Newhouse JG . A new Medicare end-of-life benefit for nursing home residents, Health Affairs (Millwood), 2010; 29 ( 1 ): 130–135
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