A clinician shares how she vets home-based palliative care companies to ensure they are providing the best possible palliative care.

Physican sitting at desk on computer, interviewing person in suit2

I recently interviewed a company that advertised its home-based palliative care program to find out whether their services might be appropriate for one of my own patients. But when they nonchalantly opened our conversation with a line that anyone can hang out a shingle and say they offer palliative care, I just shook my head.

This, as you probably know, is a problem.

I work at a large academic medical center in Texas with an inpatient palliative care consultation service and an outpatient palliative care clinic. As in other parts of the country, a number of community-based agencies have sprung up here in the last five years or so purporting to offer home-based palliative care services. Some offer multidisciplinary palliative care with symptom management, but many offer minimal-to-no palliative care with the hope to sway patients into hospice when they have pain.

"If I referred my patients to a company without being certain that they would provide great palliative care, I could be risking my patients’ health and well-being, as well as my relationship with them."

If I referred my patients to a company without being certain that they would provide great palliative care, I could be risking my patients’ health and well-being, as well as my relationship with them.

The questions have become, how do you know which companies to trust? How do you know which are providing true palliative care, and which ones are providing care but not palliative care?

Perpetuating misconceptions about palliative care

Ostensibly, it makes sense that some of our patients might benefit from receiving palliative care in their homes once they’ve left the hospital or stopped coming to the clinic. But here’s why we need to be careful when referring our patients to these companies: they might not actually be providing palliative care per to our field’s standards, the NCP Clinical Practice Guidelines for Quality Palliative Care, 4th Edition. Some do—and they do a good job—but some don’t.

"I worry that if these home-based companies do not provide true palliative care [...] it will perpetuate or even exacerbate the confusion over palliative care."

A lot of public misconception about the role of palliative care already exists. I worry that if these home-based companies do not provide true palliative care, making quality of life better for their patients through multidisciplinary support by a team of trained specialists, it will perpetuate or even exacerbate the confusion over palliative care. And that could give patients a negative perception, undermining our credibility or authority as palliative care specialists. People don’t always understand what palliative care is and what it can do for them. Sometimes people even conflate palliative care with hospice, not realizing the differences that exist between these two models.

Unfortunately, that can be a barrier to a patient who might benefit from our services. They might not seek out palliative care or may refuse a consultation because they erroneously believe that we are hospice. They may believe they’ll have to give up certain medications or treatment options. That’s not the impression we want the public to have about palliative care.

How to vet a home-based company

Our patients and their families trust that we will provide them with the best possible palliative care. And we want to know that they’re being cared for appropriately when they walk out of our hospital. We want to ensure they are followed with adequate symptom control to avoid unnecessary (and unwanted) emergency department visits.

So, we want to refer them to providers who are capable of providing the care that our patients need at the next step of their journey. This is also upholding the integrity of our specialty field.

"Before sending my patients to any home-based company, I always vet them. This means speaking with the leadership team of the company, including its owner, clinical staff, and liaisons to better understand the services offered, and interviewing them [...]"

Before sending my patients to any home-based company, I always vet them. This means speaking with the leadership team of the company, including its owner, clinical staff, and liaisons to better understand the services offered, and interviewing them with the following questions. (You might add these questions to your list, too.):

  • What are the various roles represented on your team?
  • What services do you provide to patients in their homes?
  • Do you provide symptom assessment and medication management services?
  • Who sees your patients in their homes?
  • How often does your staff see patients at home?
  • How do you manage pain, and how are prescriptions handled?
  • How do you handle patient emergencies and after-hours calls?
  • How do you communicate with your patients’ other doctors, and what is your process for coordinating care?
  • How do you discuss goals of care with your patients?
  • How do you transition patients to hospice when they’re ready to make the shift?

The answers you receive can help you determine if they’re actually using a palliative care model.

For example, if they tell you they don’t offer medication management, that’s a red flag. Symptom assessment and medication management are two key aspects of palliative care, and all patients receiving palliative care are entitled to receive these services. You might ask the company how the patients will get medication if they need it. A patient should not have to turn to hospice to get pain medication if they’re receiving palliative care.

Another red flag would be if there is no social worker, counselor, or chaplain. The palliative care model is one that emphasizes the multidisciplinary approach. If a company admitted to me that they don’t have these professionals on their team, I’d follow up by asking how their patients will receive those services. If a patient will no longer be coming to my clinic, I don’t want them to sacrifice this aspect of care, which would help with their emotional and spiritual needs.

Relationships remain a priority

Ultimately, we palliative care providers have a responsibility to know what is available in our home-based communities. We should ask those important questions before we refer any of our patients to an outside agency. (When new companies pop up, we can ask to meet with them, too. It’s important to not make any assumptions.)

At the same time, we can focus on building new relationships with the home-based companies that are providing true palliative care services. We can support them in providing care for our patients. After all, we don’t stop caring for our patients once they go home. In fact, we prioritize keeping open lines of communication with these companies for just that reason. Our team makes it a point to check in about once a quarter with the companies that we’ve vetted and approved, and our nurse case manager regularly calls and checks in with them. In this manner, we can ensure that our patients are receiving the palliative care that they need.

Three Sheets of Newspaper
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