Transformation of a Home Health-based PC Program

Topic: Building Palliative Care Into the Organizational DNA

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Established five years ago within a century-old, well-established home health agency, this palliative care program was underwhelmed, inefficient, and unsustainable in its hospice-focused format. It lacked palliative attention to detail, and the home health benefit was not emphasized. Furthermore, it drained resources at a concerning rate and made little contribution, if any, to the overall fiscal wellbeing of the agency. Upon scrutiny and close analysis, a major transformation was needed to keep the palliative care program going. To turn the tide, leadership reviewed evidence-based models for palliative care, restructured the staffing hierarchy, restored the value of association with its certified home health agency, and leveraged the administrative infrastructure to best advantage. Applying these methods resulted in positive changes. A new and improved program structure was pivotal to success: administrative roles were redefined; staff education was instituted at regular intervals to create scale; grand rounds were established and held quarterly. For the first time, profitability became real: the palliative care contribution margin in the agency went from -30% to +18% in less than six months. And the program gained strength in stakeholder buy-in: recognition and confidence from associated hospitals and medical practices became palpable in terms of increased referrals and overall agency momentum and growth. The transformation is an astonishing product of new vision with a home health-focus that leveraged scale with administration and staff. The resultant viability of the palliative care program is proof of transformative success.


  • Gwendolyn E. Bondi, MS
  • Program Manager, Palliative Care - Care Choices
  • Visiting Nurse Service of Northeastern NY
  • 108 Erie Blvd.
  • Schenectady, NY 12203
  • (518) 860-8965


  • Vernon Pertelle, MBA

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