Palliative care focuses on managing pain for people with serious diseases, and that was the topic recently on the Talking Health program on News Radio 1240 KQEN.
Guests Connie Kinman, the director of Critical Care and Shaw Heart Center at CHI Mercy Health, and Tammy Gilster, a palliative care nurse, were interviewed by host Lisa Platt, about when to seek palliative care, and what to expect.
The following is an edited version of that interview.
Lisa: Tammy, what is palliative care?
Tammy: Palliative care came about initially from hospice care, which is end-of-life care. The palliative part was intended to make patient’s lives more comfortable, to reduce suffering and increase quality of life.
Some wonderful physicians and people at hospice realized that palliative care could be applied to any phase of life, and to many life-limiting or life-long diseases. Through a grant we were able to start an inpatient hospital palliative care program at Mercy.
We consult with and assess patients, but most of what we do is help them manage their pain and symptoms. We also help them with creating a life-long plan on how to live with their disease and also support the whole family along with the patient.
Lisa: Can you talk about palliative care in relation to curative treatment?
Tammy: We like to start palliative care with a patient as early as we can. Even if it’s something like high blood pressure or diabetes, there’s much you can do to cure or improve or hold those diseases at bay.
If a patient needs hospitalization, we can treat some of the symptoms along with really good comprehensive curative care to help shorten their length of stay. Palliative care also can reduce ER visits, because we do a lot of education about how patients can treat their conditions at home.
It prevents a lot of hospital and ER time, which takes a lot of stress off of them financially.
Lisa: How does a patient get access to palliative care?
Tammy: Again, the goal is always to get palliative care started at the beginning of a diagnosis, not when a patient comes into the hospital at end-of-life.
This is much easier to do in the community through the private sector and the primary care physician, but if we have patients that come into the hospital that have been diagnosed with a chronic disease within the last two years, it can really enhance their quality of life earlier.
Connie: Palliative care is very effective with chronic diseases, like congestive heart failure, COPD, pneumonia, Parkinson’s, MS, ALS and cancer.
Sometimes, it’s not just one health issue people are living with, it can be multiple, and this can really cause a lot of symptoms and suffering.
Lisa: What is a multidisciplinary approach?
Tammy: We focus on the person’s mind, body and spirit, and as part of a family. So we work with chaplain services, social services, case managers, physical therapy and volunteers. When we discharge patients from the hospital and they go home, we also try to work with community groups to support them and help them transition back to their life.
Lisa: How does a family know if palliative care is right for them?
Tammy: Palliative care is always a choice. We introduce ourselves to patients and ask permission to have an assessment of them that covers a lot of areas, such as the kind of care they do, their physical condition, their medications and social, cultural and spiritual stresses.
We also cover important information like advanced care planning, advanced directive and power of attorney.
I’ve heard extraordinary stories of financial stress related to medical care, so we assess that, and tell patients ways we can help. Then we try to connect them with people that can help them.
Lisa: What happens once these patients leave the hospital?
Tammy: Inpatient palliative care is just for patients while they are in the hospital, but we often call patients at home and follow up with them. Patients are always welcome to call and leave messages for us at our office.
Lisa: Does insurance cover palliative care?
Tammy: Only if it’s a billed by a physician or nurse practitioner. At this point a nurse who is not a nurse practitioner (N.P.) can’t bill insurance or generate revenue for the program.
Lisa: How does palliative care work with a patient’s provider?
Tammy: That’s a new and evolving process. The providers getting used to it and learning more about it, so right now we’re presenting it to the patient and their bringing it to their doctor or other healthcare provider.
We’re going to start with the hospital staff. If we’re going to ask patients to have an advance directive, then we think every Mercy employee should have one. Right now primary care physicians and patients are embracing it, but it’s still pretty new.
Lisa: Do you have to necessarily be in the hospital or can you be at home or even assisted living if you are going to get palliative care?
Tammy: For our program, you have to be in the hospital, but many case providers and case management groups have started to address palliative care in the community. In other communities, you can get it no matter where you’re at so that will be coming we hope.
Lisa: How long can somebody be on palliative care?
Tammy: It’s an ongoing process; we don’t really discharge people from palliative care. We don’t ever take them off our list unless they or their physician ask us to, and they usually don’t.
Lisa: If someone has questions about palliative care, who do they contact?
Tammy: They can contact our facility. If someone wants to come to Mercy, there are many handouts in the main lobby. They also can call the main office and ask for Palliative Care
The main number is 541-673-0611. Our website is www.chimercyhealth.com.