Palliative Care: A Paradigm of Care Responsive to the Demands for Health Care Reform in America
Sherman, Deborah Witt, Cheon, Jooyoung, Nursing Economics
* Palliative care is poised to become a universally available approach to health care which addresses both the needs of patients and families experiencing serious, progressive, and life-threatening illness, and also the costs of delivering such needed services.
* Palliative care and hospice are part of a continuum of care with palliative care provided at any time during the illness trajectory, while hospice care is offered at the end of life.
* Within the context of health care reform, we believe palliative care addresses critical economic imperatives while enhancing quality of life even as death approaches.
* As leaders in health care, advance practice nurses, specifically, and the nursing community in general are best positioned with the knowledge, expertise, and commitment to advance the specialty of palliative care and lead the way in the reform of America's health care system.
INMARCH 2010, THE AFFORDABLE Care Act was passed by Congress and signed into law by President Obama. This act expands access to health care to over 30 million Americans (Pelosi, 2010). The Act increases insurance coverage for pre-existing conditions, and increases projected national medical spending with the expansion of Medicaid to include more low-income Ameri - cans (Foster, 2009; Keehan et al., 2011), while projecting a reduction in spending on Medicare of $400 billion over a 10-year period (Pelosi, 2010). The Affordable Care Act of 2010 requires the Centers for Medicare and Medi - caid Services to implement a 3- year demonstration project which allows patients to receive aggressive treatment as well as palliative/ hospice care concurrently (Office of the Legislative Counsel, 2010). This will require a rethinking of hospice eligibility criteria to be less stringent than having a current prognosis of 6 months or less to live for patients with advanced illness (Casarett, 2011). This moves in the right direction as the addition of palliative-hospice care to aggressive treatment reduces health care utilization and costs (Brumley et al., 2007; Temel et al., 2010).
The project also evaluates the cost saving of palliative home health care programs and will evaluate patients' quality of life. The expectation is that the results of this 3-year project will indicate that palliative care, in addition to life-sustaining treatment, will improve patients' survival when compared to usual care (Temel et al., 2010). Palliative care has great relevance to efforts to reform the health care system, insuring quality, consistency, and effectiveness of health care delivery (Meier & Beresford, 2009).
Palliative Care as a Paradigm of Care
Palliative care is a paradigm of care, which expands the tradition- al disease-model of treatment to anticipate, prevent, and alleviate the suffering associated with serious, progressive, chronic, lifethreatening illness at any point during the illness trajectory (Na - tional Consensus Project [NCP] for Quality Palliative Care, 2009). It is now recognized as a specialty in medicine, nursing, and social work with an inherent interdisciplinary nature (Grant, Elk, Ferrell, Morrison, & von Gunten, 2009). Palliative care addresses the physical, emotional, social, and spiritual needs of patients and their families with the goal of improving their quality of life. This occurs through the aggressive treatment of pain and other symptoms, as well as optimizing function and assisting patients and families with health care decision making (NCP, 2009). Through conversations with pa tients and families regarding advanced care planning, palliative care focuses on matching treatments with the patient's and family's values and preferences (Meier & Beresford, 2009). It improves communication across all care settings and results in continuous and well-coordinated care during illness transitions.
The experience of serious lifethreatening illness is overwhelming for patients. …