Nursing Home Palliative Care
Mr. C’s Experience
By: John S. Morris MD FAAHPM
Chief Medical Officer Palliative Care
Mr. C was frustrated, discouraged and scared. The past 12 months have not gone well. His Parkinson’s disease had gotten worse. This caused him to be hospitalized 6 times with falls, broken bones and infections. Now he was living in the skilled nursing facility and he just returned from another hospital admission for pneumonia caused by swallowing difficulties. Rikki, the Four Seasons palliative care nurse practitioner, entered his room and could see his distress. From his chart she knew about the progression of his serious illness, multiple falls, swallowing difficulty, weight loss and pneumonia. Now she could see just how much he was suffering.
She sat next to Mr. C to listen to his story. The palliative care team seeks to understand who he is as a person and what he values so the team can help him develop a personalized medical plan to live the best quality of life possible. Mr. C described with slow, slurred speech how being diagnosed with Parkinson’s in his 50’s was so traumatic. His wife could not handle the serious illness and left him. Living alone was difficult. Now he feels like the youngest person in the nursing facility at 63 years old. He described how frustrating it is to do simple things like walk, talk and eat. He wants to spend time with his mom and sister and stay out of the hospital. He is hoping to eat better to gain weight, get his strength back, walk safely and avoid pneumonia.
Rikki was able to develop a plan to help him improve his quality of life. She worked the nursing home team to decrease some of his medication and plan for his inevitable infections. Marsha, the palliative care RN worked with him and the nursing home staff to teach them both how to minimize risk of falls and infection. Marsha helped the staff develop the confidence to care for Mr. C without sending him to the hospital. Chris, the palliative care social worker helped Mr. C set up regular skype visits with his mom and sister. Chris also spent time talking with him to help him deal with his anger and fear. In no time, Mr. C gained weight and improved his ability to walk safely. He enjoys time with his family and has made some new friends in the facility. He is enjoying life again.
Palliative care is extra support for people with serious illness. Palliative care providers like Rikki are experts in pain and symptom management. The palliative care team provides guidance for the challenging decisions people with serious illness face and support for the stresses of serious illness.
Palliative care helps people in nursing homes with improved symptom management, quality of life, and less stress from serious illness. Palliative care can help nursing facilities by providing extra medical and communication support to care for the most challenging patients. Palliative care can help prevent patients from being transferred to the hospital.
Palliative care programs can only bill for the medical provider and typically lose money providing interdisciplinary team care. Because of the many benefits of palliative care some insurers and Medicare are providing models with extra payment for palliative care teams. Now is a great time to start or enhance your palliative care program. Join us for our 2-day Palliative Care Program Development workshop in September. Leaders appreciate the practical planning and small group workshop.
Finding trained palliative care staff can also be challenging. We offer practical clinical training in our Palliative Care Immersion Course for your clinical staff. Join us for a weeklong 40 hours of CME intensive, interactive clinical training course. Great for new palliative care staff or experienced staff who want to hone their skills.