When it comes to access to palliative care services, we must begin to courageously think “outside the box”. There is more to sustainable solutions than the Triple Aim of quality of life and satisfaction for people with illness and their families leading lower costs. We must become increasingly mindful of the people providing the care. We must modify or replace the current structures of healthcare delivery to reflect new architecture that insures the quality of life and satisfaction of this scarce and extraordinary resource of palliative care nurses, social workers, spiritual counselors, and doctors. The well-being of too often burned out professional caregivers is no more or less important than the well-being of those we serve, and yet we are driven beyond balance. We are driven by our employers and we are driven by our difficulty to look past the suffering that our current system of healthcare inflicts, let alone the simple challenge of serious illness and dying.Value based payment models will help only if payments are sufficient to support interdisciplinary teams with the time and space to support people with illness to define value and goals on their own terms.
- Palliative care is simply people caring for people with the time needed to apply an approach that invites folks to become or remain empowered. New structures of delivery, such as telemedicine, and new architectures of employment, such as what we are doing at www.ResolutionCare.com , are small examples of the kind of innovation and activism that is possible in our field. The future of healthcare may rest on the case we make with society defining sustainability and sanity in the care of of people with serious illness and approaching death. Thanks to the pioneers that have gotten us here and to the many among us now that have a clear sense of what’s possible for the people under our care AND for our own families.
The Center to Advance Palliative Care (CAPC) recently released a report entitled America’s Care of Serious Illness: 2015 State-by-State Report Card on Access to Palliative Care in Our Nation’s Hospitals. The CAPC has once again done an amazing job creating an accurate appraisal and coupling it with a powerful Call-to-Action for the field of Palliative Care. So much ground has been gained in the last decade to advance the quality and availability of palliative care services, and our field enjoys continued growth in acceptance and traction with the public. However, in the face of such growth in demand for the kind of value brought by well-resourced interdisciplinary teams and the exploding demographics on the path ahead, the mismatch of demand to access is profound. Not only is it felt acutely by people with serious illness in need, those of us deeply dedicated to providing this kind of inspired care on the ground are hurting now and will be hurting worse. Missing data from the Report Card is variable, and often extremely inadequate staffing of palliative care programs, the extent to which programs are not able to keep up with need, and the exaggerated deficiencies in rural America need to be explored further.