Palliative care is patient-, resident- and family-centered, optimizing quality of life by anticipating, preventing and treating suffering. Research conducted by Susan Mitchell, M.D., M.P.H., a geriatrician at HRC and an Institute for Aging Research investigator, found that residents in nursing homes across the country, especially those with dementia, often do not receive the benefits of palliative care as they reach the end of life. In response, HRC developed a Palliative Care Program, with a consulting team that includes David Tsai, M.D., a geriatrician who is board certified in palliative care medicine; chaplain Jody Comart, Ph.D., a licensed clinical psychologist; Anne Mahler, M.S., R.N., clinical nurse specialist; and social worker Carol Hani, M.S.W.
The Palliative Care Program works with the resident/patient, family, and the primary health-care team to personalize a plan of care based on the resident’s wishes and values. The purpose is to relieve physical, psychological, spiritual and emotional suffering due to pain and other symptoms. HRC is committed to pioneering one of the first advanced models for palliative care in long-term care, which will eventually be implemented at all Hebrew SeniorLife facilities and influence geriatric palliative care throughout the U.S.
Palliative care is different from hospice care. Hospice care is usually offered when curative treatment has stopped and life expectancy is less than six months. Palliative care is available to every resident at any stage of illness, including when aggressive, curative care treatment is still employed. The goals of care are reviewed and revised regularly. Dr. Comart emphasizes that communication is a critical component of palliative care. “We help residents and families think, early in their stay at HRC, about their hopes for treatment, quality of life, and how they want to manage their care,” she says. “Open communication involves talking about prognosis, likely paths of illness, treatment choices, and making decisions about what will help them achieve comfort and peace of mind.”
In keeping with HSL’s mission to educate staff to relieve suffering toward the end of life, direct care and administrative staff received training in the principles and components of this palliative care model in 2007. Education about state-of-the- art palliative care will be offered to staff on an ongoing basis. The consult team members also serve as mentors and educators when they collaborate with staff to address symptom management, ethical issues, goal setting, grief, and the full realm of needs of residents and patients on their units. Team members participate in research on the benefits of palliative care, as well as policies and procedures to build palliative care approaches into everyday care.
“Our ultimate goal is doing what’s best for the residents, patients, family and staff. With palliative care, as people move along the continuum, we are able to stay focused and connected, provide the best care, and help patients and families experience comfort and peace at the end of life,” says Robert Schreiber, M.D., Medical Director of Outpatient Primary Care Practice, Community-Based Programs, Innovation and Development.