Expanding palliative care’s reach in the community via the elder service agency network

Abstract

Over the past two decades, palliative care has established itself as a promising approach to address the complex needs of individuals with advanced illness. Palliative care is well-established in US hospitals and has recently begun to expand outside of the hospital setting to meet the needs of non-hospitalized individuals. Experts have called for the development of innovative community-based models that facilitate delivery of palliative care to this target population. Elder service agencies are important partners that researchers should collaborate with to develop new and promising models. Millions of older adults receive aging network services in the US, highlighting the potential reach of these models. Recent health care reform efforts provide support for community-based initiatives, where coordination of care and services, delivered via health and social service agencies, is highly prioritized. This article describes the rationale for developing such approaches, including efforts to educate elder service agency clients about palliative care; training agency staff in palliative care principles; building capacity for elder services providers to screen individuals for palliative care needs; embedding palliative care “champions” in agencies to educate staff and clients and coordinate access to services among those with palliative care needs; and leveraging telehealth resources to conduct comprehensive assessments by hospital palliative care teams for elder service clients who have palliative care needs. We maintain that leveraging the resources of elder service agencies could measurably expand the reach of palliative care in the community.

Assessing the palliative care needs and service use of diverse older adults in an urban medically-underserved community

“…In summary, findings from this exploratory study highlight the high symptom burden and unmet needs of Black and Latino older adults living in underserved communities with serious illness. These findings contribute to a growing literature on disparities in PC (5,6,8,10,13), calls for increased education about PC (4,11,14), and the need for further development of community-based programs tailored to the needs of seriously ill older residents of low-income, racially/ethnically diverse communities (3,4,14,(32)(33)(34)(35). In addition, the investigators' successful engagement with service and faith-based providers and older residents in East and Central Harlem confirms the benefits of developing community partnerships and using CBPR methods to engage diverse stakeholders in addressing the challenges older adults and their families face in managing serious illnesses (18).…”

“…Although palliative care (PC) has become increasingly prevalent over the past several decades (1,2), significant gaps persist in access to and utilization of services. Home and community-based hospice programs serving people who are terminally ill have proliferated since the early 1980s, but PC programs for people living with chronic or serious illnesses remain primarily hospital-based, with limited reach into community settings (3,4). The lack of palliative and supportive care services to meet the needs of seriously-ill older adults living in the community perpetuates critical health care disparities in this growing population.…”