The Case for Home-Based Palliative Care

The Case of Home-Based Palliative Care

Those with long term or terminal illness want their healthcare at home, not in the hospital. Home is where comfort, family, and familiarity lies. As hospital visits become increasingly challenging in the time of COVID-19, home-based palliative care is rising to meet this challenge with companies such as Kara Health leading the way. Home-based palliative care (or supportive care) not only provides financial savings for health plans but improves clinical outcomes and increases patient satisfaction.

Benefits of Home-Based Palliative Care

Home-based palliative care is an integrative approach that guides patients and their families through serious illness. Palliative teams include physicians, nurses, nutritionists, clinical therapists, and chaplains or spiritual guides. Palliative care programs are designed to treat the whole patient by providing them with an extra layer of support that considers the physical, psychological, social, and spiritual stress that comes with managing serious illness.

The ability to receive care at home greatly reduces suffering by increasing physical comfort and diminishing fear and anxiety. Fear and anxiety are natural responses to long-term or terminal illness and have become more prevalent since the current global pandemic. Palliative patients are increasingly fearful of hospital stays due to the increased risk surrounding COVID-19. Routine hospital visits are challenging, and emergency visits trigger fear of viral exposure and possible long-term separation from family and friends.

Overcoming Obstacles to Home-Based Palliative Care

Twenty years ago, studies found that approximately 40-50% of patients preferred at-home care versus care in a hospital. This number has been steadily growing, and in 2019, the number of at-home deaths surpassed hospital deaths for the first time in over 50 years. The preference for homecare is growing, and yet providers continue to cite barriers which prevent them from offering home-based care as an option. Organizations such as Kara Health aim to address these barriers to home-based palliative care by leveraging technology, prioritizing quality, and managing costs.

Integrating Technology

Increased demand on physicians’ time, lack of supportive infrastructure, and concerns about patient safety are oft-cited by providers as reasons to keep care in the hospital. Kara Health’s role is to mitigate these obstacles by serving as a supportive layer that streamlines care and communication, reduces acute events, and keeps patients out of emergency settings.

Technology and the smart use of data directly address provider concerns by minimizing the communication breakdown that occurs when patients are physically distanced from their caregivers. Digital records, reports, and real-time updates allow for seamless communication between patients, primary care physicians, and providers. The intelligent application of technology makes it possible to achieve personalized and attentive care regardless of the patient’s location.

Access to medicines, durable medical equipment (DME) and additional services such as transportation directly address providers’ home-based healthcare concerns and add value by improving outcomes and increasing patient satisfaction. Expediting authorizations and establishing supply chains that bring the hospital to the patient (not the other way around) makes providers’ lives easier, keeps quality of care high, and lowers the cost of care. 

Amidst the current pandemic, in-home delivery of medications, equipment, and PPE are of increasingly high value. Virtual COVID-19 screenings and telehealth-based education on infection control contribute to easing patient fears and increasing patient safety.

Facilitating Full Spectrum Care 

Assigning a patient to palliative care and sending them home is often mistaken for giving up on prolonging life or managing disease. Palliative care is not hospice and can and should be used in conjunction with curative treatment. In fact, those who are concurrently enrolled in treatment and palliative care programs live just as long or longer than those in treatment only, with markedly improved quality of life., These positive outcomes increase with earlier referral to palliative care.

Addressing the entire patient journey from disease control to hospice is a significant part of what it means to provide holistic care. Palliative services include advance planning initiatives which can be difficult for PCPs to discuss with patients, especially in hospital settings which may emphasize taking curative action. Studies demonstrate when advance directives or POLST forms are completed, outcomes are markedly improved. 

At Kara Health, an 81% POLST completion rate means patients are profoundly involved in their own care. Hospital admissions are reduced and patients are more likely to enroll in hospice in a timely manner. Early hospice referral is linked to lower rates of hospital admission, less emergency service usage, and fewer in-hospital deaths.

As a pandemic-stricken nation reports heartbreaking stories of loved ones isolated in hospital settings, patients and families are more urgently considering the option to remain comfortably at home through the end of life. Palliative care partners directly facilitate such transitions through each stage of care.  

Addressing Costs

Unclear pathways for homecare reimbursement or fear of increased expenses have historically prevented both providers and patients from seeking home-based care. Thankfully, changes in reimbursement policies are beginning to reflect what homecare studies have long shown, that total cost of care is reduced with palliative care and further reduced by transferring care from an acute setting to the patient’s home.

By intently following plans of care and enlisting technology to support high-risk patients 24/7, Kara Health has a proven track record of reducing acute incidents and decreasing usage of emergency services and hospitalizations, all of which substantially lower the cost of healthcare.

Studies find simply educating families on the meaning of palliative care and the potential for reduced hospital expenses breaks down barriers to enrollment by easing desperation and distrust. Developing technology solutions that optimize care delivery without sacrificing quality is a major priority for Kara Health and its results-driven founding team. This aptitude has created a passionate and compassionate culture that equally prioritizes patient satisfaction, cost-savings for payers, and relationship building with providers. 

Kara Health, Palliative Care and COVID-19

The current global pandemic has highlighted the need for home-based palliative care services, as more patients express fears around going to the hospital for outpatient and inpatient care. Patients are also seeking assurance they’ll be safe within their homes, especially if receiving visits from health care providers.

Kara Health’s standard business practices, which include round-the-clock telehealth services, expedited medication and equipment delivery, and emotional and spiritual care have proven invaluable in reassuring patients during the COVID-19 pandemic. 

The decision to offer at-home palliative care to vulnerable populations directly responds to patients’ preferences. The desire for homecare has been long in the making and remains a rare area in which quality of care can be improved while costs are reduced. 

In the new normal that we find ourselves in, transferring care from the hospital to the home is more than a reaction to the pandemic, but an indication of the increasing value of early and more global palliative care referral.