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Palliative Care in Rural Communities
Palliative care is an approach to managing chronic disease and other serious and advanced illness that centers on relieving suffering and improving quality of life for patients and their families. Seven out of ten Americans who die each year die of a chronic disease. Our health care services need to evolve to provide appropriate care.
Palliative care customizes treatment to meet the needs of each individual, seeking to relieve pain, anxiety, shortness of breath, fatigue, nausea, loss of appetite, and other symptoms. Practitioners of palliative care help patients and their families understand treatment options, and facilitate effective communication among health care professionals, patients, and family members. Emotional and spiritual support for the patient and family are hallmarks of palliative care.
Palliative care differs from hospice in that it is appropriate at any point in a serious illness and can be provided at the same time as curative treatment. It may be offered in a variety of settings: hospitals, long-term care facilities, or people's homes. Aside from improving patient comfort and family satisfaction, studies have shown that hospital-based palliative care can have a positive economic impact.
To date, palliative care programs have developed primarily in large hospitals in urban settings. Models of palliative care for long-term care and for rural communities lag behind.
According to Minnesota's state demographer, by 2030, 21 percent of Minnesota's population will be over the age of 65, compared to 12 percent in 2000. This trend has enormous implications for health care services in rural areas, which already are burdened by fewer health care resources and a larger percent of elderly residents.
Palliative Care. This presentation defines the components and importance of palliative care, discusses approaches and interventions to help patients and families identify and communicate goals for care, especially in the home care setting, and discusses ways professional staff can support patients and families who are "not ready" for hospice. Presented by Shiri Etzioni, MD, Lyn Ceronsky, APRN, MS, and Virginia Bender, RN, BS of Transitions and Life Choices, University of Minnesota Medical Center, Fairview Health Services. (57-minute recorded Webinar) Handout (42-slide PowerPoint PDF)
Rural palliative care
Rural communities are uniquely positioned to meet the challenges of providing palliative care through collaborative efforts. Rural communities with similar areas of focus can benefit from structured opportunities to connect and share tools and lessons learned in implementation. A set process and timeline, access to palliative care program development expertise, and external facilitation to help initiate and develop community-based teams are important aspects that can assist in further developing community-based palliative care efforts in rural areas.
Stratis Health is working to establish or strengthen palliative care programs in rural Minnesota communities. We assist with building skills to improve care planning, symptom management, communication, coordination, and delivery of care to improve the quality of life for those with chronic diseases or life-limiting illness. We initially supported 10 rural Minnesota communities in a learning collaborative and are now providing similar assistance to six additional communities.
These projects are a collaboration between Stratis Health and Fairview Health Services' Palliative Care Program. Stratis Health leads the initiatives, acting as the convener and bringing expertise in rural health, quality improvement, and learning collaboratives. Fairview is a supporting partner, providing clinical and operational expertise in palliative care. UCare is funding the initiative and playing an advisory role.
Managing a serious illness "takes a village." Palliative care brings together the support systems that patients—along with their doctors and with their families—need to determine how to plan for the best quality of life. For this reason, the community teams participating in the rural palliative care projects are made up of a variety of professionals from doctors and nurses to bereavement coordinators and clergy. Different organizations participate on each of the teams, representing various combinations of care settings, including:
Each team develops and implements an action plan for developing and/or enhancing a palliative care program in their community. These programs help patients better manage their symptoms, improve satisfaction with the family-clinician relationships, decrease problems with transitions between health care providers—such as when patients move from hospitals to nursing homes or from nursing homes to receiving care at home from a home health agency.
Rural palliative care community development projects
Stratis Health provides one-on-one foundational support and technical assistance for communities looking to start or strengthen their community-based palliative care services.
Minnesota rural palliative care initiative
Stratis Health facilitated an 18-month learning collaborative through which community teams designed a model or focus for their community and received education to improve skills in palliative care. The 10 communities participated in three learning sessions on palliative care, including care models in rural communities and core competencies for palliative care. Between the learning sessions, they worked to achieve goals and received technical support. The work culminated with an outcomes congress, where key learnings and accomplishments were shared.
Six of the 10 communities that participated in the Minnesota Rural Palliative Care Initiative were providing palliative care services by the conclusion of the initiative. The other four were focusing their efforts on standing orders, advanced care planning, and education to health care professionals and the community—all components that build a foundation for palliative care services. Of the 10 communities, only Red Wing and Staples offered palliative care in their communities prior to the project.
Thirty-five communities applied to participate in the initiative, indicating a strong interest and need to develop palliative care services to support rural communities. Stratis Health's rural palliative care project is a model for implementing palliative care programs in rural areas throughout Minnesota and the country. The Minnesota Department of Health—Office of Rural Health and Primary Care provided supplemental funding to cover a stipend to each community to help off-set travel costs for the Minnesota Rural Palliative Care Initiative.
Minnesota Rural Palliative Care Initiative Project Brief July 2011 (4-page PDF)
Minnesota Rural Palliative Care Initiative Final Report June 2011 (28-page PDF)
Resources exclusively for initiative participants > Password required to view this content.
National rural health project
During a six-month pilot project, Stratis Health provided technical assistance, for planning and developing palliative care services, to three rural communities: Franklin, North Carolina; Ruleville, Mississippi; and Valley City, North Dakota. The project was conducted under contract with the National Rural Health Association, funded through the Health Resources and Services Administration, Office of Rural Health Policy. National Rural Health Association, Rural Palliative Care Pilot Project, Final Report, September 29, 2009 (40-page PDF)
Palliative care. An overview of Stratis Health’s work (2-page PDF)
Contact Stratis Health for assistance with your quality improvement and patient safety needs.
If your organization has projects it would like to work on, contact us to discuss how we can work together to support initiatives related to palliative care.
tel: 952-854-3306 | toll-free: 1-877-STRATIS