Expanding Rural Palliative Care Nationally

Rural communities are uniquely positioned to meet the challenges of providing palliative care through collaborative efforts. Stratis Health recently concluded a six-month pilot project that provided technical assistance, for planning and developing palliative care services, to three rural communities:

• Franklin, North Carolina
• Ruleville, Mississippi
• Valley City, North Dakota

Each community team completed an initial needs assessment, attended an in-person capacity building session with education and action planning for palliative care, and participated in formal technical assistance calls, all developed and led by Stratis Health.
All three teams formed a community-based team from multiple care settings and developed an action plan related to palliative care processes. Two teams focused their efforts on advance directives. The third focused on linkages between agencies that could provide services and on developing a “Care Captain” program with volunteers to support patients with complex care issues.

Project learnings

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.

On-site community workshops were a key factor in implementing pilot palliative care projects in rural communities.
Rural communities with similar areas of focus can benefit from structured opportunities to connect and share tools and lessons learned in implementation.

An extended time frame, such as one year, may allow teams to further implement their action plans before the project formally ends.

All three teams identified financial support for ongoing efforts related to palliative care services as an ongoing challenge. The lack of reimbursement for interdisciplinary palliative care services will continue to be a concern and barrier for the communities to fully implement team based palliative care. Policy changes for reimbursement of palliative care services, and/or grant funding to help sustain collaborative efforts would be extremely valuable in expanding rural palliative care services through this community-based model.

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.

Final Report, September 29, 2009 (40-page PDF)

Updates on the Minnesota Rural Palliative Care Initiative