Adviser LeadingAge New York Winter 2014 Winter 2014 | Page 24

ENHANCING PARTNERSHIPS

23

Specialist Palliative Care
Russell K. Portenoy MD, chief medical officer, MJHS Hospice and Palliative Care;
director, MJHS Institute for Innovation in Palliative Care, New York
Barbara Hiney RN, executive vice president, MJHS Hospice and Palliative Care

P

alliative care is a model of care
– appropriate for all patients
with life-threatening illness – which
aims to reduce the illness burden
of the patient and the family from
the time of diagnosis forward.
Generalist-level palliative care
comprises a set of best practices,
such as symptom management,
that should be routinely provided
to patients with serious illness.
Specialist-level palliative care
includes an array of interventions
provided by trained professionals
who work as a team. Although
palliative care starts at diagnosis,
specialists usually focus on advanced
illness, when needs are more
complex.
Palliative care consultative
programs evolved after taking
root in hospitals. More recently,
specialist palliative care has
emerged in the community and
in nursing homes. New York
has the seventh highest 30 day
re-hospitalization rates for
skilled nursing facilities, and
approximately 25 percent of
patients die in nursing home.
Because of this, the MJHS Hospice
& Palliative Care Organization
partnered with a large NYC
Metropolitan Medical Center’s
Care Management Organization
(CMO) and developed an Early
Intervention Community-Based
Palliative Care service for the

hospital’s key nursing homes in
their MCO network.
Initially, MJHS implemented a
screening and early intervention
palliative care model in a 700 bed
skilled nursing facility. Research
has shown that patients with
advanced illnesses want to achieve
a sense of control, want their pain
and symptoms addressed, want to
avoid inappropriate prolongation of
their dying process, want to relieve
burdens on their families and
hope to strengthen relationships
with loved ones. Our program
uses a standardized process for
screening patients for potential
unmet palliative care needs,
including advanced care planning
and symptom management on
a monthly basis. Those skilled
residents who are screened and
determined to have an unmet
palliative care need are referred for
a palliative care consultation from
a specialist-level palliative care
physician or nurse practitioner.
The palliative care physician
and/or nurse practitioner
completes a comprehensive
assessment, resulting in “Plan
of Care” recommendations and
specific interventions focused on
the resident’s unmet needs.
Patients who appear eligible for
the hospice benefit receive a
consultation to determine hospice
(Continued on page 24)

Adviser a publication of LeadingAge New York | Winter 2014