FEATURE
COMING FULL CIRCLE: Home-Based
Palliative Care as an Innovation in Aging
Lori Earnshaw, MD, FAAHPM
F
ully conscious while on a fentanyl
drip and with an endotracheal tube
down his throat, the 70-something
emaciated man raised his index
finger to wipe tears from his tired
eyes. “I just hope to make it home,” he wrote
on the dry-erase board. As sick as he was, he
would not compromise his literary prowess
to write less than a complete sentence. He was alone. His sister lived
out of town, and my palliative care team and the ICU nurse stood
in silence as he came to terms with the possibility that he might die
if he discontinued ventilatory support in order to avoid long-term
ventilation through a tracheostomy at an LTAC facility. Against all
odds, he survived his hospital stay and was discharged home with
hospice care through Hosparus Health, which provided his oxygen
by nasal cannula, morphine for breathlessness, interdisciplinary
team support, and a 24/7 call center with a nurse on the other end
of the line.
He thrived on hospice services, so much so that he had to
be discharged six months later because he had gained weight,
his symptoms improved, and he was able to resume his writing.
He had not been to the emergency department (ED) or hospital
once during his hospice enrollment. Despite the hospice team’s
efforts to provide continuity of care after discharge, nothing could
replicate the services he received from hospice. He had three ED
visits in the next year because of COPD exacerbation, became
very depressed and suffered from panic attacks. He had difficulty
leaving home to attend his multiple physician appointments, and
he was confused by numerous prescriptions, often in duplicate or
with conflicting indications.
What my patient needed was home-based palliative care, but it
would be three years before Louisville would have such a program
and before I would meet him again. In my role with Hosparus
Health, I visited him in his home, reminiscent of the interiors I
saw as a child in the 1970s Architectural Digests. His height took
me by surprise, as well as seeing him donned in a button-down
shirt and corduroy pants. He was relieved to see a familiar face.
He told me that he heard a commercial about new programs at
Hosparus Health on the local public radio station, and he called to
see if we might be able to help again. He had a positive experience
with hospice, and he sadly hoped that he might have a prognosis
of less than six months, so he could benefit from services again.
He had not met the prognostic criteria when evaluated by the
hospice admission nurse, but I was able to provide a palliative care
consultation. Fortunately, we enrolled him in our home-based
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MARCH 2019
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