(P72) Perspectives on Collaborative Palliative Care Delivery for Home Health Patients

Introduction/

Objective: Upon hospital discharge, medically complex patients are frequently referred for skilled nursing facility (SNF) care or skilled home health care (HHC). Both settings provide restorative and supportive services, however, the intensity of services, such as around the clock nursing support, are greater in SNF care. Both settings have high rates of rehospitalizations. However, individuals often desire to avoid care in an institutional setting, eager to return home and remain there. Supporting patients in the home allows for more targeted use of SNF by individuals that may lack housing and caregiver resources. Palliative care support has been identified as one mechanism for supporting seriously ill patients discharged to home with HHC. However, identifying patients with unmet palliative care needs and coordinating with healthcare teams across settings to support these patients is challenging. We sought perspectives from key stakeholders to learn how HHC can best assess and address unmet palliative needs.

Design/Methodology: We conducted semi-structured interviews with primary care providers (PCPs), home health clinicians, hospitalists, patients receiving HHC, and their caregivers. Interview topics included experiences with care coordination and implementing palliative supports in HHC. Our multidisciplinary team used an iterative approach to thematically analyze interview data.

Results: We conducted 53 interviews with PCPs (n=17), hospitalists (n=11), HHC clinicians and staff (n=10), patients (n=4), and caregivers (n=11). Each group affirmed the potential for HHC to serve a more prominent role to identify, coordinate, and provide palliative supports in the home.

Key themes of risk for facility placement and need for caregiver supports emerged as important considerations for supporting seriously ill older adults. Serious illness, including a variety of diagnosis with poor trajectories such as cancer and chronic disease with end stage illness were identified as needing improved home support. Patients’ desire to remain in their home, despite qualifying for SNF care led to some concerns about needing support to do so safely and avoid losing independence. Moreover, participants indicated that caregivers are often overwhelmed with trying to provide sufficient care at home while others identified the lack of reliable caregivers as a threat to a patient’s desire to avoid institutional care.

Conclusion/

Discussion: Based on multiple perspectives, there is need for a new model of HHC that includes palliative care supports for medically complex patients following hospitalization. Findings from these interviews have been incorporated into design of a new palliative HHC model, which our team is currently piloting.