Across the United States, the homebound population is expected to increase by more than 50 percent over the next 20 years (Desai, 2008.) Lack of home-based palliative care for the homebound population is associated with several adverse outcomes, including increased emergency department visits and hospitalizations as well as decreased caregiver well-being. As the healthcare market moves towards bundled and shared savings payment models, the incentive will be to keep the patient at a “lower cost setting.” Innovative care models designed to deliver high quality care while containing cost are vital for sustainability of healthcare delivery at the local and national level. In 2011, approximately two million people or 5.6 percent of the elderly Medicare population living in the community were completely or mostly homebound. The majority of these patients experience significant symptoms associated with their advanced diseases, in particular, pain and depression. More than 50 percent of these patients prefer to be cared for in the home setting, expressing this preference particularly when asked about end of life care (Higginson IJ, 2013). According to the 2018 Palliative Care Growth Snapshot issued by the Center to Advance Palliative Care, the prevalence of hospitals (50 or more beds) palliative care in U.S. hospitals has increased significantly from 658 to 1,831from year 2000 to 2016. The rise in prevalence of in-patient palliative care in U.S. hospitals has been steady over the last 16 years. Same is not true for community based palliative care as services are still lacking for the homebound population. Patients …
Across the United States, the homebound population is expected to increase by more than 50 percent over the next 20 years (Desai, 2008.) Lack of home-based palliative care for the homebound population is associated with several adverse outcomes, including increased emergency department visits and hospitalizations as well as decreased caregiver well-being. As the healthcare market moves towards bundled and shared savings payment models, the incentive will be to keep the patient at a “lower cost setting.”
Innovative care models designed to deliver high quality care while containing cost are vital for sustainability of healthcare delivery at the local and national level. In 2011, approximately two million people or 5.6 percent of the elderly Medicare population living in the community were completely or mostly homebound. The majority of these patients experience significant symptoms associated with their advanced diseases, in particular, pain and depression. More than 50 percent of these patients prefer to be cared for in the home setting, expressing this preference particularly when asked about end of life care (Higginson IJ, 2013).
According to the 2018 Palliative Care Growth Snapshot issued by the Center to Advance Palliative Care, the prevalence of hospitals (50 or more beds) palliative care in U.S. hospitals has increased significantly from 658 to 1,831from year 2000 to 2016. The rise in prevalence of in-patient palliative care in U.S. hospitals has been steady over the last 16 years. Same is not true for community based palliative care as services are still lacking for the homebound population.
Patients who benefit from home-based palliative care are typically those with advanced complex illnesses or life-limiting diagnoses and a high risk of morbidity and mortality. These individuals most often do not have a predictable prognosis and are not eligible for or interested in electing formal hospice services (Lukas L, Feb 2013). These patients are among an increasing number of elderly and frail persons who are homebound, usually due to the presence of multiple chronic illnesses including cognitive impairment with resultant functional limitations and decline.
Start-up programs quickly face more demand than can realistically be met, making it necessary to balance priorities. Piloting the program one patient at a time will permit initiation of services on a small scale while testing operations and stakeholders’ response. Therefore, establishing a very specific and narrow referral criterion (initially) is crucial before initiating services. This specific criterion can be established collaboratively with referring partner. Early collaboration will allow program leadership to build strong relationship with local area hospital systems, primary care and or specialist physician practices.
An important note: In the United States, most patients receiving home-based palliative care do so under a medical practice model and are not required to meet the definitions of being homebound as it applies to home health, particularly if the clinician determines it is medically necessary to see a patient in the home setting to optimize their assessment and treatment plan. However, documentation of the need for home-based care is typically required for insurance coverage (referenced below #3).
Reference
- Brumley R, Enguidanos S, Jamison P, Seitz R, Morgenstern N, Saito S, McIlwane J, Hillary K, Gonzalez J. Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care. J Am Geriatr Soc. 2007 Jul;55(7):993-1000. doi: 10.1111/j.1532-5415.2007.01234.x. PMID: 17608870.
- Riolfi M, Buja A, Zanardo C, Marangon CF, Manno P, Baldo V. Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: a retrospective cohort study. Palliat Med. 2014 May;28(5):403-11. doi: 10.1177/0269216313517283. Epub 2013 Dec 23. PMID: 24367058.
- https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c07.pdf
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