Main description:

Meeting the Needs of Older Adults with Serious Illness: Challenges and Opportunities in the Age of Health Care Reform provides an introduction to the principles of palliative care; describes current models of delivering palliative care across care settings, and examines opportunities in the setting of healthcare policy reform for palliative care to improve outcomes for patients, families and healthcare institutions. The United States is currently facing a crisis in health care marked by unsustainable spending and quality that is poor relative to international benchmarks. Yet this is also a critical time of opportunity. Because of its focus on quality of care, the Affordable Care Act is poised to expand access to palliative care services for the sickest, most vulnerable, and therefore most costly, 5% of patients- a small group who nonetheless drive about 50% of all healthcare spending. Palliative care is specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness-whatever the diagnosis or stage of illness. The goal is to improve quality of life for both the patient and the family. Research has demonstrated palliative care's positive impact on health care value. Patients (and family caregivers) receiving palliative care experience improved quality of life, better symptom management, lower rates of depression and anxiety, and improved survival. Because patient and family needs are met, crises are prevented, thereby directly reducing need for emergency department and hospital use and their associated costs. An epiphenomenon of better quality of care, the lower costs associated with palliative care have been observed in multiple studies.

Meeting the Needs of Older Adults with Serious Illness: Challenges and Opportunities in the Age of Health Care Reform, a roadmap for effective policy and program design, brings together expert clinicians, researchers and policy leaders, who tackle key areas where real-world policy options to improve access to quality palliative care could have a substantial role in improving value.

Contents:

Current Needs of Older Adults with Serious Illness

Chapter 1
When More is Less: Overuse of medical services harms patients
Shannon Brownlee, MS, Christine Cassel, MD, and Vikas Saini, MD

Chapter 2
Disparities in Access to Palliative Care
Cardinale B. Smith and Otis W. Brawley

Chapter 3
Family Caregiving and Palliative Care: Aligning Theory, Practice, and Policy
Carol Levine and Carol V. O'Shaughnessy

Settings for the Care of the Seriously Ill

Chapter 4
This is Your Life: Achieving a Comprehensive, Person-Centered Model of Care at the Intersection of Policy, Politics, and Private Sector Innovation
Brad Stuart, M.D., Andrew MacPherson, Gary Bacher

Chapter 5
Hospice and Health Care Reform: What is the Optimal Path?
Melissa D. Aldridge, Jean S. Kutner

Chapter 6
Palliative Care in the Long Term Care Setting
Mary Ersek, Justine S. Sefcik, David G. Stevenson

Measuring Quality and Paying for the Care of the Seriously Ill

Chapter 7
Meeting the Needs of Older Adults with Serious Illness: Challenges and Opportunities in the Age of Health Care Reform
Laura C. Hanson, MD, MPH, Anna Schenck, PhD, Helen Burstin, MD, MPH

Chapter 8
Palliative care's impact on utilization and costs: Implications for health services research and policy
J. Brian Cassel

Chapter 9
Long-term Services and Supports: A Necessary Complement to Palliative Care
Judy Feder, Harriet Komisar, and Robert Berenson

Chapter 10
The Manifest Destinies of Managed Care and Palliative Care
Richard H Bernstein Karol DiBello

Platforms for Improvement

Chapter 11
Models of Care Delivery and Coordination: Palliative Care Integration within Accountable Care Organizations
Robert Sawicki, Susan Block, Lori Bishop, Monique Reese, Dottie Deremo, Susan Block, MD, Vicki Jackson, MD, and Thomas Lee, MD

Chapter 12
Implementing a Care Planning System: How to Fix the Most Pervasive Errors in Health Care
Bernard J. Hammes, Ph.D., Linda A. Briggs, M.A., M.S., R.N., William Silvester, M.D., Kent Wilson, M.D., Sue Schettle, John Maycroft, M.P.P., Julie Sandoval, M.D., Ann E. Orders, M.H.A., Melissa Stern, M.B.A.

Chapter 13
Igniting Action to Integrate Palliative Care in our US Health System: The Role of Disease Specific Advocacy Groups
A cancer advocacy case study
Rebecca Kirch, Andy Miller

Chapter 14
What do you mean you don't also offer palliative care? Effective public engagement to harness demand to improve care for serious illness
Sharyn M. Sutton PhD and Marian S. Grant, DNP, CRNP, RN

Chapter 15
Research Priorities in Palliative Care for Older Adults
R. Sean Morrison, MD

Chapter 16
Medical and Nursing Education & Training
Charles F. von Gunten, MD, PhD, Betty R. Ferrell, RN, PhD