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As I write this in mid-October, the Florida Department of Health has recorded 306,665 cases of COVID-19 in South Florida. With no idea when the pandemic will end, whether it will return and what the long-term effects on some patients will be, health care providers continue to fortify their facilities from the virus, deliver patient care and prepare for a possible next phase. Among the most promising strategies to reduce utilization of health care resources is community-based palliative care, provided in hospital as well as at home, to treat advanced illness for longer than the period just before death.
Beyond improving outcomes for patients in hospital battling COVID-19, community-based palliative care can be the most effective solution for those facing long-term effects of the virus and other diseases. At MorseLife Hospice and Palliative Care in West Palm Beach, we see patients living with cancer, congestive heart failure, COPD, kidney failure, Alzheimer’s and Parkinson’s, among other illnesses. Studies suggest that by allocating resources to specific patient and family needs, palliative care reduces the total cost of home-based care by 36%, cuts hospital admissions in half and lowers emergency room visits by more than one-third.
Providing community-based palliative care has taken on new urgency during the pandemic, as home-based care can help prevent transmission. Citing this, more than 60 groups including the National Hospice & Palliative Care Organization, National Coalition for Hospice & Palliative Care, National Association of Home Care & Hospice and the Center for the Advancement of Palliative Care have sent letters to the U.S. Department of Health and Human Services requesting a demonstration to test community-based palliative care benefit programs within Medicare.
On the state level, the non-partisan Florida Tax Watch stated in a March 2019 report that a system of care reimbursement for public and private payors must be developed for palliative care. That same report, published one year before the pandemic began, predicted that home-based palliative care could reduce the nation’s overall health care costs by $103 billion during the next two decades. Those savings will increase in the wake of COVID-19.
Consensus among health care researchers indicates that ignoring the possible long-term effects of COVID-19 poses significant risk to our nation’s health and our health care system. The Kaiser Family Foundation estimates 41% of adults ages 18 and older have a higher risk of developing more serious illness after having COVID-19 due to age, underlying health conditions or both. The Mayo Clinic sites imaging tests taken months after recovery showing lasting damage to heart muscle, even in people who experienced only mild COVID-19 symptoms. The type of pneumonia often associated with COVID-19 can cause long-term lung damage. Researchers at the Icahn School of Medicine at Mount Sinai suggest there will be a significant increase in patients with chronic kidney disease and a September paper in the Journal of Parkinson’s Disease called the projected increase in long-term neurological consequences the “silent wave” of COVID-19.
The call to action of this growing body of research is clear. Community-based palliative care should be elevated in importance to a primary method of treating symptoms, improving outcomes and quality of life, and reducing utilization of health care services.
As we anxiously await a vaccine and new therapeutics to treat COVID-19, community-based palliative care can play an important role. Designated by the Florida Legislature as the only Teaching Hospice in the state, MorseLife Hospice and Palliative Care is on the leading-edge of sustainable best practices for dealing with the long-term effects of the pandemic for years to come.
