Program aims to improve palliative care in rural communities

Finding quality care nearby is a real challenge for rural Americans. According to the National Organization of State Rural Health Offices, only 9% of all doctors, 10% of psychologists and psychiatrists, and 12% of all pharmacists practice in rural communities. There are half as many specialists and dentists per 100,000 inhabitants in rural areas as in urban areas.

Another type of medical care that’s hard to come by in rural America is palliative care, which helps people with serious illnesses and their caregivers. Andrew Nelson, host of the Exploring Rural Health podcast from the Rural Health Information Hub (RHIhub), which is supported by the US Department of Health and Human Services, addressed this issue in a recent episode.

He interviewed Karla Weng, Senior Program Manager for Stratis Health, and Pat Custis, Director of the Washington State Office of Rural Health, about their work to expand access to hospice palliative care in rural Washington. Washington, North Dakota and Wisconsin.

What is palliative care?

“Palliative care really focuses on relieving symptoms, pain and stress, and can be appropriate at any age and stage, alongside curative care,” Weng said. Palliative care is a type of palliative care, but anyone with advanced or serious illness or multiple chronic illnesses can benefit from palliative care.

“The focus is often on pain and symptom management, psychosocial and spiritual support for the family and the patient, and a lot of work around continuity of care plan,” she says. “It provides the information and support needed to make decisions about a plan of care using the patient’s goals and values.”

Build a program

Weng says Stratis Health started a rural palliative care project in Minnesota in 2008, and with recently acquired foundation funding, they now work with state offices of rural health in Washington, Dakota. North and Wisconsin.

“We really focused on a community capacity-based approach to help rural communities develop palliative care services,” she says.

Rather than giving communities a cookie-cutter plan to follow, the program looks at community resources and identifies who in the community has the capacity, passion and interest in developing services and then developing a coherent plan. She says, “If there is a group of people trying to improve lives, how do you tap into and connect with those resources?”

Weng says palliative care has traditionally been provided in hospitals, but it doesn’t necessarily work in rural settings. “They don’t have the volume of inpatients and they don’t have specialists,” she says. “So there’s a lot of opportunity to have more community-centered care that adds a layer of palliative support.”

This may mean patient phone calls, home visits, home nursing, meals on wheels or other services. “It’s really not as dependent on that hospital care as the basis of childbirth,” Weng said. “They might need a clinical consultation, but they might also need the chaplain to stop by or a volunteer to come by once a week and play cards with them. It makes a huge difference in their overall outlook. .”

Pets can also make a big difference in a patient’s state of mind. Justis says a program in Oregon provides companion animal care for rural patients, from walking dogs to trimming nails to taking animals to the vet when needed. “It’s a huge relief for people who are really sick and fear losing one of their best sources of comfort if they can’t care for their pet,” she says. “There are many non-medical support opportunities where rural communities can thrive.”

Care closer to home

“We want people to be able to stay with the people they love and the places they love at a time when they need that support the most,” Justis said. “So we’re trying to help this rural team learn the skills to be comfortable.” She says this largely focuses on communication skills training for healthcare providers.

“When a care team in a rural community sees someone in pain, the provider may be inclined to say, ‘We don’t have what they need here. I have to send them somewhere else,’” Justis explains. “That’s the cycle we really want to break by letting providers, clinical teams, and the community know there’s another way. You don’t have to drop out of care just because your aggressive treatment options are slowing down.”

Increasing the availability of telehealth visits helps. “Telehealth case consultations are partly direct clinical assistance with a difficult case, but they are also excellent teaching opportunities for local teams to participate with people who specialize in palliative care,” Justis said. She says caregivers are not only using virtual visits to communicate with remote specialist teams, but also with the people they serve, as many of their service areas span large counties.

“One of the quotes we use a lot when talking about this job is Arthur Ashe, the tennis player, who said, ‘Start where you are, use what you have, do what you can. “,” Weng says. “I think that really fits with our whole approach to establishing palliative care services in rural settings.”

Learn more

Listen to the podcast to learn more about rural palliative care initiatives, funding issues, and how to establish or improve palliative care in your community.

About Keneth T. Graves

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