Hospice and Palliative Care Resources
Looking Ahead
Hospice and Palliative Care are Changing
Evolving industry and patient needs are re-envisioning end-of-life care
“Hospice has historically been home or community-based, but we are now experiencing remarkable growth in at-home palliative care across the country. In some places, hospital-at-home and skilled nursing-at-home programs are gaining prominence, too. The landscape of complex care is changing,” said Dr. Comfort, who oversees Calvary’s at-home palliative care consult service and Calvary Hospice. Together, the programs care for more than 500 patients daily across greater New York.
According to experts, including Dr. Comfort, those changes will require a culture shift — including legislative, educative, regulatory, and organizational — to unlock care-at-home potential. Global consulting firm McKinsey & Company reported in 2022, for example, that healthcare systems redesigning their care-at-home services would need to deliver more patient-centric and equitable care while addressing at-home clinical requirements and substantial workforce issues, especially the chronic shortage of skilled palliative and hospice health experts.
Washington is paying attention, too. Last year, a bipartisan group of nine Senators wrote to the U.S. Centers for Medicare and Medicaid Services, calling for better support to improve access to palliative care at home.
“Lawmakers understand that with an aging population, there is a substantial rise in complex life-limiting illnesses such as cancer, heart disease, and neurological disorders,” explained Dr. Comfort. “In addition, their constituents are becoming more aware of and accepting of palliative and hospice care. They know hospice and palliative care need to be better integrated with the needs of our communities and mainstream healthcare services.”
Trends and Changes in Hospice and Palliative Care in the United States
Increased Integration into Mainstream Healthcare: Many healthcare systems now have specialized palliative care teams to provide support alongside curative treatments.
Expanding Access to Services: This includes initiatives to reach underserved populations, improve awareness, and reduce barriers to accessing end-of-life care.
Telehealth, which allows for remote consultations, monitoring, and support for patients and their families, improving accessibility to care.
Training and Education, not only for specialized palliative care teams but general healthcare providers to ensure that they have the necessary skills to address the complex needs of patients with serious illnesses.
Policy Changes: We will see changes to insurance and other financial models that will center around improving access, quality of care, and the sustainability of these services.
Advocacy and Public Awareness will grow as perceptions of hospice and palliative care change. Earlier discussions about end-of-life preferences and care goals will be greatly emphasized.
What could transform the Hospice and Palliative Care landscape the most?
Education, according to Dr. Comfort.
Across healthcare, efforts to overcome the chronic shortage of nurses and technicians include reskilling programs and partnerships with universities, colleges, and schools to train and educate the next generation of at-home healthcare professionals.
“At Calvary, we’re training more healthcare professionals ourselves for hospice and palliative care careers, as well as educating healthcare professionals outside of our sector so they have the necessary skills to address the complex needs of their patients.”
In 2022, Calvary established an RN Residency program in Palliative and End-of-Life Care, an internal program to address a country-wide nursing shortage, which the National Hospice and Palliative Care Organization described in May of 2023 as “critical.”
Five RNs graduated from the Calvary Residency in 2023 and are working for Calvary. Two new students joined the program for 2024. Demand, however, consistently outpaces capacity to meet it, according to Dr. Comfort.
“Calvary and hospice providers like Calvary need qualified staff to serve in end-of-life care roles. They need to be experts in pain management, symptom control, psychosocial support, and communication,” said Dr. Comfort.
“We also deal with everyone else’s concerns in the sector, like an aging workforce. Nursing schools are stepping up but grappling with faculty shortages, too. They, in turn, struggle to secure clinical placements for students because many hospital units are closed due to staff shortages. It’s essentially a self-perpetuating cycle.”
The Road Ahead
While the terrain is challenging, Dr. Comfort points to positive developments and advancements in hospice and palliative care, such as telehealth services, which will increase access to palliative care, especially for individuals in underserved areas.
“We are already facilitating e-consultations throughout New York, monitoring symptoms, and supporting patients and their families,” he said.
Calvary is also pursuing research with local institutions and universities to explore and understand palliative care’s psychosocial and spiritual aspects and advocate for changes that will shape healthcare policy, training and education, and financing that will grow and sustain hospice and palliative care services.
“None of us know what tomorrow will bring; COVID-19 underscored that,” Dr. Comfort observed.
“What I can tell you is that Calvary — which in many respects established and defined palliative and hospice care in America 125 years ago — is helping to shape the new landscape. We have known, forever, really, that care-at-home is indispensable to patients and families. Everyone else seems to be catching onto that idea now. Whatever changes come, we remain committed to comfort, care, and compassion, ensuring the best patient and family experience for everyone entrusted to our care.”