ECMC cares about patients. The Advanced Illness Management and Palliative Care program helps care for chronically ill patients. The Conversation Project assists in discussions of end-of-life care. The Legal Assistance Center works with the healthcare community to aid patients to address underlying legal problems that harm their health.
Dr. Kathleen Grimm, President, ECMC Medical-Dental Staff and Clinical Assistant Professor of Medicine at the State University of New York at Buffalo School of Medicine and Biomedical Sciences, shares how these programs are benefiting patients.
Selected Podcast
Palliative Care: Supporting the Whole Patient
Featuring:
Learn more about Kathleen T. Grimm, MD
Kathleen T. Grimm, MD
Dr. Kathleen Grimm is a member of the Board of Directors at ECMC. In addition, she currently serves as Clinical Assistant Professor of Medicine at the State University of New York at Buffalo School of Medicine and Biomedical Sciences.Learn more about Kathleen T. Grimm, MD
Transcription:
Bill Klaproth (Host): From chronically ill patients to end-of-life care and legal assistance, ECMC helps patients and families throughout the western New York region manage these often-difficult periods of life. Here to talk with us about ECMC Palliative Care, the Conversation Project and the Legal Assistance Center is Dr. Kathleen Grimm, President of ECMC’s Medical and Dental staff and Clinical Assistant Professor of Medicine at the University of Buffalo’s Jacobs School of Medicine and Biomedical Sciences. Dr. Grimm, thanks for your time. So, let’s start with palliative care. Can you first tell us the difference between palliative care and hospice care as there is a difference?
Kathleen T Grimm, MD, FAAP, FASCP, MHSC (Guest): Yes Bill, there is, and it’s often misunderstood by many people including many health professionals. Palliative care is care of patients who are seriously ill and it follows them for a longer time period often than hospice because if you are working with a palliative care team; you may also be receiving what is generally thought of as curative care. So, you may still be getting chemotherapy. You may still be getting dialysis. You may still be working through the process of trying to understand all the different interventions that are being offered and trying to work with your health team toward decision making. Palliative care like hospice care supports all the needs of the patient including spiritual, the cultural needs, and in our particular institution, legal needs of our patients as they go through their serious illness.
So, often a palliative care team can follow a patient for two to three years and build a relationship and try to deal with their pain issues, their emotional issues; the whole-person context. Hospice care also addresses all the needs of the patients, but it is well-understood I think as being time-limited. So, there must be an absolute prognostic timeline for hospice care to occur, although the joke is that many people graduate from hospice because they do such good care. The difference between palliative care and hospice essentially is that most people to qualify for hospice care, move away from curative care. So, they move away from chemotherapy and dialysis and those interventions. Both supportive teams may eventually develop goals that are almost mirrored, but palliative care does not move away from curative care as part of the need to have a palliative care team support you.
Bill: That’s very good to know and a good distinction. So, let’s stick with palliative care. Can you tell us about the ECMC Palliative Care Program? I know you touched on a few things but give us a more in-depth look at the ECMC Program.
Dr. Grimm: And thank you Bill. I love the fact that you asked and could probably talk about this for a long time. I think the team here is very unique in that it offers more than just physician input into working with the patient and family. Because you can well imagine, that a patient and family going through serious illness may face many challenges including a lot of the financial challenges and wanting to understand things like disability, etc. They face emotional difficulty and many of our population really want to be connected with a spiritual support system. So, we are very fortunate here at ECMC that we have a very unique team I think in this area in that we have a fulltime psychologist on our team who we have trained in communication with us and is a lovely addition to our team. We have a chaplain who volunteers with us. We have physicians and a nurse practitioner. We also have a social worker which is essential to every team, but he also works in a transitions of care methodology, so he can stay in contact with families after they leave the hospital which is lovely too. And as you mentioned, what we call our medical legal partnership, which is legal assistance for people facing legal needs or have legal questions as they move through a serious and chronic illness.
Bill: I definitely want to learn more about that coming up, but before we get to that, I also want to talk about the Conversation Project. So, through palliative care and hospice care; difficult conversations need to be had. Can you tell us about the Conversation Project, what that is and how it works?
Dr. Grimm: I would love to. So, we were very fortunate, and I will maybe blow our horn a little bit, we were very fortunate to be among a very small number of institutions across the country that became part of what was called The Conversation Ready Project which was under the umbrella of the Institute for Healthcare Improvement. And through that initiative, became very involved with The Conversation Project itself. Simply put, The Conversation Project is as it may sound, it’s about having conversations long before a serious chronic crisis point in an illness may arise. Because the sad part Bill, is that many patients and families are faced with making very difficult decisions in a crisis mode. So, Conversation Project is about having what they like to call value-based conversations, not asking what medical intervention do you want; but who are you as a person? What’s important to you? What matters to you? If you were to very sick, what would be the important part of you and your care that you would want your health team to know? And these conversations are meant to be had at the kitchen table with family, with friends, with your church if you would like, with your pastor, so that people don’t have to make very difficult decisions only in crisis mode. It’s a national social media campaign. There’s a lot of information on the website conversaitonproject.org and what we love about it particularly is there’s a toolkit that people can use so that it’s not just about sitting down and saying do you want to be resuscitated; it’s about what would be important to you. Would it be really important that you know everything about your disease or would you just want the doctor to tell you their recommendations? You know simple questions that families and patients can talk about among themselves.
Bill: So beneficial The Conversation Project. I could see why it’s important to have these conversations early and I also want to turn to legal advice. You mentioned this earlier. Can you tell us about the Legal Assistance Center at ECMC?
Dr. Grimm: Yes. We are unique I believe. We probably haven’t written enough about this. But we are fairly unique in our palliative care team that we have a medical legal partnership which means that an attorney works with our team when we identify, or she may identify needs that the patient and family may have that are outside of just let’s say the healthcare team needs. So, these may be needs such as disability issues, job issues. We have had our lawyer do very unique things for us and for our patients when patients are struggling to try to get to doctors’ appointments but may have limited leases on their vehicles. She’s actually been able to work to extend the number of miles on their lease and this is in one patient that we had. But it was wonderful because this patient could then continue to come for treatment which was a barrier. And these are the needs that in a doctor’s office aren’t often identified by just saying, ‘How are you doing. How’s the treatment going?’ These are in the social determinants that really are important in a patient’s life and a family’s life so that they continue to be connected to the healthcare system and receive the treatment that they would like to get.
Bill: It’s these small details that really make a big difference in a person’s life when you are talking about palliative care and hospice, etc. Dr. Grimm, quickly if you could share with us how a family should member or a patient inquire about these services?
Dr. Grimm: So, the nice thing about the current healthcare system in almost the entire country is that there are palliative care teams in most larger hospitals. I think the quote is about 90% of hospitals over 300 beds have a palliative care presence. So, if a patient is sick, if a family is struggling with decision making, if there are emotional and social needs that a patient’s family would like to be supported in; they can ask for palliative care consult while they are in the hospital. It is not the same as asking for hospice. I don’t want to mislead people and not say that often people are sick enough that it may lead to a partnership with hospice and that’s the reality of being very ill. But I will say for our service here, we have a very small unit here and often we end up discharging people from our service and trying to just stay connected to them once they leave the hospital. So, it’s not just talks about death and dying, but talking about what’s important to you? Help me to understand what makes your life meaningful and how do I help share in the decision-making process with you?
Bill: Such beneficial information. Dr. Grimm, thank you so much for your time today. And for more information on ECMC Palliative Care, The Conversation Project and or the Legal Assistance Center; please visit www.ecmc.edu, that’s www.ecmc.edu. This is the True Care Health Cast from Erie County Medical Center. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): From chronically ill patients to end-of-life care and legal assistance, ECMC helps patients and families throughout the western New York region manage these often-difficult periods of life. Here to talk with us about ECMC Palliative Care, the Conversation Project and the Legal Assistance Center is Dr. Kathleen Grimm, President of ECMC’s Medical and Dental staff and Clinical Assistant Professor of Medicine at the University of Buffalo’s Jacobs School of Medicine and Biomedical Sciences. Dr. Grimm, thanks for your time. So, let’s start with palliative care. Can you first tell us the difference between palliative care and hospice care as there is a difference?
Kathleen T Grimm, MD, FAAP, FASCP, MHSC (Guest): Yes Bill, there is, and it’s often misunderstood by many people including many health professionals. Palliative care is care of patients who are seriously ill and it follows them for a longer time period often than hospice because if you are working with a palliative care team; you may also be receiving what is generally thought of as curative care. So, you may still be getting chemotherapy. You may still be getting dialysis. You may still be working through the process of trying to understand all the different interventions that are being offered and trying to work with your health team toward decision making. Palliative care like hospice care supports all the needs of the patient including spiritual, the cultural needs, and in our particular institution, legal needs of our patients as they go through their serious illness.
So, often a palliative care team can follow a patient for two to three years and build a relationship and try to deal with their pain issues, their emotional issues; the whole-person context. Hospice care also addresses all the needs of the patients, but it is well-understood I think as being time-limited. So, there must be an absolute prognostic timeline for hospice care to occur, although the joke is that many people graduate from hospice because they do such good care. The difference between palliative care and hospice essentially is that most people to qualify for hospice care, move away from curative care. So, they move away from chemotherapy and dialysis and those interventions. Both supportive teams may eventually develop goals that are almost mirrored, but palliative care does not move away from curative care as part of the need to have a palliative care team support you.
Bill: That’s very good to know and a good distinction. So, let’s stick with palliative care. Can you tell us about the ECMC Palliative Care Program? I know you touched on a few things but give us a more in-depth look at the ECMC Program.
Dr. Grimm: And thank you Bill. I love the fact that you asked and could probably talk about this for a long time. I think the team here is very unique in that it offers more than just physician input into working with the patient and family. Because you can well imagine, that a patient and family going through serious illness may face many challenges including a lot of the financial challenges and wanting to understand things like disability, etc. They face emotional difficulty and many of our population really want to be connected with a spiritual support system. So, we are very fortunate here at ECMC that we have a very unique team I think in this area in that we have a fulltime psychologist on our team who we have trained in communication with us and is a lovely addition to our team. We have a chaplain who volunteers with us. We have physicians and a nurse practitioner. We also have a social worker which is essential to every team, but he also works in a transitions of care methodology, so he can stay in contact with families after they leave the hospital which is lovely too. And as you mentioned, what we call our medical legal partnership, which is legal assistance for people facing legal needs or have legal questions as they move through a serious and chronic illness.
Bill: I definitely want to learn more about that coming up, but before we get to that, I also want to talk about the Conversation Project. So, through palliative care and hospice care; difficult conversations need to be had. Can you tell us about the Conversation Project, what that is and how it works?
Dr. Grimm: I would love to. So, we were very fortunate, and I will maybe blow our horn a little bit, we were very fortunate to be among a very small number of institutions across the country that became part of what was called The Conversation Ready Project which was under the umbrella of the Institute for Healthcare Improvement. And through that initiative, became very involved with The Conversation Project itself. Simply put, The Conversation Project is as it may sound, it’s about having conversations long before a serious chronic crisis point in an illness may arise. Because the sad part Bill, is that many patients and families are faced with making very difficult decisions in a crisis mode. So, Conversation Project is about having what they like to call value-based conversations, not asking what medical intervention do you want; but who are you as a person? What’s important to you? What matters to you? If you were to very sick, what would be the important part of you and your care that you would want your health team to know? And these conversations are meant to be had at the kitchen table with family, with friends, with your church if you would like, with your pastor, so that people don’t have to make very difficult decisions only in crisis mode. It’s a national social media campaign. There’s a lot of information on the website conversaitonproject.org and what we love about it particularly is there’s a toolkit that people can use so that it’s not just about sitting down and saying do you want to be resuscitated; it’s about what would be important to you. Would it be really important that you know everything about your disease or would you just want the doctor to tell you their recommendations? You know simple questions that families and patients can talk about among themselves.
Bill: So beneficial The Conversation Project. I could see why it’s important to have these conversations early and I also want to turn to legal advice. You mentioned this earlier. Can you tell us about the Legal Assistance Center at ECMC?
Dr. Grimm: Yes. We are unique I believe. We probably haven’t written enough about this. But we are fairly unique in our palliative care team that we have a medical legal partnership which means that an attorney works with our team when we identify, or she may identify needs that the patient and family may have that are outside of just let’s say the healthcare team needs. So, these may be needs such as disability issues, job issues. We have had our lawyer do very unique things for us and for our patients when patients are struggling to try to get to doctors’ appointments but may have limited leases on their vehicles. She’s actually been able to work to extend the number of miles on their lease and this is in one patient that we had. But it was wonderful because this patient could then continue to come for treatment which was a barrier. And these are the needs that in a doctor’s office aren’t often identified by just saying, ‘How are you doing. How’s the treatment going?’ These are in the social determinants that really are important in a patient’s life and a family’s life so that they continue to be connected to the healthcare system and receive the treatment that they would like to get.
Bill: It’s these small details that really make a big difference in a person’s life when you are talking about palliative care and hospice, etc. Dr. Grimm, quickly if you could share with us how a family should member or a patient inquire about these services?
Dr. Grimm: So, the nice thing about the current healthcare system in almost the entire country is that there are palliative care teams in most larger hospitals. I think the quote is about 90% of hospitals over 300 beds have a palliative care presence. So, if a patient is sick, if a family is struggling with decision making, if there are emotional and social needs that a patient’s family would like to be supported in; they can ask for palliative care consult while they are in the hospital. It is not the same as asking for hospice. I don’t want to mislead people and not say that often people are sick enough that it may lead to a partnership with hospice and that’s the reality of being very ill. But I will say for our service here, we have a very small unit here and often we end up discharging people from our service and trying to just stay connected to them once they leave the hospital. So, it’s not just talks about death and dying, but talking about what’s important to you? Help me to understand what makes your life meaningful and how do I help share in the decision-making process with you?
Bill: Such beneficial information. Dr. Grimm, thank you so much for your time today. And for more information on ECMC Palliative Care, The Conversation Project and or the Legal Assistance Center; please visit www.ecmc.edu, that’s www.ecmc.edu. This is the True Care Health Cast from Erie County Medical Center. I’m Bill Klaproth. Thanks for listening.