Transcription:

Deborah Howell: Welcome to Right Beside You, a Reid Health podcast. I'm Deborah Howell, and I invite you to listen as we discuss inpatient palliative care today. Joining me is Brenda Carr-Vogelgesang, a nurse practitioner for inpatient palliative care with Reid Health. Brenda, such a pleasure to have you with us today.

Brenda Carr-Vogelgesang: Thank you so much. It's a pleasure to be here.

Deborah Howell: Love it. Can you define for us what exactly are palliative care services?

Brenda Carr-Vogelgesang: Oh, it's a variety of services. For one, palliative services provides symptom-based care that follows the needs of patients over the progression of a disease or serious illness. We work alongside in partnership with patients' doctors to provide the extra layer of support the patient and their families need.

We focus on relieving the stress, pain, and discomfort of chronic or serious illnesses such as pain, nausea, vomiting, constipation, decreased appetite, anxiety, insomnia, et cetera. We further facilitate goals of care discussions to assist patients and families with understanding disease progression and treatment options. We assist with advanced care planning by spending the extra time communicating and educating patients on the importance for code status discussions and appointing a health decision maker who could make the medical decisions for them if they are no longer able to do so.

And we also support those difficult discussions when to proceed forward with end-of-life care when a patient has entered the stage in their disease progression, whereas conservative management is no longer effective or sufficient and they are in need of aggressive symptom-based management under hospice services.

Deborah Howell: Well, I must say it is God's work you do. And boy, you have the perfect voice for it too. Such a comforting voice.

Brenda Carr-Vogelgesang: Thank you. Thank you.

Deborah Howell: Now, I'm hoping you can explain what the difference is between palliative care and hospice care because there's a certain amount of confusion around that.

Brenda Carr-Vogelgesang: There absolutely is. And we receive this quite frequently. And we also find that people interchange those two services together quite frequently as well. And I think that pretty much goes along with the fact that there are several ways the palliative program or service is provided and whether it's provided through our hospital-led program or a hospice-based program or a clinic-based program, I think that's where the confusion lies.

And to keep it simple, both services provide symptom-based care. Palliative services will follow alongside the treatment teams, such as your family doctor, your cardiologist during any stage of a serious illness or disease to provide that extra layer of support. Palliative care and curative care can be provided at the same time for any duration of any serious illness. If a patient is in need of end-of-life care and conservative management is no longer effective, then we will refer them to hospice if the patient and family agrees to do so.

Now, hospice generally will follow for six months or less when a patient is not expected to survive more than six months. You know, at that time all curative treatments are stopped and the patient will no longer seek medical treatment or services through their treatment team. So they will no longer followup with their family doctor. They will no longer follow up with their heart doctor or their kidney doctor. And the goal at this point is comfort-based care only and hospice will manage that service solely.

Deborah Howell: That is a very beautiful explanation. Thank you so much. Who would qualify for inpatient palliative care?

Brenda Carr-Vogelgesang: You know, the general referral criteria is basically the same for inpatient and outpatient. All it involves is a presence of serious illnesses. It could be cancer, lung disease, heart disease, kidney disease, dementia, any neurological impairment that is progressively worsening. And this is evidenced by the inability to maintain daily routines such as dressing, toileting, bathing, eating, et cetera, weight loss, multiple hospital readmissions, poor prognosis, and maybe some advanced care planning conflicts. All of those will qualify for inpatient and outpatient services.

Deborah Howell: Well, that answers my next question. There is such a thing as outpatient palliative care.

Brenda Carr-Vogelgesang: There certainly is. And as a matter of fact, if we see them here in the hospitals, underneath our inpatient team, we recommend following them outpatient. And at that time, we would prefer to arrange a follow-up appointment. Now with COVID and stuff and with COVID and the barriers that we have with our patients not being able to physically walk to an appointment, we offer virtual visits, phone visits, or we also offer clinic visits as well.

Deborah Howell: Very good. Now is palliative care usually covered by insurance?

Brenda Carr-Vogelgesang: It is. Most insurance plans cover this service, including Medicare and Medicaid.

Deborah Howell: Wonderful. How long has palliative care really been in effect?

Brenda Carr-Vogelgesang: You know, it's been around for at least 10 years or so. Medicare is recently recognizing it as supportive services and, therefore, it has actually gained esteem in proceeding forward to help treat patients in their dire needs. We have found that a lot of programs are newly developing or just have started up within the last five or six years.

Deborah Howell: Because it just seems now that this is just so necessary. And what are some of the best benefits of good palliative care?

Brenda Carr-Vogelgesang: Well, one of the benefits is it's improving quality of life by reducing symptom burden to allow patients to continue seeking medical treatment. For example, if someone is having a great deal of pain and discomfort from, if we were to look at cancer treatments, some of the chemo medicine and late radiation that is on board, if someone is having a lot of symptoms, they're not feeling good, they're not feeling well, they may not want to continue to pursue this, well with palliative onboard and helping assist with the symptom-based care that allows people to feel better and therefore they'll continue wanting to seek medical treatment.

We also help in reducing unnecessary ED visits and readmissions, which can be costly. We provide that patient and family support. We'd like to establish goals of care and continue discussions throughout the duration of care. And we'd like to keep that continuity of care.

Deborah Howell: Well, this has been so informative, Brenda. As we wrap up, when is it time to consider palliative care for a loved one?

Brenda Carr-Vogelgesang: It's any time they're in any stage of illnesses or diseases. And we just go back to what would qualify for inpatient palliative care, those with serious illnesses, such as cancer, lung disease and heart disease. We would like to say as soon as someone is diagnosed, you know, consider bringing palliative on board so we can start those discussions and proceeding forward.

Deborah Howell: All great information. Thank you so much, Brenda. I do hope you'll join us again soon.

Brenda Carr-Vogelgesang: Thank you so much. I appreciate being involved in this.

Deborah Howell: You can call (765) 983-3344 to schedule your appointment today. Or for more information, you can always visit ReidHealth.org to get connected with one of our providers. That concludes this episode of Right Beside You, a Reid Health podcast. Please remember to subscribe, rate and review this podcast and all the other Reid Health podcasts. I'm Deborah Howell. Have a great day.