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HOSPICE & PALLIATIVE CARE IN SOUTH FLORIDA

Making the Case for Palliative Care

A joint study by the Center to liative care.” person 65 and older. This has far-
Advance Palliative Care and the What more proof do we need that reaching implications for the funding
National Palliative Care Research palliative care isn’t just for the last six of Medicare and Medicaid, as well as
Center (America’s Care of Serious months of life than the fact that approx- for the need to develop a caregiver and
Illness: 2019 State-by-State Report imately nine in 10 of the nation’s sickest provider workforce.
Card on Access to Palliative Care in patients (the five percent who account Congress should pass the Palliative
Our Nation’s Hospitals) offers an for half of all health care costs) are Care and Hospice Education and
instructive snapshot of where we are expected to live for more than a year? Training Act which would promote
today. Of the 89 palliative care pro- The rate of serious illness and func- grants to medical schools and teach-
grams offered at 138 Florida hospitals tional dependency driving these num- ing hospitals and provide workforce
in the study, fully one-half were the sole bers will only increase as the popula- development and career incentive
provider of palliative care for its com- tion ages. It is time to support evidence- awards.
munity, which earned the state an over- driven best practices in order to The State’s aforementioned grade of
all grade of “B” in the report. BY KEITH A. MYERS increase access and manage costs. “B” is not a bad grade unless you or
Additional studies demonstrate that Last year, the Centers for Medicare someone you love is struggling with a
palliative care reduces avoidable spend- • Reduces total costs of home-based and Medicaid Services contracted with serious illness – as is the case for at
ing and unneeded services across set- care by 36%. the American Academy of Hospice and least 12 million adults and 400,000
tings in the following ways: On the state level, more can be done Palliative Medicine to develop new pal- children across the country. Palliative
• Reduces inpatient readmissions by to improve costs. Florida Tax Watch, liative care quality metrics. Locally, care should be readily available in
48% and costs by 28% per day which has been a nonpartisan watch- Palm Beach Hospice and Palliative Care South Florida.
• Reduces hospital admissions by dog for four decades, noted in a March by MorseLife is the only teaching pro-
half and emergency room visits by more 2019 report, “To ensure the financial gram in the state. We will be sharing Keith A. Myers is president and CEO
than one-third stability of palliative care providers, a data to drive best-practices in the field. MorseLife Health System and Palm
• Reduces the need for patients to be system of care reimbursement that can The Census Bureau offers the sober- Beach Hospice and Palliative Care. He is
transferred from skilled nursing facili- be used by public and private payors ing projection that as early as next the Not-For-Profit Vice President on the
ties to the hospital or emergency room must be developed, along with a defini- year there will be fewer than four peo- Board of Directors of the Florida
by 43% ple of working age (20 to 64) to every Health Care Association.
tion of the services that constitute pal-

Cover Story: “She Has Horrible Pain …Won’t Someone Please Help Us.”

Continued from page 1
their families and caregivers. pioneering the “modern” hospice move- ment. Opioids are not considered first- accomplished with sound strategies and
The shared media coverage by televi- ment and for her early emphasis on pal- line treatment for chronic pain outside of practices that promote the safe use of
sion, internet, and news sources has liative care in clinical practice. She cancer, palliative and end-of-life care, opioids, prescribed by professionally
brought to the nation’s attention an opi- coined the term ‘‘total pain”, illuminat- and for symptoms associated with short- competent practitioners. The awareness
ate crisis affecting public health and ing how complicated and multidimen- ness of breath (terminal dyspnea) at end of palliative care in helping to manage
influencing the countrywide conversa- sional pain can be with having physical, of life, with there being exceptions under pain, as well as to improve health, well-
tion about pain management. Without a psychological, social, emotional, and special circumstances. ness, and satisfaction, is growing. Most
doubt, our current opioid predicament spiritual components that contribute to a Our legislature has enacted bills to large hospitals recognize the value and
has tremendous effects on our collective “total pain” experience that is as unique safeguard opiate use in Florida. Effective offer inpatient palliative care services. I
welfare, both social and economic. The as the people who face it. Palliative July 1, 2018, House Bill No. 21 increased have the privilege to provide and super-
National Institutes of Health (NIH) Medicine endeavors to maximize quality the regulation, training, and reporting vise care as the Medical Director for
recently published on their website that of life for patients and families facing required for prescribing and dispensing Catholic Palliative Care Services (CPCS).
the total "economic burden" of prescrip- serious illnesses. It supports curative controlled substances. It defined acute CPCS offers services in various settings,
tion opioid misuse alone in the United treatment intended to prolong life, and it pain with restrictions on certain pre- including at home and in hospitals.
States is estimated at $78.5 billion a year; also provides choices to life-sustaining scriptions, required prescribers to con- Since December 2018, CPCS provides
including costs of healthcare, lost pro- treatment near the end of life, particular- sult the prescription drug monitoring palliative care services at Holy Cross
ductivity, addiction treatment, and crim- ly when the value and benefits are ques- program (PDMP) before prescribing Hospital. We partner with physicians at
inal justice involvement. The website tionable. This is accomplished by controlled substances with certain Holy Cross Hospital to support person-
also states that more than 130 people in exploring and defining the goals of care exceptions, among other mandates. centered care and to optimize health in
the United States die after overdosing on for each patient and family, by support- Effective July 1, 2019, House Bill No. serious illness. The CPCS Team at Holy
opioids every day. The staggering statis- ing Advance Care Planning, and by serv- 451 (HB 451) established that competent Cross Hospital includes a fulltime staff
tical evidence, tragic stories, and untime- ing as a patient advocate in shared deci- adults have the right of self-determina- comprised of a Board-Certified Palliative
ly deaths illustrate how the issue sion making and medical management. tion regarding healthcare decisions, Care Physician, Advanced Registered
deserves our full attention and purpose- Palliative care also focuses on optimizing including the right to refuse treatment Nurse Practitioner (ARNP), Social
ful efforts to responsibly protect our symptom relief by managing difficult with a Schedule II opioid controlled sub- Worker, Chaplain, and Nurse Navigator.
communities and to deploy sound mech- symptoms such as pain, as well as short- stance. The bill also required practition- Our Catholic Palliative Care Team will
anisms for opiate use, diversion and ness of breath, constipation, nausea, loss ers to provide an educational pamphlet continue to adapt to the changing
addiction. Our recognition and efforts to of appetite, difficulty sleeping, and from the Department of Health (DOH) to healthcare landscape, while advocating
end the opiate crisis however does not depression, to name a few. inform patients about available nonopi- and delivering effective pain manage-
change the fact that pain exists, and it Palliative physicians recognize, like oid alternatives for the treatment of pain ment for people with pain, and for their
requires conscientious and dutiful treat- other clinicians, that nonopioid alterna- and to discuss nonopioid alternatives, families and caregivers. We hear you,
ment. tives for pain are always considered first- among other requirements. and we are here to help.
Part of the reason I pursued becoming line treatment with examples including Pain control is a central component of
a physician was to satisfy my curiosity of nonopioid medicinal products, physical symptom management, and its reliable Dr. Tracy Romanello is Medical Director
the human body, a wonderous and and occupational therapy, selective inter- oversight is critically important to at Catholic Palliative Care Services and
unique system marvelous in design. ventional procedures and treatments, patients, families, caregivers, and other Catholic Hospice. For additional informa-
How the body responds and adapts to chiropractic treatments, massage thera- healthcare providers. It is imperative to tion, contact Catholic Palliative Care
insult and to injury fascinates me, and py, acupuncture, and music and pet ther- have thoughtful consideration for our Services at (305) 351-7086 or by email at
pain is a unique complexity. Dame apy. More research for the use of medical opioid crisis while navigating the regula- palliativecare@catholichospice.org.
Cicely Saunders, an English physician marijuana is anticipated for optimizing tory landscape, without compromising
and writer, had a legendary career for its role in pain and symptom manage- effective pain management. This can be

26 November 2019 southfloridahospitalnews.com South Florida Hospital News