The continued increase in hospital palliative care teams is especially evident at Danbury Hospital, which recently expanded its program to include outpatients with pulmonary diseases.
The reason for the expansion, according to Dr. Damanjeet Chaubey, the facility’s medical director for palliative care service and chief of hospital medicine, is simple: “It makes for better patient care, which is why we went into medicine in the first place.”
Available at the Western Connecticut Medical Group Pulmonary and Sleep Disorders office in Danbury, the service focuses on making palliative care available early in the process of treating chronically ill patients before they require hospitalization. The hospital is the only one in the state to have received advanced certification for palliative care from the state’s independent, nonprofit Joint Commission.
Unlike end-of-life hospice care, palliative care helps patients and their families deal with serious illness by treating physical and emotional symptoms and reducing suffering at different stages of the disease. Palliative care teams – typically composed of doctors, advanced practice registered nurses, licensed clinical social workers, dietary and spiritual care specialists – are trained and skilled in advanced care planning, while discussing patients’ personal goals to help guide the treatment strategy.
“It’s very interdiscipline-based care,” Chaubey said. “The first step is to meet and define what matters most to the patient and the family, and how to align treatment to reflect that. It’s simple to say, but can be very difficult to achieve. It can otherwise be incredibly difficult to get all those health care providers on the same page.”
According to a report by the Center to Advance Palliative Care and the National Palliative Care Research Center, 67 percent of U.S. hospitals with 50 or more beds reported having palliative care teams in 2015, up from 63 percent in 2011 and 53 percent in 2008. The number of states with “A” grades – defined as more than 80 percent of the state’s hospitals reporting a palliative care team – also increased, from 3 percent in 2008 to 17 percent in 2015.
Additional services her team provides, Chaubey said, include referrals for hospice care at the appropriate time and advance care planning to document health care and end-of-life wishes.
“We offer palliative care for a number of situations,” she said, “including for people looking to lose weight, who are often short of breath or suffer from depression.”
The true goal, she said, is to begin palliative care early, “when they are just starting to face a serious illness.” Otherwise, she said, “You’re dealing with the sickest of the sick, where important decisions need to be made in crisis situations. Whenever possible, we want to get involved before the situation has reached crisis level.”
Planning ahead in a realistic way is usually beneficial to patients and their families, she said. “If you’re looking at someone with COPD” – chronic obstructive pulmonary disease, “it’s very beneficial for them, their family and their caregiver to know what the symptoms can be if the disease worsens and to explain what is likely to happen in the future. Patients often feel that palliative care helps with their quality of life.”
Danbury’s palliative team will also follow patients into nursing homes to continue following the mutually agreed-upon plan, continuing the service after they’re discharged home or remain at the facility if the condition worsens.
For elderly patients with pulmonary conditions, continuous trips to their doctor’s office or the hospital can be especially onerous, Chaubey said. “At-home palliative care can keep them from ending up in a revolving cycle of going to and from the ER,” she said.
Danbury also has two physicians making home visits under the palliative program, “and when’s the last time you heard of a doctor making a house call?” she asked. “That, and our work with visiting nurses and home care agencies, has been a real game-changer.”
As Danbury is part of the Western Connecticut Health Network, Chaubey said she has also been able to help fellow facility Norwalk Hospital build its palliative care resources. “They had one nurse specialist there with palliative care training – it was not very robust,” she said. “But now we’re developing the same program at Norwalk, establishing a team that will be similar to ours.”
By next year, she said, Norwalk will also have a palliative care team specializing in pulmonary diseases.
“We want to continue to grow this program across disciplines and hospitals,” Chaubey declared. “We’re working closely with our donors, foundation board members and others in an effort to see more philanthropic support in this area.”