The Visiting Nurse Association of Greater St. Louis (VNA) provides in-home palliative care to patients courtesy of our Advanced Illness Management (AIM) program. This is a physician-led program that focuses on symptom relief for people living with serious chronic illness, which often causes frequent hospital and ER visits.
The goal is to keep patients at home and to keep their symptoms better controlled. People who go into the hospital will often return home weaker and less able to care for themselves, even after stays in rehabilitation facilities.
The AIM program tries to be proactive to keep these people at home where they feel most comfortable and to gradually regain strength. Here are some of the most common illnesses we come across in our AIM program and how palliative care addresses them.
Home-Based Palliative Care for Advanced Chronic Obstructive Pulmonary Disease (COPD)
Our AIM team evaluates people with very advanced COPD as well as other lung diseases. These people are almost always on oxygen as well as steroids and often require antibiotics to clear up pneumonia or bronchitis. They tend to have frequent acute flares, so it’s the goal of the AIM team to closely follow them and try to get them the correct medications to take at the onset of flares. AIM medical providers make every effort to keep patients’ primary care physician and/or pulmonologist in the loop. Our AIM program has demonstrated that being proactive in having appropriate medications readily available significantly reduces these patients' hospitalizations as well as visits to the emergency room and/or urgent care.
Home-Based Palliative Care for Congestive Heart Failure (CHF)
Heart disease and heart failure remain two of the most common chronic medical problems people face as they age, causing frequent hospital admissions and ER visits. Just as with COPD patients, the goal of our palliative care team is to help patients better manage CHF symptoms in the home by addressing the need for medication adjustments early on during flares. And, once again, the people receiving care through AIM go to the hospital less.
Home-Based Palliative Care for Advanced Kidney Disease
Patients with advanced renal failure often have other diseases such as heart failure, angina, dementia or diabetes. There are so many other diseases they battle not only physically but socially and emotionally, especially when they go onto dialysis. Our AIM team works to find ways to keep all of these issues as stable as possible.
Home-Based Palliative Care for Advanced Liver Disease
Advanced liver disease can be very physically uncomfortable for patients, especially when they have extra fluid in their abdomen and/or extremities. The AIM team tries to find ways to help them manage the symptoms, which ultimately improves their quality of life and helps them stay more comfortable in the home.
Home-Based Palliative Care for Cancer
The cancer patients the AIM team sees most often suffer from cancer pain and/or side effects from treatment. For a number of reasons, cancer patients often have difficulty receiving adequate cancer-related pain management, and this is when our AIM team steps in. People are less likely to continue cancer treatment if they are in severe pain, or to put it another way, better pain control helps these patients to pursue potentially life-prolonging and/or life-saving treatment options. Other symptoms, such as nausea and vomiting, fatigue, depression and loss of appetite, are also commonly managed by the AIM team in collaboration with the oncologist.
Home-Based Palliative Care for Urinary Tract Infections (UTI)
There are no strict protocols when it comes to treating UTIs through palliative care. However, the senior population does not always manifest the usual signs and symptoms of a UTI. In fact, one of the most common symptoms is severe confusion which can often lead to emergency room visits and/or hospitalizations. The AIM team engages the patient and/or caregivers to watch for confusion and other symptoms and to alert the AIM team so we can pursue prompt evaluation and treatment in the home. Depending on the frequency of UTIs, the AIM team may also start preventative medications.
Home-Based Palliative Care for Advanced Neurological Conditions
When it comes to dementia, we typically see Alzheimer’s and vascular dementia among our patients or some combination of the two. Oftentimes we come across patients who are paranoid or agitated and won’t cooperate with going outside of the home, so having a home-based palliative care team can be a big help to both the patient and their caregivers.
Parkinson’s Disease has many variants. These patients are usually under the care of a neurologist, so our goal is to assess for other symptoms related to the disease that are not controlled by their current medications. Such symptoms include falling, bowel and urinary issues and behavioral problems. The AIM team thoroughly assesses and offers possible management options.
What is the difference between hospice care and home-based palliative care?
Home-based palliative care can be provided along with curative treatment and is covered under "Part B" Medicare and some commercial health insurance plans the same as a doctor's office visit. The focus of home-based palliative care is on relieving symptoms, stress and pain with a goal to enhance stability of serious chronic illnesses, reduce hospital admissions and ER visits and thus improve quality of life for both patients and their caregivers.
Hospice care is a covered benefit under "Part A" Medicare, so all services provided for a person's life-ending illness are paid for which include a medical director (MD/DO), RN's, bath aides, social services and spiritual counselors. The focus of hospice care is on relieving symptoms, stress and pain at the end of life.
To learn more about our VNA AIM home-based palliative care program, visit https://www.vnastl.com/aim-information
