Comments on GeriPal - Geriatrics and Palliative Care Blog: Interview with Seth Landefeld about Geriatrics and...

This is a great and intuitive development in the p...

2011-02-15T08:12:20.094-08:00

This is a great and intuitive development in the progress of palliative medicine. I am a BC palliative care doc and often tell people that I'm an "amateur geriatrician" based on affinity, experience, and some extra training in geriatrics.
One thing that combining the two might help with is in the expansion of PC training programs in underserved areas. Here in Utah, we have a crushing lack of training programs. Working together with Geriatrics is likely to be our only way to bootstrap into being able to train new PC doctors, who are sorely needed here.

Petra and Ken, Great discussion. I think that whet...

2009-09-29T07:14:23.401-07:00

Petra and Ken,
Great discussion. I think that whether or not the eligibility for hospice and subsequent hospice services (due to artificial medicare imposed guidelines) has the unintended effect of limiting access to palliative care depends on how one defines palliative care. My hope is that the integrative model of palliative care as working along side all other treatment modalities becomes a normal part of care of all patients. Actually a nursing home setting (assuming mostly geriatric pts and geriatric trained staff) may be the ideal place to provide excellent palliative care.

Petra--i agree with you that the issue of palliati...

2009-09-23T23:28:16.098-07:00

Petra--i agree with you that the issue of palliative care in the nursing home is a big issue. It seems there are few nursing home patients in whom palliative care should not be a big a part of the care plan. However, many of these patients will not be hospice candidates---either because they do not qualify on prognostic grounds (and this is a population in which the prognostic criteria for hospice makes little sense) or because the patient/family is not ready for hospice.

Getting nursing home patients palliative care outside of hospice often proves difficult. I sometimes wonder if having hospice as a separate service in the nursing home has the unintended consequence of making access to palliative care difficult for nonhospice patients. And for hospice patients, integrating hospice services into the NH care plan can be difficult. There certainly seems to be a need for a more unified approach.

I am encouraged to hear that there is interest in ...

2009-09-23T17:13:01.068-07:00

I am encouraged to hear that there is interest in more integration between geriatric and palliative care and agree wholeheartedly that nursing home patients would benefit from the joint expertise of geriatric and palliative care.

Unfortunately, palliative care for most nursing home residents is only accessible through hospice care. This leads invariably to "no palliatve care" for those who are not deemed to "die in 6 months" even if they would greatly benefit from a palliative care approach and often duplication of services (Social work, nursing, nurses aides, therapists) for those who are eligible for hospice but do not require a lot of palliation or support, because this is already provided by regular nursing home staff. I hope that more integration will allow for more tailor made approaches of care to the patients' needs rather than being labeled "traditional", "palliative", "geriatric" or "hospice" care.

The Geriatrics/Palliative Medicine Summit was a te...

2009-09-17T09:18:51.494-07:00

The Geriatrics/Palliative Medicine Summit was a terrific example of what motivated leaders with shared interests can accomplish. Seth mentioned a "joint statement" of principles, which is now working its way through the Boards of AGS and AAHPM. This is an important product of the meeting, but additional concrete action steps were also developed in different areas: Education & Training, Research, Public Policy, Clinical Care, and Leadership & Organizational Structure. I expect to see those action plans further developed and implemented through each organization's committee structure. Stay tuned :)

(The John A. Hartford Foundation put up a Grants at Work news piece on the summit HERE.)

I would love to learn if there were any real concr...

2009-09-02T20:47:36.970-07:00

I would love to learn if there were any real concrete next steps discussed at this meeting; steps that we as a community can take to move this forward. Did they come up with any action plans that we can work on? Or was it just suggested areas of collaboration?