Caring for those who need it most. For the Health of America.
People with a serious or terminal illness may benefit from palliative care, which supports a patient’s own goals of care, from continuing treatment to alleviating pain and other symptoms. The pandemic has meant changes in the way patients receive palliative care. And it’s raised concerns about contracting COVID-19 for patients who may need to go to the hospital. Blue Shield of California is working with providers throughout California to ensure palliative care patients continue receiving the support they need.
Janice Curtin is a community-based palliative care social worker for Snowline Supportive Services near Sacramento, California.
Blue Shield of California is one of the only health plans to offer community-based palliative care in every county. Curtin and her agency work closely with an interdisciplinary team at the health plan that identifies patients who might benefit from palliative care. They meet regularly to discuss cases.
Palliative care: intimate and in person
Until recently, Curtin drove miles across rural areas, visiting patients with serious or terminal illnesses. Her work: to understand a patient’s goals for care and collaborate with their medical team to try to reach those goals. Curtin says it’s more personal than what might happen at a hospital bed. “You know, we are actually in ‘Charlene's’ home,” says Curtin. “We are sitting on her couch. We are looking at her garden. We're meeting the people that are important to her.” A patient’s goal might be to continue treatment, receive only pain management, or perhaps even to live long enough to see a grandchild graduate.
These days, during a global pandemic, Curtin sees most of her patients virtually or on the phone. She thought she would lose the intimate rapport needed to talk with clients about how they want to spend their final months, whether they want to be resuscitated, continuing or stopping treatment, pain and symptom management.
But that didn’t happen.
More time with patients, but more urgency to plan ahead
Because she’s not driving as many hours, Curtin is able to see more patients and spend more time with them. “And we're able to dig a little deeper and establish what I find to be an amazing rapport,” says Curtin. Nurses are always on call to visit patients who need immediate help.
That’s been an unexpected benefit of virtual palliative care. But concern about the pandemic has made her patients fearful of going to the emergency room or being admitted to the hospital. Contracting COVID-19, on top of a serious illness, would be devastating – not only for the patient but potentially for family members who could be exposed. What’s more, loved ones might not be able to be near a patient’s bedside.
“Those concerns, during this pandemic, make it more urgent to talk about a patient’s goals of care,” says Curtin. “It means articulating for patients what it looks like to be on life support in the hospital or what it looks like if your family can't visit you.” Curtin helps patients plan and document their wishes.
The conversations may sound difficult. But Curtin says she comes away from appointments thinking less about sickness and death, and more about living. “I think every day my patients teach me lessons about how I need to live my life,” says Curtin, “how I need to not waste time and make the best of what I have.”
Blue Shield of California is a licensee of the Blue Cross Blue Shield Association, an association of independently owned, locally operated Blue Cross Blue Shield companies.
Snowline, established in 1979, is a nonprofit, community-based organization dedicated to serving its community by enhancing the lives of those with chronic, serious illness, and patients nearing end-of-life.