Elizur Bello Leveraging the Health System to Meet
Dale Mayer, , PhD, RN Patient and Family Needs
Mark Walker
www.capc.org
Leveraging the Health System
to Meet Patient and Family
Needs
Elizur Bello, Dale Mayer, & Mark Walker
October 28, 2016
Objectives
Describe the roles of critical access hospitals,
community health workers, and paramedics in the
delivery of care for seriously ill patients
Identify how including these partners in the
extended palliative care team benefits the team,
patients and families
Identify strategies to intergrade partnerships with
frontline health workers into the work of the
palliative care team
Speakers
Elizur Bello, Health Promotion Services
Manager/Community Health Worker, The Next
Door Inc., Hood River, Oregon
D. Dale M. Mayer, Assistant Professor at
Montana State University College of Nursing
Mark Walker, Manager of Clinical Services,
Emergency Medical Care, Nova Scotia, Canada
1
Elizur Bello Leveraging the Health System to Meet
Dale Mayer, , PhD, RN Patient and Family Needs
Mark Walker
www.capc.org
Limited Access for Services
Geographic location may limit
access to services, which are
typically located in less rural areas
Geographic location can limit
transportation during inclement
weather leading to lack of access
to services
Public transportation may be
limited, thus community members
who are not able to transport
themselves may have difficulty
accessing services
Low bandwidth may limit
adequate internet service which
often limits the ability to use
telemedicine options
4
Meet Mr. Garcia
79 year old man
monolingual Spanish speaker
Insurance
h/o metastatic colon cancer - spread to
the bone
steady decline for the past 12 months
limited daily activities in the past 30 days
goal is to avoid hospitalization
wants to die at home
family struggling to navigate the health
system due to cultural differences and
limited understanding of palliative care
2
Elizur Bello Leveraging the Health System to Meet
Dale Mayer, , PhD, RN Patient and Family Needs
Mark Walker
www.capc.org
EMS
3
Elizur Bello Leveraging the Health System to Meet
Dale Mayer, , PhD, RN Patient and Family Needs
Mark Walker
www.capc.org
Nova Scotia (Canada eh)
11
12
4
Elizur Bello Leveraging the Health System to Meet
Dale Mayer, , PhD, RN Patient and Family Needs
Mark Walker
www.capc.org
13
14
15
5
Elizur Bello Leveraging the Health System to Meet
Dale Mayer, , PhD, RN Patient and Family Needs
Mark Walker
www.capc.org
16
17
18
6
Elizur Bello Leveraging the Health System to Meet
Dale Mayer, , PhD, RN Patient and Family Needs
Mark Walker
www.capc.org
19
20
21
7
Elizur Bello Leveraging the Health System to Meet
Dale Mayer, , PhD, RN Patient and Family Needs
Mark Walker
www.capc.org
Urban Hospitals
Critical Access Hospitals
have 25 or less inpatient beds
are located in a rural area
more than a 35 mile drive from any
other hospital, or more than a 15
mile drive from any other hospital in
areas with mountainous terrain or
secondary roads
furnish 24-hour emergency care
services, 7 days a week
required to have an average length
of stay of 96 hours or less
Trend is for CAH to affiliate with
larger hospitals
23
24
8
Elizur Bello Leveraging the Health System to Meet
Dale Mayer, , PhD, RN Patient and Family Needs
Mark Walker
www.capc.org
More about CAHs
CAH provide local access
to:
acute inpatient services,
ambulatory care,
obstetrics, and general
surgery
Some, but not all CAH,
provide ICU services and
home care services, few
have palliative care
programs
Staffing may be 1 RN, 2
LPNs and one CNA
RNs working in CAH must
be expert generalists
25
Where does Mr. Garcia
live?
35 miles from a CAH
w/10 acute care beds & 15 swing beds
Home health services are available
a 200 bed hospital with level II trauma
services is located 100 miles away over
a mountain pass
Mr. Garcia
has a pain crisis at
midnight
911 is called
Transport to CAH for acute care
Community health worker needed to
assist with language/cultural barriers
9
Elizur Bello Leveraging the Health System to Meet
Dale Mayer, , PhD, RN Patient and Family Needs
Mark Walker
www.capc.org
What do we already know or
imagine about Community
Health Workers?
Community Health Workers
(CHW) in Rural Settings
Trusted member of community and/or has an
unusually close understanding of the community
served
Serve as a liaison between health/social services
and the community
CHW builds individual & community capacity
by increasing health knowledge and self-
sufficiency
29
Definitions of CHWs
(ORS 414.025)
Community health worker means an
individual who:
Has expertise or experience in
public health;
Works in an urban or rural
community, either for pay or as a
volunteer in association with a
local health care system;
To the extent practicable, shares
ethnicity, language,
socioeconomic status and life
experiences with the residents of
the community where the worker
serves;
10
Elizur Bello Leveraging the Health System to Meet
Dale Mayer, , PhD, RN Patient and Family Needs
Mark Walker
www.capc.org
Definitions of CHWs
(ORS 414.025) continued
Assists members of the
community to improve their
health and increases the
capacity of the community
to meet the health care
needs of its residents and
achieve wellness;
Provides health education
and information that is
culturally appropriate to the
individuals being served;
Definitions of CHWs
(ORS 414.025) continued
Assists community
residents in receiving the
care they need;
May give peer
counseling and
guidance on health
behaviors; and
May provide direct
services such as first aid
or blood pressure
screening.
Roles of Community Health Workers (NCHA Study,
1998)
1. Providing cultural mediation
between communities and the
health care and social service
system
2. Providing culturally-appropriate
and accessible health education
and information
3. Assuring that people get the
services they need
4. Providing informal counseling
and social support
5. Advocating for individual and
community needs
6. Providing direct service
7. Building individual and
community capacity
11
Elizur Bello Leveraging the Health System to Meet
Dale Mayer, , PhD, RN Patient and Family Needs
Mark Walker
www.capc.org
Back to Mr. Garcia
Goal to establish a coordinated plan
And avoid repeated trips to hospital
Non-pharmacological interventions
Family administered analgesia
Coordinated with local EMS agency and medical oversight
team
Improve palliative care (change acuity level to enable closer
follow-up)
Mr. Garcia goes home by ambulance with family, w/PC
support from local CAH staff and CHW serving as a
liaison between health and social services in the rural
community
Two weeks later
Another pain crisis
911 called Mr. G is palliative (non lights and sirens response)
Paramedics contact primary care MD and establish plan of care
CHW assists EMS and supports family
Breakthrough analgesia provided patient resting comfortably and
remains at home
Family understands revised care plan/administer breakthrough pain
medications
Communication provided to the primary MD & home health team based on
EMS call visit from home health nurse arranged for following day
CHW provides support and helps family access local services so that
Mr. Garcia is able to stay home to die at home
Take Away Message
EMS, CAH, and CHW can be an effective way to
ensure seriously ill community members get the
care they deserve where they live
An extended palliative care team benefits patients,
families, & the health care system & all palliative care
programs can function as we described
Establish partnerships with all healthcare disciplines
and systems that is centered around patient care
36
12
Elizur Bello Leveraging the Health System to Meet
Dale Mayer, , PhD, RN Patient and Family Needs
Mark Walker
www.capc.org
We welcome your comments
and questions!
Contact Information for
Speakers
Elizur Bello
The Next Door, 965 Tucker Rd. Hood River, OR 97031
[email protected] 541 436 0314
Dale Mayer
Montana State University College of Nursing , 32 Campus Dr.-7416
Missoula MT, 59812 [email protected] 406 243 5609
Mark Walker
Emergency Health Services, Nova Scotia
[email protected] 902 832 8364
13
