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Heart Failure and the co-morbidities that result are
dramatically changing healthcare and provider
requirements.
As South Carolina’s only Geriatric Wellness System, we
serve hundreds of these patients and are profoundly
affected by their stories.
In an attempt to provide greater value for patients and
their families, we commissioned an independent research
firm to investigate these trends.
We are pleased to bring this informative presentation to you!
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Areas Covered
Latest Baby Boom Trends
Exposing the 5 biggest
challenges of caring for the
aging HF generation.
Discovering 1 KEY step to
decreasing workload and
improving your patients’
quality of life..
5 Most Dangerous Trends:
1. Baby Boomers flooding the
system
2. Unclear patient and family
expectations with HF
3. More acute health
co-morbidities
4. Longer life expectancy
5. Higher cost-of-care
Did you know?
There are approximately 5.3
million people suffering from
congestive heart failure (CHF) in
the United States.
The lifetime risk of developing
heart failure at the age of 40 is
20%, and approximately 380,000
people above the age of 65 will
be diagnosed with CHF annually.
Did you know?
The number of patients with CHF
discharged from the hospital rose
from 400,000 in 1979 to over 1
million in 2005.
Within 4-6 months after discharge
47% of the patients are likely to be
readmitted.
The five year mortality rate for
patients with CHF was 48% from
1996-2000
Every year there are approx. 550,000 new
cases of CHF Patients in the U.S.
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The total annual cost of caring for CHF in the U.S. is
more than $30 billion, with 60 percent associated with
hospitalization.
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The costs of CHF hospitalizations typically exceed
reimbursement, as the expenses associated with long
length of stay quickly overwhelm the $6,000 average
reimbursement provided by Medicare.
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Palliative Care services decrease these costs drastically.
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RS
According to the SC Department on
Aging, there are currently 800,000
(20%) seniors in SC alone.
This
amount is expected to double to 1.9
million by 2030.
Baby Boomers are retiring at an average
rate of 10,000 a day.
In 2000, there were 4.2 million
Americans age 85 or older. By 2030,
nearly 9 million Americans will be over
the age of 85.
This aging population will increase the
demand for primary, geriatric, palliative
and end-of-life care for patients with
chronic disease.
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A Study Found
More than 6 of every 10 Boomers
will be managing more than one chronic
condition. (COPD, CHF, Diabetes)
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More than one out of every three
Boomers – over 21 million – will be
considered obese.
(THIS WILL INCREASE FALL RISKS AND ER VISITS)
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Our Future Geriatric Population
Life Expectancy
ER Visits
 Hospitalizations only improve
symptoms in 35-50% of the
cases
 40% of patients dying of Cancer
get palliative care
(Only 4% for HF patients)
 54% of patients were predicted
to have a prognosis of 6 months
or more however patients died
within 3 days
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End – Stage CHF:
Suffering Undertreated / Under recognized
Severe symptoms in last 48-72 hours prior to
death:
Breathlessness 66%
Pain
41%
Confusion
15%
Dyspnea
50%
Depression
59%
Anxiety / Fear 45%
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End of Life Care Planning & Goals
AIDS: 52%
Cancer patients: 47%
HEART FAILURE: 5%
23% wanted DNR
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Aggressive / Curative
Treatment
JG
Hospice Care
Bereavement
CURRENT MODEL OF END OF LIFE CARE
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A Better Option
Palliative /Concurrent Care
Disease-Modifying
Treatment
Hospice
Care
CURATIVE
Bereavement
Support
HEALING
Terminal
Illness
Death
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Studies has proven that the Interdisciplinary approach to
Palliative Care can help to reduce HF symptoms and
exacerbations while increasing quality of life and life
expectancy.
Medical Director
Nurses
Social Workers
Chaplains
Counselors
Palliative Care Extends Life, Study Finds
By DONALD G. McNEIL Jr. Published: August 18,
2010
Palliative Care Can Extend Life 2010
Palliative Care Early On Has Many Benefits
Published in Journal Watch General Medicine
September 30, 2010
Palliative care prolongs life, reduces suffering
March 2007
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Barriers to Palliative Care
• Concern of “Losing Patient”
• Prognostication difficult
(Disease trajectory / When to Refer)
• Perceived inability of palliative care to
manage complex care
• Perception that all meds must be d/cd
• Sense of “Giving Up” on your patient
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Provides care in the relief of pain and other stressing symptoms.
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Works with your current treatments not in lieu of.
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Affirms life
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Reduces hospitalizations
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Focuses on Healing.
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Intends neither to hasten nor postpone death.
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Offers a support system to patients (and caregivers) to help patients live as
actively as possible until death.
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Specialized, State of the Art Care Plans for:
Pain
Edema
Nausea
Dyspnea
Non-Compliance
Altered Physical Mobility
Spiritual / Psychosocial Needs
Agitation / Depression / Anxiety
Delirium & Cognitive Difficulties
Alteration in family coping / management
Knowledge of Disease Process / Caregiver Preparations (DNR)
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5 Steps to Improving Patient Care
1.
Partner with an in home
Palliative Care Provider.
2. Clearly define & redefine
patient’s goals for care.
3. Focus on educating caregivers
as well as patients on disease
progression.
4. Reinforce symptom control
management and self care.
5. Set realistic expectations.
VISION:
Create Strong Partnership with single, continuity providers
to Offer Full Range of Coordinated, Clinical Services to
Patients.
Initial Goals:
Services:
1. Seamless & Integrated Services
1.
Strategic Partnerships
2. Convenience for Patients &
Families
2.
In-Home Physician / NP
visits routine.
3. Minimize Hospitalization
3.
Call P.C. provider before 911
4. Decrease exacerbations
4.
Initiate & F/up Care plans
5. Increase QOL
5.
Disease education / Crisis
Control Interventions
YOUR VISIT AND
CARE
Increased QOL
Palliative Care visit
& Life Expectancy
AT PATIENT’S HOME
Better clinical
outcomes
Care Plan
Goals / Education
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JG
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Currently serving over 600 patients, we specialize and tailor care for
chronic & terminally ill patients suffering CHF symptoms.
Palliative care is the active total care of your residents whose disease or
symptoms may or may not respond to curative treatment. The goal of
palliative care is to prevent and relieve suffering and to support the
best quality of life for residents and their families, regardless of the
stage of the disease or the need for other therapies. Unlike hospitals
and clinics we bring our palliative care physicians and NPs to you and
care for the patient in their home setting.
Providence is not a replacement of your care, it’s a complement that will:
1. Communicate with you regarding your patients’ progress.
2. Consistently update you with any care plans initiated as well as
medication updates.
3. Conduct ourselves in an ethical and respectful manner.
4. Serve with an attitude of unselfish concern.
5. Meet the needs and strive to exceed the expectations of those we
serve through continuous improvement.
6. Constantly explore, study and develop new concepts and
opportunities.
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Those patients deemed two years or less of life
expectancy.
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Frequent hospitalizations.
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Highly symptomatic/ refractory patients usually NYHA Class III/ IV patients
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Those with non-compliance.
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Caregiver breakdown.
RS
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QUESTIONS / COMMENTS
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Adler ED et al. Palliative Care in the Treatment of Advanced Heart Failure. Contemporary
Reviews in Cardiovascular Medicine. Circulation 2009; 120:2597-2606.
American Heart Association. Heart Disease and Stroke Facts, 2006 Update. Dallas, Texas:
AHA, 2006.
American Hospital Association. How Boomers Will Change Health Care, 2007. Chicago, Illinois:
AHA, 2007
Esciencenews.com. Remote Monitoring Improves Heart Failure Patients’ Health, 2008.
Framingham Heart Study. Lifetime Risk For Developing congestive heart failure: 2002 Dec
10;106(24):3068-72.
Goodlin, SJ. Palliative Care in Congestive Heart Failure. Journal of the American College of
Cardiology, 2009; 54:386-396.
HemaniS et al. Providing Palliative Care in End-Stage Heart Failure. Journal of Hospice and
Palliative Nursing, 2008; 10(2):100-105.
Hupcey, JE et al. Heart Failure and Palliative Care: Implications in Practice. Journal of Palliative
Medicine, 2009 June; 12(6):531-536.
Jaarsma, T et al. Palliative Care in Heart Failure: A Position Statement from the Palliative Care
Workshop of the Heart Failure Association of the European Society of Cardiology. European
Journal of Heart Failure, 2009; 11:433-443.
McNeil Donald G. Jr. et al. Palliative Care Extends Life. New York Times, August 18, 2010.
Pyenson, Bruce. Palliative Care prolongs life, reduces suffering. Journal of Pain and Symptom
Management, 2007.
South Carolina Department on Aging, Statistics, 2010. Columbia, South Carolina: 2012.
Selman L et al. Improving End-Of-Life Care for Patients With Chronic Heart Failure. Heart,
2007; 93:963-967.
Unroe, KT et al. Resource Use in the Last 6 Months of Life Among Medicare Beneficiaries With
Heart Failure, 2000-2007. Archives of Internal Medicine, 2011; 171(3):196-203.
Zuger, Abigail, MD et al. Palliative Care Early On Has Many Benefits. Journal Watch, September
30, 2010.
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