By CRAIG FREILICH
POTSDAM – In nine years, St. Lawrence County’s primary palliative care program has grown to about 30 patients at any given time receiving help with the pain and suffering of chronic illness.
The growth in the number of palliative care patients has led to the addition of employees, including a new nurse practitioner, as well as renovations of a former private residence to create offices to house palliative care staff.
The second part of services provided by 30-year-old Hospice and Palliative Care of St. Lawrence Valley now accounts for nearly a third of the total patient count. Today, the organization generally has 70 to 80 patients in its hospice program and 30 in the palliative care program.
Palliative care is the easing of pain and suffering. It applies to hospice patients who don’t have long to live, but it also now applies to people who have a condition that will not be cured, such as diabetes or heart, lung or kidney failure. Those are conditions which require constant attention and frequently involve physical and emotional pain, but which don’t lead to the imminent death of the patient.
The same philosophy is at work in both programs: ease the suffering of the patient and loved ones.
Palliative care patients are those who can’t be cured, and whose suffering could continue for a long time. They face extended periods of disability without much prospect of recovery. That includes people recently released from a hospital who might not be prepared to manage on their own or with just family support.
But they are also people who, if given adequate information and support, stand a good chance of an improved the quality of life for a lot longer.
“There are no cookie-cutter cases,” said Hospice spokeswoman Kellie Hitchman. “They all vary, sometimes drastically. It’s based on the needs of the patients, and palliative care continues to evolve” in its scope and depth.
“And palliative care is an outgrowth of our home support program,” said Hospice Executive Director Brian Gardam, “but that was limited in scope to 30 days after a hospital discharge.”
Two types of palliative care programs are offered. Generally there is a 30-day limit on what the palliative care programs will do for a patient. At least one of their grants is structured that way. The aim is to get people on the way to “managing their symptoms on their own. But if someone requires several follow-up visits, we will make them,” Hichman said.
Staffers make follow-up visits to keep down the need for hospital readmissions through educating people about their chronic diseases and how to manage them and their medications, and to improve their quality of life with help from family.
“These are all ‘palliative care’ issues we were dealing with already” in the hospice setting, said Gardam.
“We recognized that a lot of people could benefit from the range of services hospice provides but weren’t getting them because they did meet the hospice criteria.
“There are lots of similarities,” Gardam said. “Both deal with serious illness, focus on relieving pain and stress, with a goal to improve the quality of life. Palliative care is appropriate at any age, at any stage of a serious illness. It need not meet the hospice criterion of expiring within six months.
“It was something people found missing from care. We had experience, we could stretch ourselves. We had to get creative with grants and other funding, since there is no specific Medicare benefit as there is for hospice.”
Neither the hospice nor palliative care program provides residential accommodations. “Maybe that’s something we’ll do down the road. Most hospice patients are at home – about 85 percent. We also serve people in nursing homes. Right now we have about 10 in nursing homes.”
In the future, Gardam said, he envisions providing palliative care regularly to nursing home residents, too. “There’s definitely a role there for palliative care.”
Certified nurse practitioner Marie-Paule (Missy) Heylen recently joined the staff to begin providing palliative care consultations in homes, hospitals and at the new Palliative Care Center next to the main administrative building along U.S. Rt. 11.
“It was a double-wide modular home, a private residence,” said Gardam. They spent a total of about $230,000 on the purchase of the land and the building and for converting it into “a consultation office and office space for staff.”
In the converted house, the nurse practitioner will work with palliative care staff members RN Susan Caldwell and social worker Jill Deno. They will likely be joined soon by a clerical support person.
The addition of a nurse practitioner to the palliative care team will allow them to work more closely with a patient’s attending physician on things like treatment and medication plans, Gardam said.
“Missy can act as a clinician -- doing assessments, devising care plans, medication plans, and working with a patient’s attending physician.”
As Heylen prepares for her new duties, “we have an ambitious schedule for her with meetings and visiting hospitals and cancer treatment centers. People might see her come around and learn what her plans are.”