Delivering care in the home is a real benefit to homebound patients. Coordination between Bridges’ team of clinicians: specialists in primary care, palliative care, case management, nursing and administration are a major factor in meeting the unique needs and goals of their patients.
The well-known SUPPORT trial, conducted in 1998, showed that 82 percent of patients expressed the desire to die at home. In the US, only one third of patients fulfill this desire.1
The majority of people enter hospice only a few days before death, too late in their trajectory to reap much benefit from the services. Most are in nursing homes or hospitals, and progress too far to have the chance to return home.
Compounding the tragedy of unfulfilled wishes, the expense of hospital and nursing home care in the last year of life is tremendous. End of life care represents 28 percent of total US health care costs.2
One in four Medicare dollars is spent on services for the five percent of beneficiaries in the last year of life.
The most significant predictor of having wishes to die at home fulfilled and avoiding the high cost and discomfort of hospitalization is use of hospice.
Unfortunately, over one-third of patients in hospice care begin their time with hospice less than one week before death.4 This is not sufficient time to realize major benefits.
The Bridges program has been successful at enrolling patients in hospice care and doing so earlier on. In 2017, 73 percent of palliative care patients were in hospice at the time of death; better than the national average of 50 percent.
Bridges patients also had a much longer average time on hospice: the national median length of stay was 18.2 days,5 while Bridges’ patients had a median length of stay of 36.2 days.
Also of note was that 82 percent of Bridges’ patients died at home with hospice or palliative support. Nearly the reverse is true for national statistics, with 81 percent dying in a hospital or nursing home.
With the Bridges program, WellMed is working to better the experience of their most complex patients in the most challenging moments of their lives.
By coordinating care and addressing end-of-life issues with trained specialists, in time, patients are more likely to have their values respected and wishes honored.
Transitions in care are made smoother by team collaboration. Unnecessary hospitalizations can be avoided through close contact with clinicians and access to care in the home. Pain and suffering is reduced by closely attending to symptom management.
Before Bridges, life for the many seriously ill patients included gaps in care, difficult transitions, and pain and suffering. WellMed palliative care has grown from 20 patients in San Antonio in 2013 to nearly 4,000 across Texas and Florida in 2017.
The program has created a place for the diverse needs of people at the end of their lives. Through better coordination and communication, patient wishes are being honored and values are being upheld.
Families and caregivers have greater support. Bridges is an opportunity to have better quality of life, making each lasting day a better experience.