Training in hospice and palliative care a ‘huge need’

Hospice and palliative care are growing fields.

Members of the baby boomer generation, a population of 76.4 billion, are reaching “old age” and putting a strain on palliative care and hospice programs like no other generation so far because of longer life expectancies and advanced treatment options.

According to the National Hospice and Palliative Care Organization, in 2011, 1.65 million patients received services from hospice, and 44.6 percent of all deaths in the United States were under the care of a hospice program. Those numbers are likely to increase with the baby boomer generation.

There has already been a tremendous amount of attention given to the looming doctor and nursing shortage, and hospice and palliative care are already behind when it comes to the number of caregivers in the profession.

That is, in part, because hospice and palliative care are relatively new fields. The first hospice program opened in 1974, and hospice and palliative medicine only became an approved subspecialty by the American Board of Medical Specialties in 2006.

The Center for Palliative Care said, in 2010, there were only 73 accredited allopathic subspecialty training fellowship programs in the United States. Collectively, those programs were producing approximately 86 new palliative medicine physicians per year.

Hospice and palliative care programs in West Michigan are experiencing the need for more trained professionals both currently and to meet future needs.

“Our greatest need is people who really specialize in end-of-life care,” said Marcie Hillary, vice president of resource development for Hospice of Michigan. “We have a huge growing population who are facing end of life, and we just don’t have the specialties developed and enough clinicians to care for that population.”

Hillary said Hospice of Michigan currently employs approximately 600 people, most of whom serve in clinician roles, which include physicians, nurses, social workers, hospice aides and spiritual care givers.

“We want them to be trained and certified in hospice and palliative care,” she said. “That kind of training is a huge need for us.”

In fact, Hospice of Michigan pays for one to two physicians each year to become certified in hospice and palliative care. It provides similar training for its hospice aides, who assist patients with personal care, including things like bathing and dressing.

Hospice of Michigan also offers its training program to other hospice programs, home care agencies and health care organizations.

As the Hispanic population continues to grow, Hillary said there is also an increasing need for bilingual and culturally competent clinicians. In fact, she noted different demographic groups require different skill sets, another one of those groups being veterans and, more specifically, combat veterans. Hospice of Michigan is developing training programs specifically targeted at the unique needs of these groups.

Faith Hospice, a West Michigan based program that, along with Holland Home of Grand Rapids, is part of umbrella company Christian Living Services, employs approximately 130 people in a variety of disciplines.

Laurie VanderLaan, professional recruiter for Holland Home, said hospice care is becoming a more valued service, which means more people are choosing to take advantage of it and, as it grows, increased staff will be necessary in several areas.

In addition to needing more on-call and after-hours staff to meet 24/7 service needs, VanderLaan said staff with technology skills also are a must.

“Electronic medical records are here and with that brings a higher value on computer skills for our health care professionals,” she said.

“The future is health care informatics, a blend of health care, computer science, technology and information security.”

Lisa Ashley, president and CEO of Hospice and Palliative Care Association of Michigan, agreed technology will play an increasing part in the future of hospice care, and staff must be trained to use it.

“Almost all hospice providers today have electronic medical records and require staff to document within that EMR,” she said.

Ashley is also worried about having enough clinicians willing to work in rural areas.

“Currently, finding qualified, experienced hospice staff is challenging for most hospice organizations and particularly those in rural areas,” she said. “Staffing may be an issue for small, rural providers who are unable to meet the demands for service if they are unable to recruit and pay professional staff for needed care.”

Both Grand Valley State University Kirkhof College of Nursing and Michigan State University College of Human Medicine are working to integrate end-of-life care training into their programs to ensure hospice and palliative care programs of the future have the workforce to operate effectively and serve the growing patient need.

Cynthia McCurren, dean of the GVSU Kirkhof College of Nursing, said end-of-life training has always been integrated into nursing curricula, but the strategies continue to evolve. She said several Kirkhof faculty have completed the national End-of-Life Nursing Education Consortium education program, which focuses on improving palliative care.

“The project provides undergraduate and graduate nursing faculty, CE (continuing education) providers, staff development educators, specialty nurses in pediatrics, oncology, critical care and geriatrics, and other nurses with training in palliative care so they can teach this essential information to nursing students and practicing nurses,” she said.

The training helps faculty integrate end-of-life content into all levels of the nursing curricula.

Kirkhof also partners with organizations in the community, including Hospice of Michigan, to advance its hospice and palliative care training. The HOM partnership involves a nursing scholarship, which guarantees the selected student receives a job from HOM following graduation.

“KCON second-degree nursing students are eligible for this opportunity, earning a scholarship that pays for their tuition, provides for a clinical experience with HOM during the educational clinical learning, and leads to the position post-graduation,” she said.

Even with these programs, McCurren noted significant workforce challenges.

A shortage of nursing school faculty is restricting nursing program enrollments, and a significant segment of the nursing workforce is nearing retirement age, she said.

“GVSU strives to admit as many students in the undergraduate and graduate programs as we have capacity to accommodate,” McCurren said. “The biggest restriction to enrollment is access to clinical sites for the clinical education component and adequate numbers of qualified faculty.”

Currently, the KCON program has 1,290 undergraduate and graduate nursing students enrolled for 2014.

MSU College of Human Medicine is also working to advance end-of-life care training among its medical students.

Dr. Peggy Thompson, associate dean for MSU College of Human Medicine’s Grand Rapids campus, said medical students at MSU receive the majority of that training during the third year in the program as part of their family medicine clerkship.

She said students take part in online learning regarding hospice and palliative care, attend an interactive lecture on the topic and in most cases spend the day with a hospice and palliative care specialist in one of the hospitals or attend a home visit with a palliative care nurse.

All MSU medical students also participate in an end-of-life discussion with a patient during either their first or second year.

“Students go in pairs to visit a patient in the community who is living with a chronic illness … and the students have different tasks they accomplish over the six visits. One of those is talking to them about their end-of-life plan,” she explained.

Thompson said she is seeing more doctors seek out hospice and palliative care training.

“Doctors … from all different disciplines … decide they want to go into hospice and palliative care. In Grand Rapids, we have a palliative care fellowship and it’s actually run through the family medicine residency program, but people will come from emergency medicine or internal medicine or family medicine into that specialty, or some anesthesiologists who are interested in pain management might go into that specialty.”

She said even doctors who aren’t looking to become certified in hospice and palliative medicine are going through training to become more comfortable in talking with patients about end of life.

“There is a real need for all physicians to be addressing issues of end of life earlier with their patients and having the general population understand what palliative care is and what hospice care is, and what they aren’t,” she said.

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