About 300 health care providers from around the Los Angeles region gathered for a day-long conference Saturday to learn more about palliative care and end-of-life planning. L.A.'s largest Medi-Cal plan brought them together to learn more about a new state regulation that took effect in early 2018.
In 2014, California passed a law requiring Medi-Cal Managed Care patients get access to palliative care. Now, patients with congestive heart failure, advanced cancer, liver disease, and chronic obstructive pulmonary disease can get more services to address suffering associated with their illness. Over those four years, the state has been ramping up to prepare for the new patient need.
What is palliative care?
“The goal of palliative care is to palliate — to make patients are more comfortable as their disease progresses,” said Dr. Richard Seidman, chief medical officer at L.A. Care.
That comfort could include controlling pain with medication, but Kate Meyers, senior program officer with California Health Care Foundation, says it goes further than that.
“Palliative care is care that focuses on quality of life for someone with a serious illness,” she said.
Sonia Hernandez, the nurse who manages LA Care's new palliative care program, says a team of providers works to take care of a patient's overall suffering, and that could include emotional and spiritual suffering.
In some cases, however, it is the physical symptoms of diseases that cause distress. Hernandez gives the example of someone with COPD or lung cancer.
“Not being able to able to breathe has to be suffering, has to be uncomfortable. So, palliative care is preventing that suffering or treating that suffering,” she said.
In other cases, it's the circumstances that weigh on a patient.
Hernandez says the first patient to use the new program has advanced cancer. Before he got sick, he used to be an involved member of his church. Those activities are limited now.
“His treatment for palliative [care] really focuses on his mental and spiritual health,” she said.
The team that works with him includes a chaplain and mental health providers.
“It’s customizable. It’s patient centered and it addresses every single need,” said Hernandez.
Palliative care is often confused with hospice care, even among doctors, says Hernandez.
The difference is palliative care patients are still in treatment for their underlying disease.
How can you access it?
California now requires palliative care services be made available to Medi-Cal patients. But they've already been available under Medicare and some private health insurance plans. That doesn't mean all doctors know how to refer patients to those services.
"There's a knowledge and an experience gap," said Dr. Seidman.
The head physician for the health plan says it's important that patients advocate for themselves and their family members.
Meyers agrees, and she advocates persistence.
“Ask. Ask and ask for palliative care services. If the person they’re asking doesn’t know what that is, ask someone else within that health system,” she said.
"Health care professionals have an obligation to improve the way they have these conversations with their patients," said Seidman.
He wants to see doctors to have more detailed discussions about what patients want for their treatment as their critical illnesses advance.
He says if you're ill, you should ask your doctor to go over a Physician Order for Life-Sustaining Treatment--or POLST--form to detail exactly how you want your treatment to proceed.