Access to home-based palliative care (HBPC) is limited. To identify the barriers to its delivery, and discuss solutions, in one study leaders of HBPC programs — large and small, urban and rural — were surveyed and interviewed.

The follow are summaries of various results of this study.
“Appropriate referrals depend on consistent criteria”
- Lack of understanding of palliative care and consistent patient eligibility criteria pose barriers to accurately identifying appropriate patients.
- Imprecise or exaggerated eligibility criteria lead to late or inappropriate referrals; inability to meet needs of referrers, patients, and families; and threatens the program´s credibility.
- Programs fail to focus on defined eligibility criteria that ensure the feasibility of well-delivered care.

There are “barriers to identifying high-need patients”
- HBPC programs may not have the expertise to use clinical data to identify high-need patients or to demonstrate their services and thereby reduce the cost of care for these patients.
- An integrated data system (electronic health records) can lead to earlier palliative care referrals, but is often not available to programs.

There is a need to consider the staffing complexities
- Workforce scarcity is wide for specialty-trained staff in all clinical disciplines delivering HBPC.
- Program quality is compromised by challenges of staff recruitment, retention, and compensation; additional challenges include team composition, staffing ratios, and training.
- Programs struggle to financially support a full interdisciplinary team.
- Finding and keeping skilled, experienced staff is difficult, particularly in a marketplace where compensation packages for HBPC staff are not competitive.

Addressing retention, resiliency, and burnout
- Tackling turnover and burnout is a perpetual challenge that drains resources.
- Inconsistent salaries contribute to staff turnover.
- Insufficient leadership is demoralizing for staff.

This information is from a study in a high-income country, but it may be also useful for countries at other socioeconomic levels.

See reference for more information.

Adapted from Twohig JS. Bringing home-based palliative care to scale with effective program design. The Palliative Pulse, May 2018. Internet. Internet. Available at https://palliativeinpractice.org/palliative-pulse/the-palliative-pulse-may-2018/bringing-home-based-palliative-care-to-scale-with-effective-program-design/ Accessed on May 2, 2018