A Bigger Picture for Palliative Care
As the practice has evolved beyond symptom management, in-home providers are positioned for the future
By Kara Holbert
Since the late 1960s, palliative care has supported terminally ill patients by addressing their symptoms and improving their quality of life as they undergo curative or life-prolonging treatment. Initially established as a specialized field focused on symptom management, palliative care has seen fundamental changes since the ’80s and ’90s, inspired by advancements in post-acute care and the public’s evolving expectations of this service.
Today, palliative care encompasses far more than just symptom relief and adopts a comprehensive approach to help ensure a patient’s well-being. This evolution highlights the importance of early intervention, psychological support and more—all administered by an interdisciplinary team and increasingly delivered in the comfort of home. Yet more than 60 years since its inception, the same question still arises—what exactly should palliative care entail? What essential needs must it address to offer meaningful, sustainable support for families in search of this service for their loved ones?
A New Holistic Focus
In 1997, the Institute of Medicine released a report, “Approaching Death: Improving Care at the End of Life,” calling out discrepancies between what the public wanted from end-of-life care and their actual experiences with it. It was one of many thought-provoking publications that both promoted hospice care, a subset of palliative care, and inspired discussion among medical professionals. Discourse like this has continued to progress over nearly three decades, resulting in palliative care’s shift toward a more holistic framework.
Central to the continued evolution of palliative care is an acknowledgment that patients’ needs extend far beyond symptom management. Addressing psychological and psychosocial needs is critical in the role of recovery. Rather than primarily treating a condition's physical symptoms, the goal is now to improve a patient’s quality of life as they receive care, addressing the physical, emotional, mental and spiritual challenges they and their families commonly face.
Early Intervention & Psychological Support
Multiple global studies have shown that palliative care patients have a high prevalence of mental health challenges.
While some start receiving palliative care with a pre-existing mental health condition, others may develop one along the way. In total, up to 50% of palliative care patients have reported experiencing some level of psychological distress.
Palliative care professionals start treating their patients the moment they're diagnosed with a life-threatening condition to address a range of physical, emotional and mental health concerns. A diverse team comprised of clinical and non-medical care professionals is often assembled to address each element of the client’s personalized care plan. This process is key to offering the highest standard of care.
Addressing these concerns can take many forms. Here are a few key tactics and best practices that caregivers are implementing to address clients’ holistic needs.
1. Take an interdisciplinary approach.
By integrating a team of care professionals—including psychologists, physicians, nurses, chaplains and social workers—a wider range of physiological symptoms can be addressed at once. Implementing a collaborative and communicative care team to come together with the best care plan for the client is key to a comprehensive approach.
2. Give patients a voice.
Allowing space for patients to voice their distress and needs enables us to tailor their care. Not only does it relieve emotional discomfort, but it also helps us find a resolution more efficiently. Promoting open conversations can ultimately improve their quality of life and may even prevent their symptoms from worsening.
3. Build companionship
According to a 2024 study published in the journal “Death Studies,” companionship helps people live well and prepare for death more comfortably. The study shows companionship in palliative care offers opportunities for conversation, patient support and advocacy. It’s also been known to enhance a patient’s level of comfort, dignity, self-respect and overall well-being.
Home-Based Palliative Care Is Critical
Nearly 2 million people are homebound in the United States, and many of them experience overwhelming barriers to obtaining the quality care they need. As costs soar, inpatient palliative care remains largely out of reach for many lower and middle-class American families. Those who do choose the hospital-based route can be more likely to face physical, social and financial pitfalls.
In recent years, the health care industry has become more aware of patients’ preferences for receiving care in the familiarity of their own homes. This realization has led to significant improvements in how in-home care encompasses the holistic elements of modern-day palliative care, fulfilling a need that clearly extends beyond the scope of end-of-life care, such as:
- Tailored activities. In-home care clients have access to personalized activities customized to their interests, abilities and health conditions. These activities—many of which are not typical of inpatient care—are designed to enhance their emotional, mental and physical wellness. As a client receives their treatments and supportive services, these customized activities can make all the difference in their quality of life while receiving palliative treatment.
- Life enrichment programs. Many homecare providers offer unique features that set them apart, such as life enrichment programs. These can include community engagement events, social outings, spiritual activities and more. Such programs can be tailored to a client’s preferences and help address loneliness and social isolation—both of which have been linked to an increased risk of chronic illness.
- Nutritional care. Nutrition is a cornerstone of general health. In-home palliative caregivers play a significant role in managing a client’s food intake by ensuring they eat the right amounts of fruits, vegetables, fiber and protein based on their condition. Because palliative care clients face chronic or life-threatening conditions, nutrition management is essential in fueling the body’s ability to fight disease and withstand certain treatments.
- Reduced hospital readmissions. A comprehensive care approach to recovery means addressing post-care needs. Those who often receive hospital-based care can experience worsening symptoms after being discharged. With home-based palliative care, they can receive one-on-one attention from caregivers to monitor their symptoms closely. This helps mitigate the likelihood of unwanted and costly rehospitalization and emergency room visits.
Rather than bandaging surface-level symptoms, each element works together with a client’s existing treatment plan to provide the comprehensive support characteristic of palliative care by today’s standards. Home-based palliative care allows the recipient to experience whole-person care, benefiting from nutrition management to social wellness, all without having to leave home.
Looking to the Future
We all play a role in the quality of life of our nation’s senior and at-risk populations. With the elderly population at an all-time high and about 56.8 million people in need of palliative care each year, the demand for it will only continue to grow.
Post-acute care is a rapidly developing field, and the public has clearly expressed a need for more than just symptom management. As palliative care continues to evolve, it’s critical to embrace new advancements with an open mind. Providers, consumers and thought leaders alike should be receptive and willing to learn from one another.
By leaning into what the public has voiced, we can adapt palliative care to be the meaningful, sustainable, all-encompassing service that patients and their families need.
Kara Holbert, RN, is the director of client services and program development at HomeWell Franchising, Inc., the franchisor of HomeWell Care Services, a non-medical homecare provider. With extensive experience as a registered nurse and care coordinator, she is passionate about educating others on the value of non-medical homecare. Visit homewellcares.com.
