Home is Where the Heart is: Congestive Heart Failure and the Benefits of Palliative Care
In April, John found himself in the emergency room—AGAIN. The symptoms of his congestive heart failure, combined with other complications, had been landing him in the emergency department (ED) on average once a month. Occasionally, he was even admitted.
But this time was different. This time John was referred to Delaware Palliative, a program of Delaware Hospice.
And it’s been nearly ten months since his last ED visit.
Palliative care serves as an extra layer of in-home support for patients with acute illnesses. It focuses on managing patients’ symptoms and improving their quality of life while they continue to pursue treatment options with their own primary care doctor and specialists.
And for patients with congestive heart failure, better management of symptoms like swelling and difficulty breathing usually means fewer late-night trips to the ED.
At Delaware Palliative, we dramatically improve the lives of people struggling with congestive heart failure by taking the following steps:
Provide in-home evaluations.
When a patient enrolls in Delaware Palliative, they receive an initial visit from one of our advanced registered nurse practitioners (ARNPs), who serves as the patient’s primary point of contact throughout their time in the program. Depending on a patient’s situation and needs, their certified nurse practitioner may visit anywhere from once or twice a week to every couple of months. The ARNP’s primary objective is to help the patient meet their goals for their treatment.
Work closely with the patient’s cardiologist or primary care doctor.
We work closely with each patient’s own cardiologist or primary care doctor to effectively manage their symptoms. The doctor gets a copy of the certified nurse practitioner’s clinical notes from every visit. If it’s an urgent matter, the ARNP will pick up the phone and call the patient’s doctor to address the situation immediately.
Intervene early to manage symptoms like swelling and lung congestion.
Symptoms associated with heart failure can escalate quickly. But sometimes it takes a few days or even a week to get an appointment with the doctor. Our palliative care team makes it a priority to evaluate and address a patient’s worsening symptoms within 24 hours, before a trip to the ED becomes inevitable.
Educate patients and family members.
The patient’s certified nurse practitioner reviews the early signs and symptoms of heart failure with the patient and their caregivers, explaining what to look for and when to call us. They also help patients create what we call a “2 a.m. Plan”—written steps the patient can take if they wake up in the middle of the night in a crisis situation, including how to recognize when to make a 911 emergency call and when to try certain interventions at home first, like a nebulizer or oxygen.
Connect patients with crucial services.
Delaware Palliative’s social workers play a critical role in helping heart failure patients meet their goals, especially when patients have little or no other support at home. When a patient first enrolls in palliative care, a social worker evaluates what additional outside resources might benefit the patient. The social worker often helps patients begin the Medicaid process to cover expenses, fill out DART applications for transportation to doctors’ appointments, and get connected with other resources like Meals on Wheels, in-home lab services, or even their church.
Far too many of our palliative care patients with heart failure say they wished they’d known about the program six months sooner. It’s never too early to get extra help managing your symptoms. Talk to your doctor today about whether palliative care is right for you.