South Dakota Association of Healthcare Organization’s Michele Snyders MSW, CSW-PIP, APHSW-C, Hospice and Palliative Care Program Manager, recently visited with MED Magazine sharing insights about Palliative Care. The article titled, Understanding Palliative Care in South Dakota: A Conversation with Michele Snyders, published in early October offered Snyders the opportunity to answer questions regarding palliative care. The full article can be viewed here.
Understanding Palliative Care in South Dakota: A Conversation with Michele Snyders
Michele Snyders, Hospice and Palliative Care Program Manager at the South Dakota Association of Healthcare Organizations (SDAHO), shares insights on palliative care in the state.
MED: Can you explain your role at SDAHO and how it relates to palliative care?
MS: My role is relatively new, created about two years ago when we absorbed the LifeCircle organization, previously run through the medical school. It is a good fit for SDAHO because we have a large number of members in post-acute care, home health, long-term care, hospice, and assisted living, as well as hospitals.
MED: What is palliative care, and how does it differ from hospice care?
MS: Palliative care is specialty medical care provided for serious illness, available from the moment of diagnosis through the end of life. It’s important to note that palliative care is not specific to people with a terminal diagnosis. You could be receiving aggressive chemotherapy with the goal of curing cancer and still benefit from palliative care. It’s meant to support anyone going through a serious illness by attending to their psychosocial, spiritual, and physical needs, as well as supporting family members and caregivers.
The key difference is that palliative care is not hospice care. Palliative care can be provided alongside curative treatments, whereas hospice is typically for end-of-life care.
There’s still a big misconception about this. When I was working in palliative care it was not uncommon to hear a provider say ‘We can’t refer to you because we’re not there yet.’ And we’d ask, ‘What do you mean? Doesn’t your patient have a serious illness?’
MED: How is palliative care delivered, and who is involved in providing it?
MS: Palliative care is delivered by an interdisciplinary team. This team may include a physician, a nurse practitioner, a nurse, a social worker, and a chaplain. Often, pharmacy is consulted too, because symptom management is a big goal. It’s important to note that palliative care never takes over the management of a patient’s care; instead, it works in conjunction with the patient’s primary care team to ensure continuity.
MED: What is the current state of palliative care in South Dakota?
MS: In South Dakota, with a population of roughly 900,000, we recently completed a survey that showed we have 12 certified hospice and palliative care physicians, with 9 of them in the southeastern part of the state. The three large health systems have palliative care teams starting with inpatient roles, and two of these systems also have outpatient teams. Some outpatient care is actually done via telehealth. There are also a couple of organizations that provide home-based palliative care.
MED: What are the different types of palliative care, and what training is involved?
MS: There are two types of palliative care:
- Specialty palliative care: This involves team members with specialized training in hospice and palliative care. They typically deal with more complex patients and situations. There is fellowship training or certification available for advanced practice providers and palliative care nurses.
- Primary palliative care: This includes teams that haven’t gone through fellowship or certification but understand basic symptom management and how to have conversations with patients about palliative care. They also know when to refer to a specialty care provider.
For training, the Center to Advance Palliative Care is a leading resource. Other programs like Vital Talk teach how to have care conversations. At SDAHO, we try to find education and webinars to make available to our members.
MED: What steps are being taken to improve palliative care access and coverage in South Dakota?
MS: We’ve recently put a palliative care definition into statute. This is a crucial step towards getting reimbursement for the entire palliative care team. Currently, only healthcare providers are reimbursed under insurance. Our next step is to explore how we can get coverage for the whole interdisciplinary team.
We’re also working on educating providers and the public about what palliative care really is. Once people understand it, they’ll see that all healthcare should be delivered this way if we want to do what’s in the best interest of patients.
Lastly, we’re looking at the benefits of palliative care, such as fewer ED visits and hospitalizations. Some states are working with independent payers to try to get teams reimbursed, and we’re exploring similar options in South Dakota.
