PeaceHealth is cutting three services in Whatcom County, with the most significant being a severe reduction to the county’s only outpatient palliative care program that provides comprehensive care for people who are chronically ill.
Blaine resident Christina Needham, 70, learned PeaceHealth’s Whatcom County outpatient palliative care program would be eliminated from a staff member visiting her home in late April. Needham, who has congestive heart failure and has been homebound since being diagnosed with stage four cancer a few years ago, said she relies on the program to manage pain and offer emotional support.
“Palliative care was there for people,” Needham said. “They cared when no one else did.”
Palliative care serves people with serious illnesses, such as cancer or heart failure, by focusing on relieving pain and improving quality of life. The holistic approach expands on regular health care, which is more procedural, by providing services such as chaplains and social workers. Consistent in-depth care catches symptoms before they require an emergency room visit, saving patients and insurance companies money. Unlike hospice, palliative care also gives comfort to people who are not terminally ill.
“We can’t all fit in a box,” Needham said. “We’re all different. I think it is paramount that palliative care doesn’t look at you like a box like doctors do.”
The reduction to outpatient palliative care is part of larger cuts PeaceHealth is in the process of implementing. PeaceHealth spokesperson Beverly Mayhew said the healthcare system, headquartered in Vancouver, Washington, has eliminated 251 positions across Washington, Oregon and Alaska. Thirty-two of those eliminated positions were in Whatcom County, accounting for the slimmed down outpatient palliative care program and closures of the allergy and immunology clinic and overnight sleep lab.
The last day to see a physician at the allergy clinic is July 10 and the overnight sleep lab closed May 15, Mayhew said. PeaceHealth will continue sleep consultations and home sleep studies as well as refer allergy patients to PeaceHealth’s primary care providers or a specialized allergist in Bellingham.
“These changes throughout the PeaceHealth system were precipitated by the challenges all healthcare organizations in the U.S. are facing: Costs are rising faster than what we are earning for the care we provide,” Mayhew said in an email.
PeaceHealth’s decision to cut its outpatient program was made largely because it only receives a 15-20 percent reimbursement rate from insurance companies, Mayhew said.
“Palliative care is not a money-maker and it’s never been a money-maker, but it’s important care,” said Marie Eaton, community champion at the Palliative Care Institute at Western Washington University.
PeaceHealth’s outpatient palliative care program is being cut from seven to two staff members, leaving one nurse and social worker to care for about 65 patients, Mayhew said. No cuts were made to the inpatient palliative care program, which consists of three providers, two nurses, one social worker, one chaplain and an administrative assistant.
Mayhew said PeaceHealth will use a new model for palliative care that uses care navigators as well as its home health team and hospice caregivers.
“Every effort will be made to minimize the impact to patients through this transition by identifying their specific needs and aligning appropriate services,” she said.
The need for palliative care
In addition to her cancer, Needham said she has a long history of health problems that stem from a car accident when she was 20 years old. She also developed neuropathy, which has created a loss of feeling in her feet and hands, after undergoing immunotherapy to treat her cancer.
Needham will now rely on the help of a local in-home health care company, which she said only focuses on basic medical care opposed to the holistic approach of palliative care. She plans to access a chaplain and social worker through the PeaceHealth St. Joseph Cancer Center.
“There are days I’ve had to work my way through all of those dark places you go to come out of a hole,” she said. “The chaplain helped me with that.”
Needham said palliative care doctors are better trained to prescribe opioids for pain, something she said people with chronic pain often need but doctors are hesitant to authorize.
Needham’s roommate Karen Howard, who is 77 and in a walker after a hip surgery, helps look after her. Howard described their situation as silent suffering, where they’re hidden from the world’s view aside from a few neighbors who know of their condition.
“People in our circumstance can’t get out and raise a ruckus,” said Howard, a former nurse. “I would sit outside of PeaceHealth with a sign if I could.”
Eaton, with the Palliative Care Institute, said she was worried about the ability of primary care doctors, who already have long waitlists, to help fill the gap.
Both Needham and Eaton said they were concerned about not having palliative care as Whatcom County’s population ages. According to the most recent U.S. Census data, 18.3 percent of the county’s population is 65 years old or over.
Opponents to the program’s cut have also voiced concern that seriously ill patients will frequent the emergency room more often.
“It’s a chaotic cycle of in and out of the emergency room,” Eaton said. “The outpatient palliative care program was designed to have people stay at home and have their symptoms managed as well as could be that would give them the best quality of life they could have, given the nature of their illness.”
Dr. Bree Johnston, who was PeaceHealth’s first palliative care specialist in Bellingham, said she was concerned PeaceHealth’s proposed outpatient model won’t truly be palliative care because it won’t have a palliative physician to provide symptom control, including through opioid prescriptions.
“The model they have proposed is not really a palliative care model,” she said. “It’s not the same at all as what palliative care has been for these patients.”
Local donors raised about $2.5 million for an outpatient palliative care program in 2018 after seeing a need that the inpatient program could not address. That money secured the first five years of program funding, set to expire in 2023, and PeaceHealth committed to supporting the program’s longevity, according to the PeaceHealth website.
While many of the palliative care supporters said they understood the financial challenges PeaceHealth is facing, they voiced that there should have been a way to save outpatient palliative care. Eaton and Needham said they wished PeaceHealth would have given Whatcom County residents enough advance notice about the reduction plan so they could try to fundraise to sustain it.
“I’m quite distressed that the PeaceHealth leadership did not come back to the community that funded that program to say, ‘We’re in a budget crisis and can you help us keep the program alive?’” Eaton said. “There was no consultation with the people in the community who worked so hard to develop a robust palliative care program.”
Mayhew said PeaceHealth has heard from many voices in the community and is taking stock of the concerns and discussions are continuing.
Needham said she worries about the other people in Whatcom County who will be left to find new services, especially those who are in the outer reaches, such as Blaine and Birch Bay.
“We need to take care of the most vulnerable people in our county because that reflects who we are as a community,” Needham said. “If we’re not taking care of the people who can’t fight back, then we’re not taking care of our community.”
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