ALL THE RIGHT THINGS [horizontal ellipsis] FOR ALL THE WRONG REASONS

For many years, I have predicted that eventually health care systems would do all the right things (eg, start palliative care programs, support hospice, integrate palliative care into critical care settings) but for all the wrong reasons. Unfortunately, I think that day has come. At the recent/annual meeting of the American Academy of Hospice and Palliative Medicine/Hospice and Palliative Nurses Association (HPNA), I had many conversations with colleagues reporting on the initiation or expansion of palliative care settings. In listening to stories of these efforts, rarely did I hear that such decisions to start or extend services were the result of awareness by health system leaders that patients and families deserved better physical, psychological, or spiritual care. Most often the news of a system's commitment to palliative care was accompanied by words in the same sentence such as "financial crisis," "bottom line," "losing money," and "the goal to get the patient out of the hospital."

Without a doubt, the field of palliative care must be directed by and respond to fiscal realities. Hospice reimbursement and complex financial issues impacting palliative care are indeed a reality that must be faced by every program hoping to survive. Shouldn't we in this field, who have fought the past 30 years to see palliative care become a reality, simply accept and rejoice that "all the right things" are happening, even if for the wrong reasons? Maybe not.

A case in point is the hospital response to form a strong hospice alliance for the prime motivation of decreasing its hospital death rate because its mortality statistics are lowering its ratings. Getting patients out of the hospital is a good thing when based on patient and family goals. But if those patients still are admitted to hospice only 5 days before death, have we really done "the right thing"? The call to "get the patient out of the hospital" is real, but is that the goal we have worked toward over the past 30 years? Is the care we are building consistent with the vision of pioneers such as Dame Cicely Saunders, Florence Wald, and Elizabeth Kubler Ross?

As professionals currently engaged in palliative care amidst enormous changes in healthcare delivery, we are the stewards of the vision for a better way to care for the seriously ill and those at the end of life. The HPNA is a vital force in promoting the original precepts of care, including interdisciplinary care, a whole-person approach, bereavement support, family caregiver support, and attention to symptoms through physical and psychological/ spiritual care. Membership in HPNA, becoming certified in our specialty, and reading this journal are all ways to keep focused on what matters.

While there is a cause for concern, there are also abundant examples of health systems that are doing the right things for the right reasons. My observation is that when you find such examples, you will also find nursing centrally involved. More than ever, nurses serve to be a moral voice, advocating for care that meets the needs of those we serve and constantly challenging the systems of care. This issue of JHPN addresses issues of keeping the vision of palliative care.

We are fortunate as professionals to be able to have witnessed the era when the words hospice and palliative care were new to our vocabulary but now are key concepts in the future delivery of healthcare. We should stay committed to the values that caused society to question care at the end of life and be strong leaders so that the right things happen, for the right reasons.

Betty Ferrell PhD, MA, FAAN, FPCN, CHPN

Editor-in-Chief

[email protected]