As the population of homebound older adults with serious illnesses increases, home healthcare agencies are challenged to meet their complex care needs (Ankuda et al., 2021; Osakwe et al., 2022). Given this change in the acuity of home care patients, better pathways to support home care clinicians to provide high-quality care are urgently needed. Early integration of home-based palliative care (HBPC) for patients with serious illnesses may improve patient and family satisfaction and patient quality of life, as well as reduce hospitalizations (Davis et al., 2015). Palliative care can be provided in conjunction with home healthcare to support seriously ill patients who are not yet eligible for hospice (Bowman, 2021). HBPC focuses on the management of distressing symptoms including pain, respiratory distress, difficulty sleeping, poor appetite, anxiety, and depression. HBPC programs work with home healthcare clinicians to identify signs that a disease is approaching its end stage and help patients and families prepare for the decisions they will need to make over the trajectory of a serious illness. One commonly raised concern involves the identification of a clinical decision-maker. Although access to a patient's emergency contact is straightforward, determining who has the legal authority to make healthcare decisions on behalf of the patient is more complex and might require deliberate planning and focused discussions. It is critical that while patients have the capacity to do so, they are supported in identifying a person or persons who can make key clinical decisions on their behalf and in accordance with their wishes.

It is important to help patients and families assess goals and preferences early in the illness. Decisions that may arise can be related to any aspect of the plan of care, such as whether to be transferred to the hospital, to start or discontinue a treatment, or to receive hospice care at end of life. HBPC teams are experts at advance care planning, which allows patients the opportunity to consider their care preferences in anticipation of the progression of their illness and can be helpful in preparing for the loss of decision-making capacity in the future (Glajchen et al., 2022).

Home healthcare agencies which are not affiliated with an HBPC program can take steps to build relationships with an HBPC program in their area, even on a consultation basis. Building these relationships will facilitate access to these important services and augment the layers of support that home healthcare clinicians can offer to seriously ill older adults and their families.

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