COVID Crisis Underscores Gaps in Serious Illness Workforce

By Larry Beresford

The COVID-19 crisis has underscored serious gaps in the U.S. healthcare system – among them, the nation’s shortage of hospice and palliative care specialists and the need for healthcare professionals in every setting to have some level of palliative care education and training, experts say.

The workforce issue was one of several topics related to the COVID-19 pandemic highlighted at a recent National Policy Forum hosted by the Coalition to Transform Advanced Care.

Speakers on the workforce panel discussion – “Caring for those with Serious Illness by Supporting Our Workforce During COVID-19 and Beyond” – pointed out that palliative care has been key to responding to the pandemic.

“Palliative care is definitely having ‘a moment’ because it’s at the heart of the most compelling issues that we’ve had to confront over these past several months,” said Jennifer Ballentine, executive director of the CSU Shiley Institute for Palliative Care.

“Since there is no curative treatment for COVID-19, all COVID care is palliative care – it must address symptom management, shared decision-making and ethical conundrums,” she said.
Still, too many frontline healthcare providers have been poorly prepared for the crisis, despite an abundance of resources to help them learn, Ballentine said.

More Specialists Needed

Ballentine was joined on the C-TAC panel by Brynn Bowman, chief strategy officer of the Center to Advance Palliative Care (CAPC), and Robert Espinoza, vice president of policy at PHI.
Bowman said that although the specialty palliative care workforce has grown significantly in the past 20 years, it still isn’t adequate to meet demand.

“We’ve seen a lot of traction on the ground, but not enough,” she said. The specialty also needs to do a better job of recruiting a diverse workforce that can better reflect the racial and ethnic diversity of the patients it serves, she added.

Bowman co-chaired a National Academies of Sciences, Engineering and Medicine roundtable in November that explored workforce issues on quality care for people with serious illness. A report on the roundtable, “Building the Workforce We Need to Care for People with Serious Illness,” is now available.

Solutions to Building the Workforce

The solutions to building the serious illness workforce are to make sure all current and future healthcare professionals have adequate palliative care training going forward, Ballentine said.

She said one of the greatest policy priorities is for the U.S. Senate to pass S.2080, the Palliative Care and Hospice Education and Training Act (PCHETA), approved by the House of Representatives on October 28.

PCHETA would increase the number of permanent faculty in palliative care at accredited medical and other professional schools; promote education and research in palliative care and hospice; and establish palliative care and hospice education centers.

There is a need to increase and standardize continuing education requirements to incorporate palliative care content, such as pain and symptom management, communication, psychosocial issues, end-of-life care, and professional self-care.

Undergraduate curriculum must also include instruction in these topics, while expanding scope of practice for nurse practitioners and physician assistants, Ballentine said.

Challenges in Long-Term Care 

Espinoza said the COVID pandemic has highlighted ongoing challenges in long-term care and related fields that employ direct-care workers, the fastest growing job category in the country.

COVID policy has deemed direct-care workers an essential service in the crisis, but these workers are undervalued and paid poverty level wages while receiving inadequate training for the work they must do, he said.

Often, they are last in line to receive adequate personal protective equipment on the job. If not protected by their employers, some may choose not to come to work, Espinoza said.
“We’re still counting how many direct care workers have lost their lives to the virus,” he said.

Espinoza also said a scattered and fractured long-term care system makes it impossible to intervene quickly in a crisis like COVID-19.

PHI has advocated for transforming the quality of direct care jobs, addressing high turnover, low pay, inconsistent training, and lack of access to paid leave and day care.

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