Home-Based Pediatric Palliative Care Delivered by a Hospice

This project was designed to address the lack of outpatient pediatric palliative care programs in Nevada by initiating a new program involving an existing specialty children's center and an existing hospice. The objectives of the project included proposing a palliative care model involving new services and licensing to a local hospice director and receive feedback and researching billing procedures and options to receive reimbursement for palliative care services offered in the home. They further included developing and proposing a plan to receive additional Medicaid funding for pediatric palliative care patients in Nevada, designing collateral materials to disseminate to health care professionals locally to improve awareness of palliative care services available in the community, and last, identifying a conference at which to present this model. This project used the complexity theory to describe how this hospice could prepare to deliver care that focuses on quality of life in a chaotic, highly variable and evolving community setting. Currently there are no outpatient pediatric palliative care programs in the state of Nevada. In 2011, at least 210 children died in Nevada of a disorder, disease, or infection process. Access to palliative care would have greatly increased the quality of life for these children and their family members, and would have likely decreased spending by Nevada Medicaid for unnecessary or unwanted hospital admissions. The objectives of the project were met by partnering with a local established hospice, assisting them to create a document of billing options, taking an educational brochure to providers in the community, and presenting the program at the 2015 National Association of Pediatric Nurse Practitioners conference upon invitation. Much work still needs to be completed to allow this program to begin functioning but major progress has been made. This important program still needs to gain improved reimbursement privileges with Nevada Medicaid and finalize their billing routine. Likely a professional organization, such as National Hospice and Palliative Care Organization, will need to be employed for some guidance and training for proper and complete billing to be possible. Long term sustainability will depend on the ability to be reimbursed sufficiently.