At every stage of an illness, you have choices.

A referral source for healthcare providers to help their patients navigate through the complexities of COVID-19 related serious illness.

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Palliative care focuses on helping patients live well.

As the COVID-19 pandemic continues to spread, taking precious lives and sending others to the hospital, the Arizona Hospital and Healthcare Association (AzHHA) offers a valuable resource to healthcare providers.

Palliative care telehealth services are available for patients experiencing acute or chronic COVID-19 symptoms and related complications in any setting such as clinics, home healthcare, long term care, assisted living and hospitals.

Cost

There is no fee to participate in this program. Click on the link below to get started now.

Get Started

Click on the link below to complete the intake form, attach a medical history form (if applicable) and work with the patient to schedule an appointment.

About Palliative Care Telehealth

The Arizona Hospital and Healthcare Association launched the Palliative Care Telehealth program in December 2020 to give COVID-19 patients the option for free care in their home or care setting.

Palliative care telehealth services are available for patients experiencing acute or chronic COVID-19 symptoms and related complications in any setting such as clinics, home healthcare, long term care, assisted living and hospitals.

There is no fee to participate in this program.

Our focus is to help patients live well. Palliative care telehealth works with the existing healthcare team to provide an extra layer of support and care focused on aligning patients' values and goals with available treatments.

Information for healthcare providers

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Information for patients and their families

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Learn more about palliative care from those who have experienced this service.

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Frequently Asked Questions

A free program for you and your loved ones to use. You can talk to (via phone) or video-chat (via smart phone or computer) with a skilled palliative care provider to help understand COVID-19 and your symptoms or other conditions that have been made worse by COVID-19.

Palliative Care is a medical specialty that is expert at communication and symptom management. It is an extra layer of care for you and your loved ones. Your healthcare team wants to provide you the best possible care but may have limitations on time. A palliative care provider spends time with you to understand your symptoms and challenges and then works with your primary care team to get you the healthcare and resources you need. They can even talk to your family or loved ones to assist in making sure everyone understands the care and treatments you want to receive.

This program was developed because of the high volume of seriously ill patients with COVID-19 in settings where there are health professional shortage areas as well as no or limited access to palliative care. Our goal is to reduce suffering and provide another layer of supportive care for Arizonans who have been affected by COVID-19.

There is no cost to the patient and no need to bill insurance. This service is paid for by a grant from the Arizona Department of Health Services.

The program will last until the funds run out. We estimate approximately 4-6 months.

No, the palliative care provider will work with your referring provider to ensure you get the care you need. They will discuss your wishes and make recommendations. The referring provider is still your main provider of care.

Your primary provider will contact you to discuss recommendations and next steps.

No, the telehealth palliative care provider will review your medication list and if changes are needed will discuss recommended changes with your referring provider. Your referring provider can then change medications as appropriate.

Yes, all telehealth palliative care providers (physicians and nurses) are licensed and credentialed

Yes, the telehealth palliative care providers can assist in completion or revision of Arizona healthcare directives and POLST portable medical orders. Forms are located here or you can provide copies of specific forms as appropriate.

Yes, the telehealth palliative care provider can conference in your family members and/or loved ones as appropriate to participate in the consultation. They can also set up a follow up meeting with them if needed.

There are many options for the palliative care consultation, depending upon available resources. When the appointment is made, the medical assistant will discuss which option is best for you and help set up the appointment if needed. Telehealth consultations are conducted using a computer or your smartphone for videoconferencing. If you do not have access to one of these devices, let us know and we can send you a device for the consultation visit. You and/or your provider will receive a reminder about the appointment as well as a meeting invite.

There are no limitations to the number of times you can see the palliative care provider.

A referral source for healthcare providers across Arizona to help their patients navigate through the complexities of COVID-19 related symptoms, or those chronic conditions exacerbated by COVID-19, by talking with a palliative care provider for symptom management or goals of care.

This program was developed because of the high volume of seriously ill patients with COVID-19 in geographical and regional settings where there are health professional shortage areas as well as no or limited access to palliative care. Systemic health and social inequalities have put people from racial and ethnic minority groups at increased risk of COVID-19. In Arizona we’ve seen a higher incidence of death and co-morbidities in American Indians, Latino Americans, African Americans, and the elderly with underlying chronic illnesses. Our goal is to reduce suffering and provide another layer of supportive care for Arizonans who have been affected by COVID-19.

With the shortage of physicians, nurses, social workers, PPE and visitation restrictions, palliative care can help you best meet the needs of your patient and their families. Trained professionals can spend more time with your patient/loved ones to support their needs. The skill sets of palliative care providers center around expert pain and symptom management, skilled communication and coordination of care and support for patients and families. A referral to telehealth palliative care helps to preserve scarce resources (e.g., PPE) and save in-person visits for people with complex palliative care needs.

Yes, the palliative care telehealth service is provided free of charge to those suffering from COVID-19 and its complications related to or exacerbated by COVID-19.

Recommendations from the Centers to Advance Palliative Care for COVID-19 referrals include:
  • Pre-existing palliative care patient
  • Symptoms refractory to palliative symptom protocols
  • On ventilatory support
  • Difficult-to-control emotional symptoms
  • Patient, family, or physician uncertainty regarding prognosis
  • Patient, family, or physician uncertainty regarding non-beneficial treatment options
  • Patient or family psychological or spiritual/existential distress
  • Patient or family request
  • Declining ability to complete activities of daily living
  • See Palliative Care Referral Criteria for COVID 19 Patients for additional guidance
Go the website palliative.vsee.me/u/clinic and complete the Intake Form. A medical assistant will follow up directly with the referring organization to obtain medical records. The medical assistant will work with the patient and/or organization to schedule the appointment and determine if a hardware device for the telehealth visit is needed. Hardware devices are available, if needed, but do require internet access. Depending on the care setting in which the consult will occur, you may:
  • Clinic: designate staff to help patients/families set up the platform (computer/phone) access, give consent and prepare.
  • Home: prepare patients/families to make sure they have a place in the home ready, and are comfortable communicating via the platform (computer/phone), have their questions answered, etc.
  • Hospital/LTC/Other Organization: ensure staff can assist with platform (computer/phone) to make the connection. If possible, have a staff member stay with the patient/loved ones to ensure their questions are asked/answered and there is appropriate follow up.

There is no cost to the patient or provider for this service.

AzHHA obtained a grant from the Arizona Department of Health Services to provide this service. Intel provided a grant to provide hardware devices if needed.

The program will last until the funds run out. We estimate approximately 4-6 months.

No, this service is provided free of charge for any person in Arizona in any care setting (e.g., home, home care, independent living, assisted living, skilled nursing, long term care, long term acute care hospital, critical access hospital, hospital).

No, the palliative care provider/consultant will contact the referring provider to discuss recommendations. The primary care or referring provider is still the person’s main provider of care.

The referring provider (physician, PA, NP) will be contacted by the telehealth palliative care provider post consultation to discuss recommendations and next steps.

No, the telehealth palliative care provider will review the medication list from the provider and discuss with the patient but will not prescribe medications. They will discuss recommendations with the referring provider, and it is up to that provider to change medications as appropriate.

Yes, all telehealth palliative care providers (physicians and nurses) are licensed and credentialed in Arizona.

Yes, the telehealth palliative care providers do have access to Arizona statutes pertaining to healthcare directives and portable medical orders through Arizona POLST.

Yes, the telehealth palliative care providers can assist in completion of Arizona healthcare directives and POLST portable medical orders. Forms are located here or you can provide copies of specific forms as appropriate.

Yes, the telehealth palliative care providers have access to Arizona statute § 36-3231 Surrogate decision makers.

Yes, the telehealth palliative care provider can conference in family members, providers and loved ones as appropriate to participate in the consultation.

There are many options for the consultation, depending upon available resources. When the appointment is made the medical assistant will identify which type of hardware device is available (computer or smartphone app - e.g., FaceTime or WhatsApp). If the patient or organization do not have access to a hardware device, one will be sent.

There are no limitations to the number of consultations that can occur.

Video Resources

Holly Ahner, MD defines palliative care
Jason and Dawn's palliative care journey
Palliative Care Telehealth
What is Palliative Care Telehealth? Sandy Severson explains how the program works.

Blog 1: Introduction to the AZ Palliative Care Telehealth Program

The COVID-19 Pandemic has impacted patients and providers across the United States. With an influx of patients in hospitals, healthcare workers are in need of a cutting-edge program to help their patients navigate the symptoms and complications associated with COVID-19. The Arizona Hospital and Healthcare Association launched the Palliative Care Telehealth program for providers to give patients palliative care remotely - reducing the burden on emergency rooms and other primary care facilities where patients might otherwise seek this level of care. Collaborating with a steering team of diverse healthcare leaders, AZHHA is delivering innovation that will alleviate the current surge on hospital systems, while simultaneously providing care to individuals affected by COVID-19. The goal of this blog is to provide insight and track the progress of the Palliative Care Telehealth program.

We, the AZHHA intern team, have been following the progress of the Palliative Care Telehealth program, and we would like to introduce ourselves. We are Nigel, a sophomore at Lehigh University studying neuroscience; Naomi, a third year at the CUNY School of Medicine Sophie Davis Program; and Skye, a junior at The George Washington University’s Elliott School of International Affairs. Nigel and Naomi are from New York City, and Skye is from the DC area. We have a driving passion for healthcare, and felt it is necessary for us to help out during the COVID-19 pandemic.

Seeing the need for everyone having the resources to receive care, especially during a pandemic, the AZHHA telehealth initiative offers valuable learnings that may ultimately inform a broader strategy for other states and facilities across the country. The innovative approach enables patients to receive palliative care services in all care settings, including at home, in clinics, long-term care facilities, skilled nursing facilities, long term acute care hospitals, and via home health agencies. With the ability to get care from facilities other than emergency rooms, patients who have no access to transportation, or feeling the effects of COVID-19, can still seek quality of life treatment, without placing additional burden on already strained resources. Furthermore, this program offers the opportunity for families to receive extra relief and support, during a very stressful and emotional time.

This blog post is the first in a series of posts that will detail the experiences and learnings of the team as they set out to stand up a functional telehealth program, with an eye toward capturing the lessons that may be applicable to other settings across the country. Our insights are based on participation in planning meetings, first person interviews, and additional supplementary research. We will aim to post bi-weekly to keep you up to date as the rollout transpires! Please reach out to aztelehealthpilot@usciviliancorps.org with any questions.

LONG COVID by Chikal A. Patel, M.D
Medical Director, Complex Care Management - Optum

In a 6-month follow-up cohort study, Huang et al. followed 733 patients after hospital discharge. Those with more severe illness during hospital stay tended to have more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestation. Of additional concern, 1 in 5 patients who did not require supplemental oxygen during hospitalization had reduced lung function 6 months after "recovery."

Of the 1,733 patients followed by Huang et al, 76% had at least one ongoing symptom 6-months after initial COVID-19 diagnosis. Among 70 non-hospitalized patients in France, Salmon-Ceron et al pointed out that while many patients had persistent symptoms of fatigue, muscle weakness, chest pressure, dyspnea, tachycardia and problems with taste and smell, more than ¼ of patients developed new neurological symptoms AFTER their acute COVID-19 illness resolved. These findings of decreased lung function 6 months after diagnosis and new neurologic symptoms after acute illness prompt the need for continued post-COVID-19 monitoring for lung dysfunction or new neurologic symptoms.

Assessment/Management of Long-COVID

Not much is understood regarding this condition and more studies are needed. Things you can do as a clinician:

  • Be aware of it
  • Be empathetic
  • Baseline and serial comprehensive reviews of systems and physical exams may better document possible long COVID manifestations
  • Symptomatic and supportive care for most symptoms, esp. neurological
  • Address and readdress goals of care conversations
Additional information on Long-COVID-19

COCA Crisis Standards of Care (cdc.gov) – Long COVID-19 Presentation from 1/28/21

Late Sequelae of COVID-19 | CDC – CDC update as of November 2020 on COVID-19 Late Sequelae

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