ROBERT SIEGEL, HOST:
Palliative care is becoming more common in hospitals. It helps seriously ill patients manage their pain, their symptoms and their stress. But it's harder to get at home. Anna Gorman reports from San Diego that health providers are trying to give patients the same support outside the hospital.
ANNA GORMAN, BYLINE: Gerald Chinchar has heart failure and chronic lung disease. The 77-year-old knows any flare up could land him in the hospital, but that's the last place he wants to be.
GERALD CHINCHAR: If they told me I had six months to live or go to the hospital and last two years, I'd say leave me home for six months. That ain't no trade to me.
GORMAN: Many older adults feel the same, but still they end up in and out of the hospital in their final years when that's not what they want. It's a massive disconnect that costs the health care system billions. A San Diego health system has found a way to keep seriously ill patients home and reduce the cost of their care. It's with home-based palliative care. Dr. Dan Hoefer created the effort called Transitions.
DAN HOEFER: Transitions is just that point where people are starting to realize they can see the end of the road. We're trying to help them through that process so it's not filled with chaos.
GORMAN: Elderly patients like Chinchar get visits at home from social workers and nurses, who help patients better manage their diseases and make end-of-life plans. They also hand out a phone number to call in a crisis.
HOEFER: The alternative before was call 911, or try to fend for yourself. Now they can call at any time, and we will go out and help them.
GORMAN: Home-based palliative care is a lot like hospice with two important differences. Patients don't have to be at the very end of life, and they can keep getting treatment like chemo or radiation. UC San Francisco Medical School professor Christine Ritchie says such programs are cropping up around the country.
CHRISTINE RITCHIE: It's in large part because of a recognition that there are many people who need these services who aren't getting them and who are ending up on the doorstep of emergency departments and hospitals.
GORMAN: But there's still a huge barrier for home-based palliative care. There's no clear way to pay for it. Suzi Johnson also helped start Transitions.
SUZI JOHNSON: Medicare pays for something really when you're broken. You have to be broken to get it fixed. And we have the exact alternative to that.
GORMAN: That alternative is keeping patients stable. Johnson convinced hospital officials that it would make financial sense, and it did. Researchers found last year that patients in Transitions cost a third less than similar patients not in the program. The reason - fewer hospital visits.
One January morning, social worker Mike Velasco and nurse Sheri Juan head to Chinchar's house.
COMPUTER-GENERATED VOICE: Take exit 16 onto Mira Mesa Boulevard.
GORMAN: During the visit, Juan looks for signs that things are getting worse.
SHERI JUAN: How's your breathing? Are you any more short of breath?
G. CHINCHAR: Normal just the way it has been.
GORMAN: Juan also goes through his dresser drawer of medicines.
G. CHINCHAR: Calcium plus.
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G. CHINCHAR: This has never been opened.
GORMAN: Juan tells Chinchar sometimes too many medications do more harm than good.
JUAN: What we like to do as a palliative care program is streamline your medication list.
GORMAN: Chinchar's wife, Mary Jo, says she appreciates the advice her husband gets about diet and exercise.
MARY JO CHINCHAR: I think hearing from somebody else what he should do, like drink the right amount of water, eat the right foods and all that is - it's better to come from somebody else.
GORMAN: Rather than his wife.
M. CHINCHAR: Uh-huh (laughter).
GORMAN: Chinchar says he never expected to live into old age. The men in his family all died young.
G. CHINCHAR: You're an old-timer if you make 60 years old.
GORMAN: But Chinchar, who has nine grandchildren and four great-grandchildren, says he's not ready to give up yet. He turned 77 last month, and now, thanks to the extra help, he's shooting for at least 80. I'm Anna Gorman in San Diego.
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SIEGEL: Anna Gorman is with our partner Kaiser Health News.
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