Practicing Palliative Care in Resource-Poor Settings

Abstract

Providing palliative care to patients dying of a terminal illness is a difficult task in any environment. When the care is for individuals who are medically underserved, uninsured, and stigmatized because of their disease, it becomes even more problematic. Nonetheless, the integration of palliative care into treatment models for underserved populations adds patient support, relief of suffering, and other dimensions to the delivery of medical care. It is an important part of the continuum of health care in resource-poor settings. Creating health care models that serve vulnerable populations is one responsibility of the US Department of Health and Human Services’ (HHS) Health Resources and Services Administration (HRSA). HRSA is charged with supporting primary health care and health professional training for underserved and uninsured populations. 1 For HRSA’s HIV/AIDS Bureau, this mission means providing a continuum of health and supportive care in the United States that begins with counseling and testing for HIV disease and ends with terminal care for individuals dying from AIDS or related complications. Through the Ryan White CARE Act (CARE Act), cities, states, and primary health providers in the United States receive funding from HRSA to provide approximately 27 services, including home health and hospice care. In 2002, the $1.9 billion allocated to the CARE Act by Congress supports these services when other patient funding streams, such as Medicaid or private insurance, are inadequate or non-existent. 2 To improve the delivery of these services, the HIV/AIDS Bureau is undertaking palliative care demonstration grants in five areas of the United States through our CARE Act Special Projects of National Significance (SPNS). These projects address individuals with advanced AIDS who are homeless, incarcerated, living in very rural areas, or are substance abusers. 3