P114 Leveraging Social and Legal Community Resources to Mitigate Health Disparities Impacting the Seriously Ill Patient

Hospital-based palliative care programs have long been frustrated with the gap between delivering quality palliative care to hospitalized patients and seeing their patients “walk the plank” back into the community where access to quality community based non-hospice palliative care is highly variable to non-existent. The best-laid palliative care plans are often confounded by the lack of coordinated, sustainable and financially viable community based social service infrastructure that can be accessed at any point in a serious illness. Patients in the midst of serious illness are particularly vulnerable to health disparity especially those with low reserve or disease progression when it is combined with poor social and/or financial support. Serious illness itself, especially those illnesses associated with prognostic uncertainly and predicated multiyear courses can trigger cascading health related social/legal/financial problems for a patient and family (induced health disparity) that were not present prior to the development of a serious illness. When serious illness is combined with health disparity risks (e.g. homelessness or unsafe housing, poverty, substance use, unemployment, lack of transportation, personal relationships characterized by physical or sexual abuse, major mental illness, racial and ethnic factors, undocumented migrants, LGBT, HIV) can reduce the likelihood of successfully undergoing a course of life-prolonging medical treatment or literally result in premature or unanticipated death. To counterbalance this reality we suggest that recognizing and engaging with established non-medical partners to leverage the social/legal/financial supports necessary to care for the seriously ill patient in the community is essential for developing successful community based palliative care programs and should be included in upfront strategic planning. An overall approach to engaging and collaborating with community partners should include: 1. Conducting a global assessment of key infrastructure and institutions 2. A review of available population based health data 3. Engagement with established community health and social service providers 4. Development of a collaborative strategic plan with each community provider. This presentation explores this initial approach to build understanding of the social-community backdrop of the patient population served as a method for supporting sustainable community based palliative care programs.