Name of Project: The Balm of Gilead
Institution: Cooper Green Hospital, Birmingham, AL
PI: F. Amos Bailey, MD
Abstract (as described by Project staff)
The Balm of Gilead is a comprehensive program for end-of-life care supported in part through funding from The Robert Wood Johnson Foundation’s Promoting Excellence in End-of-Life Care initiative. Cooper Green Hospital and the Jefferson County Department of Health are partners in the program along with partnerships established with local foundations, colleges and universities, faith communities, civic groups, and professional groups to enhance the goals of direct service to Balm of Gilead patients and families and consultation-education-outreach to the broader community. The principle objectives of the Balm of Gilead Center are twofold: First is to build a seamless program among the County’s safety net providers that integrates acute care and end-of-life care. Second is to develop and integrate systems that truly provide excellence in end-of-life care, including activities such as identifying patients earlier in the acute care process, building and coordinating the network of faith and community resources necessary for comprehensive outpatient and inpatient palliative care, and integrating palliative care processes into the larger health care system.
The Balm of Gilead Center provides inpatient palliative care for medically underserved people with terminal illnesses who do not have a place to live or do not have support services at home through a ten bed dedicated unit located on the fourth floor of Cooper Green Hospital. For those in need of home hospice care, the Balm of Gilead program provides specially trained physicians, nurses, clergy and volunteer care teams through the Jefferson County Department of Health’s hospice program.
Brief Synopsis of Program Characteristics, Successes and Challenges
The Balm of Gilead is a project of Cooper Green Hospital in Birmingham, Alabama. Cooper Green, an under-resourced, county-run hospital overseen by the Jefferson County Commissioners, is truly a safety net provider, primarily providing services to low income, uninsured African Americans. Under the leadership of Amos Bailey, MD, the Balm was created to meet the palliative care needs of this underserved population in a manner that is responsive to the economic and social realities of the community, where dying patients often lack appropriate caregivers to remain at home and where distrust of the medical system is pervasive. The Balm of Gilead itself is an umbrella organization, providing an overarching infrastructure for an array of services and programs, including:
Comfort care to meet physical, social, emotional and spiritual needs is coordinated by a interdisciplinary team of physicians, nurses, patient care technicians, clergy, social workers, music therapists and volunteers. The team is led clinically by Medical Director Bailey and administratively by project director James Bolden.
Balm of Gilead staff set out to integrate palliative care into the acute care provided at Cooper Green by building palliative care processes into daily hospital routine and by educating all hospital physicians. As a result, there has been hospital-wide adoption of Pain as the 5th Vital Sign, analgesic-dosing cards used as an equivalency dosing guide to various pain control methods, and visual analog scales for pain. To accomplish the educational objective of training all physicians in palliative care, Dr. Bailey capitalized on the unique staffing structure at Cooper Green. Residents and interns almost exclusively staff the hospital, with 20 new house officers rotating through the facility each month. Dr. Bailey meets daily with house staff for 15 minutes of palliative care Morning Reports and each house officer rotates through the Balm of Gilead inpatient unit. As a result, house staff view the Balm as part of the delivery system rather than an ‘add on’ service. Balm of Gilead staff plan to survey house staff who rotated through the project in the previous year to determine the level of palliative care knowledge and practice that carried over into new care settings, thus gleaning valuable data on how to support emerging palliative care leadership.
Part of the success of the project is attributable to the sense of community ownership it has engendered. The project relies on “Care Teams,” groups of trained, supervised volunteers recruited from faith communities, and civic and social clubs who are linked to patients and families from pre-hospice care through bereavement, staying with the patient though all care settings. These teams are offshoots of the highly successful Caresharing Initiative at University of Alabama (www.careteam.UAB.edu). Additionally, local churches sponsor rooms in the inpatient palliative care unit and pastors are involved through a program called “Clergy that Care.”
The impact of the Balm on the Cooper Green system has been rather remarkable. Hospice census increased by 27 percent in the project’s first year and 53 percent in their second year (with an average length of stay of 71 days!); there has been an increase in palliative care referrals; and more than 50 percent of the patients who die at Cooper Green now die on the Balm inpatient unit.
Exportable Products/Tools
Policy Issues
Policy issues abound surrounding payment for palliative care for uninsured, non-paying patients.
This project is the only Promoting Excellence grantee located in a county public health system. Project staff should be tapped for the expertise they have gained in issues related to caring for the uninsured.
Communications
National spotlights have repeatedly shone on the Balm of Gilead. The project was selected for presentation in the final segment of Moyer’s “On Our Own Terms” and was one of the projects featured in Pioneers in Palliative Care: Nine Case Studies sponsored by The Robert Wood Johnson Foundation and the Milbank Memorial Fund. This level of national exposure has been both a blessing and a curse and has forced project staff to devote unbudgeted time to respond to the attention brought by national media. Dr. Bailey gained additional national exposure when he was selected as a Robert Wood Johnson Foundation Community Health Leader, an award that brings prestige, connections and financial benefits to the Balm of Gilead.
The Balm staff has been successful in engaging Birmingham’s African American population in planning for and receiving end-of-life care, and they have accomplished this within the challenging environment of a public hospital. As such, staff is interested in conveying their story to other African American communities, organizations and institutions. They are also interested in disseminating their finding in public health arenas and faith-based/ministerial venues.
The project has a web site: http://www.gileadcenter.com/.
Generalizing the Model
Dr. Bailey has trained a cadre of residents and interns in palliative care, through his Morning Reports and by rotating them through the Balm unit. These clinicians will take their knowledge elsewhere, along with a perception that palliative care is a normal component of health care delivery. Additionally, Dr. Bailey has a vision for “franchising” the Balm of Gilead, so that the project’s components can be incubated in other institutions. He has recently been asked to start a similar program at the VA in Birmingham and is stepping back from a significant portion of his duties at the Balm to fulfill the VA’s request. Project staff plan to prepare a “How did we do it” manual that describes the process involved in establishing a network of palliative care services.
Words of Wisdom from the Project
When project staff were asked what advice they would offer another institution considering developing a palliative care program, they replied:
