SESSION DESCRIPTION
Discover how an integrated health system is strengthening foundational palliative care skills and advancing the future of serious illness care for seriously ill custodial nursing home residents. By scaling a pragmatic, values driven model for palliative care and advance care planning, this session offers a replicable “how to” framework that dismantles barriers, reduces unwanted utilization, improves goal concordant care, and honors what matters most to custodial nursing home residents.
OBJECTIVES
- Identify system gaps contributing to poor quality serious illness care and unwanted utilization for patients in custodial skilled nursing facilities (SNFs).
- Apply a practical, replicable framework for implementing WMM-driven workflows, including POLST translation to orders, education and training, and SNF partnership strategies—that strengthen quality outcomes and decrease unwanted utilization.
- Evaluate examples of measurable impact—including reductions in unwanted hospitalizations, increased hospice utilization, and care aligned with patient goals—to demonstrate return on investment and program value.
FACULTY
Zoe Sutton, MSN
Director, Kaiser Permanente Northern California
Supportive Care Services
Hannah Whitehead, RN, MSN, GNP-GC
Clinical Practice Leader, Kaiser Permanente Northern California
Monica Guo, MPH
Senior Business Consultant, The Permanente Medical Group, Northern California
Aveline M. Belle, BSN, RN
Nurse Manager, Kaiser Permanente Northern California