The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 22: Facilitating the TransitionMany very poor families may have a history of negative social service experiences. This maycause a rejection of any care provider entering their home. Families have been known to refusevisits from case managers, home care and hospice nurses, home health aides, pastoral workersand volunteers.Crowded living situations also increase the transmission rate of TB within the household. Patientsidentified to have TB need to be linked with appropriate surveillance teams and have allmembers of their households tested or evaluated.We need also to be mindful of further barriers to care that exist for the impoverished population,such as the following:• Transportation may be limited in areas of high crime.• Only a limited number of home-based care agencies may serve the patient’shome setting, and agencies may need protective services to accompany healthcare providers on every visit.• After-hour call services may be limited to phone assistance, whereas clients insafer areas may receive a home visit at any time.SUMMARY■ Patients and families need reassurance that their interdisciplinary team members are interestedin their quality of life, not quantity of life without quality. We must acknowledge a goodquality of life as being free of distressing symptoms, and offer patients the ability to remain asindependent in their lives and care as possible. With comprehensive assessment, we can promotepatients’ ability to achieve meaningful goals and take care of personal priorities before theend of their lives.Deliberate, informed, and conscientious practical actions should be based on understandingthe interdisciplinary team role and function, hospital discharge planning, patient and familyassessment, and home care and hospice planning. These components are paramount to promotinga continuum of care and support for people with HIV and their families at the end-of-life.XXIIU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 475