Hospital-Based Palliative Care Bridges Gaps in Care Continuum

Not all patients needing palliative care are able to receive it at home, despite a strong preference for in-home care from individuals facing serious illness.

Challenges can arise from the level of care required, which may exceed the capacity of family or other caregivers, or from home environments that are not conducive to healing. In such cases, hospital-based palliative care offers a viable solution, often with established programs that provide a better continuum of care when patients eventually transition to hospice.

Calvary Hospital, in Bronx, New York, is a 225-bed facility that has specialized in hospice and palliative care services for 125 years. It’s the only hospital in the country that exclusively provides these services. Calvary also provides in-home services, which can be provided in private homes, nursing homes and assisted living facilities throughout New York City and its suburbs.

“We work with major academic-based health care systems and other facilities in New York,” said Calvary President Michael Fosina. “When they have patients who require palliative or end-of-life care, they’ll transition care to us, and we’ll provide the right care each patient needs at the right time. We’re not competition to other providers. We complement them, so we have a strong relationship with them.”

Those relationships are key to Calvary’s long-term sustainability and future success, he said. Nurse practitioners from Calvary, for example, can provide some palliative care services in other hospitals prior to the patient being transferred. 

Fosina added that while most hospitals are designed to turn beds over every five days or less, Calvary welcomes patients for as long as they need care.

HopeHealth also has a long history within Rhode Island and Massachusetts, with nearly 50 years of providing care and more than 30,000 palliative care visits per year in addition to a strong hospice service. President and CEO Diana Franchitto said having an internal hospital champion for palliative care in the hospital setting can help programs grow.

“Having this resource can facilitate the launch of a program as well as assist with any issues as the program evolves,” Franchitto said. 

The need for palliative care services will continue to grow as the population ages, Fosina said. A 2025 report from the United States Census Bureau shows older adults outnumber children in 11 states. 

Fosina said reaching the younger generation is important not just for their parents’ care needs, but also for their own care. Colorectal cancer is increasing in adults under 55, and palliative care can start at any point following a cancer diagnosis. 

“Younger medical consumers are usually not engaged with the health care system on their own,” he said. “They’re not thinking about subspecialties of care, for example. As they start to take care of their parents, however, and talk to their parents’ primary care physicians, they should come to understand what’s available and what they need to know such as goals of care, advanced directives and end-of-life care.”

Fosina advocates that patients, families and physicians have those conversations earlier

“Practitioners and individuals don’t always like to have those discussions,” he said. “They are sometimes pushed down the road to the next provider or the next crisis, until the patient is introduced to palliative care or hospice later than they should. Better awareness of these issues could get patients the care they need sooner.”

Franchitto agreed, adding that as more people experience palliative care for their parents or other loved ones, there will be growing acceptance and demand for this service.

But, she said, it’s important that care delivery be “as efficient as possible given the current reimbursement challenges.” Over time, the development of a more financially sustainable approach to palliative care will be dependent on policy changes.

With the rise of artificial intelligence tools integrated into electronic health records, Fosina expects that predictive analytics will become a reality for palliative care. He indicated that as AI learns from existing patient records and analyzes the data, it will become a powerful tool for health care providers to identify patients who may benefit from palliative care and hospice services. 

“This proactive approach should enhance the patient’s experience, improve resource allocation, and ensure earlier, safer, better, transitions to comfort care, rather than in the patient’s last days,” Fosina said. 

Palliative care can also help hospitals operate more efficiently while providing better patient experiences. In Calvary’s case, patients already receiving in-home care can be directly admitted to its own hospital when the patient requires higher levels of care, rather than taxing another hospital’s already stretched emergency department.

“When palliative care providers are present, the specialists in the hospital, whether hospitalists, oncologists, etc., can trust the palliative care team to do this critically important work, allowing them to attend to their other patient care needs,” Franchitto said.