Home-Based Palliative Care: Toward a Balanced Care Design.

Palliative care for seriously ill adults is spreading rapidly, giving rise to a fast-growing business sector: the home-based palliative care (HBPC) industry. These programs offer services common to most palliative care programs; what distinguishes them is that services are delivered to patients in their homes. Research shows these programs hold promise for improving patient outcomes at lower cost than usual care. Given this, growth in the HBPC business is likely fueled partly by the sector's money-making potential. As in many emerging industries, there are concerns that HBPC benefit may not be enjoyed equitably by patients and other stakeholders. To safeguard HBPC quality, we take stock of where quality problems may manifest and discuss strategies to forestall these problems. We examine HBPC trends with significant implications for care quality and cost, including HBPC payment, patient enrollment, staff management, and patient visits. Recommendations pertain to quality metrics, patient disclosures, and further research.