Healthcare Professionals

LifeCourse was developed by a team of clinicians who adapted national palliative care guidelines and practices for a patient-facing approach by a lay healthcare worker.

LifeCourse employs lay healthcare workers called care guides. The care guide meets with patients where they live and helps ask the right questions, connect with needed support, and prepare for what is coming next. LifeCourse empowers patients to seek support around medical, social, psychological, spiritual, cultural, financial, and legal issues. LifeCourse assists healthcare professionals in recognizing and honoring individual preferences and supporting individuals involved in making difficult decisions.

LifeCourse serves patients living with one or more serious illnesses in an advanced stage who are not yet appropriate or eligible for hospice. Identifying patients for LifeCourse has included criteria such as:

  • A diagnosis of serious illness in an advanced stage (e.g. Class III or IV heart failure, Stage III or IV cancer, dementia, COPD, kidney failure, liver failure, Parkinson’s, coronary artery disease)
  • A series of hospitalizations (within the last 12 months)

Additional criteria to consider for provider referral include:

  • Increasing frailty and/or declining functionality
  • Needing assistance with complex decision-making and determining goals of care
  • Unaddressed psychosocial or spiritual issues

Care guides are trained on a structured visit framework which incorporates the use of question sets and standardized assessment tools. Care guides are also trained in utilizing the electronic health record to connect with resources, document patient goals and updates, and message with other healthcare professionals who the patient interacts with across settings and specialties.

During monthly in-person visits with patients, care guides will:

  • Use question sets and assessment tools to facilitate discussion of patient medical and psychosocial concerns
  • Assist patients in articulating their preferences, goals, and what matters most; confirming and adjusting on a regular basis
  • Assess understanding of health status and/or care plan
  • Support key friends and family and understand their needs as they relate to patient care and support, and help them engage in patient care and support

In addition to meeting with patients, LifeCourse care guides support their patients by communicating with the patients’ care teams.

Care guides can do this by:

  • Facilitating communication of patient goals among patient, care team, and key friends and family through the electronic health record, telephone, and/or in person as needed.
  • Assisting patients in seeking and using care and services that align with goals and preferences
  • Observing and identifying need for and providing links to:
    • healthcare services
    • community services/resources
  • Coordinating and/or facilitating advance care planning (ACP) and supportive care conversations
  • Connecting with multidisciplinary care teams as appropriate

Events and Media

IAGG World Congress The 21st IAGG World Congress of Gerontology and Geriatrics (IAGG)—taking place in San Francisco, California on July 23-27, ... more Allina Health Offers Life Lessons for the Dying by Glenn Howatt June 17, 2016 - Glenn Howatt of the Star Tribune writes about the impact of LifeCourse on individuals dealing with the challe ... more

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