June 7, 2022 — The Madrone Care Network celebrated its move from a cramped little shop behind an audio store to a 1700 square foot office building on Monday. The network started offering palliative care to patients in Mendocino County just a few months before the start of the pandemic. Physician’s assistant and founder Lynn Meadows, who was a well known longtime midwife in the community, said now, at 71, she has “evolved along this pathway of life,” to the transition for people in their last few years. She was inspired by Mother Teresa’s work in Calcutta, and considered going to India herself, but realized “through studying her, I became aware that there are people right here in Ukiah who need love.” She started a palliative care center at Adventist Health Ukiah Valley before starting the community-based version, “because the need is so great.”
Palliative care is similar to hospice care, but it differs in a few key ways. Patients in a MediCare hospice have to follow a strict protocol, like agreeing not to call 911 or pursue more curative care, like chemotherapy. Palliative care patients are often receiving treatments, and are not required to have a diagnosis of a six-month life expectancy. “Some of our patients have been with us for years,” Meadows concluded.
Medical director Dr. Ron Sand described services that range from spiritual care and basic food needs to bureaucratic wrangling. Patients receive nursing, social work, optional care from a non-denominational chaplain, and the services of a community health worker. This person offers transportation, technology for patients so they have appointments with remote providers, and food boxes. Many of the patients are with MediCal through Partnership Healthcare, which offers an insurance benefit for palliative care. Blue Shield also offers a benefit, though MediCare does not yet pay for palliative care. Sand said Madrone Care is currently serving about 80 patients in Mendocino and, more recently, Lake Counties, but “In our estimation there are many more who are unserved.”
With the pandemic, nurses and physician’s assistants offer treatment either in person or virtually, through telehealth or zoom. Physicians assistant Emily Frey stepped away from the ribbon-cutting festivities to describe some of her work. “We focus on symptom management for improved quality of life, so that’s a very focused approach,” she said. “We also concentrate a lot on advanced healthcare planning, which is kind of a euphemism for figuring out your wishes with regards to resuscitation, CPR, and just goals of care, so what are the goals that that person might have, and helping them figure that out.” Frey added that a lot of the patients are marginally housed, with “a huge amount of psychosocial needs.” The work, she said, “can be really emotionally challenging, but also really rewarding.”
Four of the qualifying diagnoses are people with end-stage liver disease, end-stage heart disease, end-stage respiratory disease, and stage three or four cancers. A new diagnosis is end-stage neurological disease, like advanced ALS or multiple sclerosis. “It’s people who have very challenging health conditions that they’re probably not going to get better from,” said clinical manager and RN Elise Gootherts. “And we really want to help them have a better quality of life.”
