The National Palliative Care Research Center

Curing suffering through palliative care research.


Rebecca Sudore, MD

Associate Professor

University of California, San Francisco

Grant Year
Grant Term
Grant Type
Pilot & Exploratory Project Support Grant

Project Description
Developing a Toolkit to Empower Medicaid-Paid Caregivers to Manage Common Palliative Care Symptoms

Millions of older adults require in-home care support in order to remain in their homes. Many of these individuals experience serious illness and common palliative care symptoms, such as pain and shortness of breath. Treating symptoms can be especially problematic for older adults with multi-morbidity who may live alone or who are dependent on others for their care because of medical and/or psychiatric illness. In-home care workers are a potentially untapped resource to help support the management of common palliative care symptoms in medically frail clients. Homecare is available to disenfranchised older or disabled adults through Medicaid's personal assistance benefit. In the U.S., 2.2 million workers provide personal assistance services for 2.7 million frail older adults with complex illness and disabilities. In California these services are known as In-Home Support Services (IHSS) and over 450,000 Californians receive them. With the aging of the population and the desire for aging in place, home health workers are expected to be among the nation’s fastest-growing occupations.  We will leverage existing pilot funds focused on developing a separate IHSS advance care planning program and use established partnerships with the San Francisco Palliative Care Committee, the Department of Aging and Adults Services, and IHSS agencies to design, refine, and pilot test an IHSS-Symptom Management Support Toolkit for IHSS workers. We will also establish an IHSS Stakeholder Advisory Board. This project is the first step in a planned research program that will lead to an R01 and larger implementation studies. Potential Impact: An IHSS-Symptom Management Support Toolkit could provide a national model for in-home symptom support for frail, disabled older adults; reduce unwanted healthcare utilization; develop the capacity of IHSS workers to provide more comprehensive support for their vulnerable older clients; and improve job satisfaction and retention of IHSS workers.

Rebecca Sudore, MD, is an Associate Professor of Medicine at UCSF, a clinician-researcher, and a Geriatrician and a Hospice and Palliative Care physician. She is also a Staff Physician at the San Francisco VA Medical Center. Her research focuses on the intersection of health literacy, geriatrics, advance care planning, and informed medical decision making. Her current research program is focused on designing and testing interactive, web-based interventions to prepare patients and their surrogate decision makers to make complex medical decisions over the course of serious and chronic illness.