Rural Palliative Care: Karl Bezak, Jeanie Youngwerth, Adie Goldberg, and Gregg Vandekieft

This episode of GeriPal explores the unique challenges and innovative solutions in delivering palliative care in rural communities, featuring experts from across the U.S. The panel—Jeannie Youngwerth, Adie Goldberg, Karl Bezak, and Gregg Vandekieft—discuss how rural palliative care differs from urban models, emphasizing the need for flexibility, local integration, and community-driven approaches. They highlight the 'MacGyver' nature of rural healthcare, where providers often wear multiple hats due to limited resources. Key themes include equity, the digital divide, workforce shortages, and the importance of humility in working with rural communities. The guests share impactful initiatives such as using EMTs as palliative care team members, telehealth programs like UPMC’s Tele Goals of Care Pause, and community-based fellowship training programs that allow providers to stay in their hometowns while gaining certification. The conversation also touches on policy barriers, including outdated Medicare hospice rules and inconsistent telehealth reimbursement, and calls for systemic changes to support sustainable rural palliative care. The episode concludes with a powerful reflection on the human element of care: rural patients often prefer to stay in their communities, surrounded by familiar faces and networks, even when facing serious illness. The panel stresses that high-quality palliative care must be tailored to local strengths and cultural contexts, not imposed from urban models. They advocate for policies that support telehealth parity, expand palliative care reimbursement in home settings, and include palliative care representatives in rural health funding decisions. Ultimately, the message is clear: rural palliative care is not about replicating urban systems, but about building resilient, locally rooted, and deeply personalized care ecosystems.