Thursday, June 28, 2012

Hospice Palliative Care in Canada

There is much misinformation on this topic.
In the US, you must qualify in order to access services and get financial coverage for palliative care. This is partly why many non-profit hospices exist in North America. Another reason, is that many physicians cannot manage palliative care, do not make house calls, and do not understand chronic pain management.

In Canada, media touts data, such as CBC's Cross Country Checkup's Palliative Care phone-in:  "70% of Canadians cannot access palliative care". Leave it to a journalist unfamiliar with palliative care to lead the public in discussing an issue they do not necessarily understand.

In truth, what is palliative care?

I wrote about his in my book. When I took the Foundations in Palliative Care Course, a year later (delivered by a specialised palliative care nurse), we attempted to define it.

My point is that palliative care is a care plan, specifically designed for the individual patient, and my be delivered at home, in a hospice, or in a hospital. Some Hospice Groups have dedicated beds, some Retirement Homes or Long-term Care place residents in a private room, and can manage the resident. Other cannot as the patient requires a morphine drip (or a CADD pump which automatically delivers morphine to a comatose patient: CADD Pump What, When How and Why).

My late father died in LTC, with regular morphine injections in the last days of his pain.
My late mother died at home,  with oral morphine pills for mild pain management. The only directive for my mother was the doctor visiting her in the morning, the day before she died, to say she was palliative, and that no other treatment would help her. He left, and went home. She never saw him again.
Doing a Life Review is a research-based strategy
for making clients more at peace.
It was a rather late diagnosis, indeed, with a tumour (# 6 or 7 - I forget) pushing up into her lungs and stopping her breathing. She went to emergency, they could do nothing, and they sent her home to die, at her wish. There was no support, no one told us to call non-profit Hospice Muskoka, where we could get advice, help and support. Since then, 2006, we have many more resources, such a Canadian Virtual Hospice.


I define a hospice as a non-profit organsation, (see more at: Hopsice Ontario), where Transfer Payment agencies coordinate volunteers. There are physical buildings across the province, actual buildings where those who have been determined to be palliative, may go for their last few weeks.
There are some terrific places in the bigger cities, although there are some small communities, such as Bancroft in North Hastings, with small homes, converted to provide a non-hospital setting.

Sandra Winspear, ED Hospice Muskoka
Dedicates a palliative care bed in hospital
Services such as : bereavement counselling, friendly visiting, respite care, Expressive Arts Bereavement Session for children in Muskoka, and for adults (e.g., Carleton Place, Muskoka), transportation, and a whole host of other services. I have volunteered for both Hospice Muskoka and Community Support Lanark County, as a friendly visitor, driver, providing respite care, advocacy for clients. I am a firm believer that the more you learn, the better off you will be. To that end, Hospices provide information such as
Palliative Care Programs  & Grief and Bereavement Programs , for those facing end-of-life concerns.

Most hospices provide a range of services, through an accredited Board of Directors, to spend taxpayers dollars wisely. Unfortunately, funding for such services involves a great deal of paperwork on the part of staff.  Some have broken free of this fettering and rely totally on private funding. (Hospice Cuts Ties With SELHIN)

Palliative Care
This is defined more as a state of treatment, rather than a delivery of services.
Once all treatment options have been discussed and set aside, it is the goal of family and friends to keep a patient comfortable. This may mean that a patient will go to a hospice setting, but I have found with the clients I have known, that family makes arrangement for care in their home.
It does not mean that anything is withheld, e.g., food, pain medications, water.

Pain Management
It does mean that any treatment that provides more pain or that will not provide any comfort is stopped. It does mean that the Pain Management Kit, which a doctor should have provided, or a nurse should have demanded, should be on hand in the home. I had a client with extreme pain, undiagnosed by the nurse, but perceived by myself and the family. In this client's case, we demanded it, and they had a prescription filled for oral morphine, to keep on hand if she had pain in the wee hours of the morning. Unfortunately, the client went into a coma, and a Morphine Patch had to be applied.

In my late mother's case it was chemotherapy, which ultimately killed her after one treatment, and she did not have her second treatment. She had the complication of a blood clot in her leg, where her lymphedema caused painful swelling.

Signs of Pain
Loss of appetite, anxiety, bleeding, constipation, cough, confusion, dehydration, depression, diarrhea, dysphagia, dyspnea, hiccoughing, intolerance of sheets on their legs, sweating, nausea, vomiting, pruritis, insomnia, mouth pain, skin problems, seizures, urinary frequency, weakness.
Watch for changes in expression, a change in behaviour, physical, intellectual, emotional spiritual pain:
  • being very quiet or moaning, rocking
  • being friendly to now being combative
  • from being cheerful to being sad
  • eating well then refusing food
  • sleeping well to insomnia
  • gestures: wringing of the hands, fidgeting with clothes, "pleating", clenching fists, flinging arms about, reflexive jerking, rubbing a body part, rhythmic body movements (banging on a table)
  • holding onto a chair for security
  • tossing and turning in bed
  • changes in body posture: slouching, slow shuffling, tense posture, rapid gait, tense sitting or lying positions

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