Saturday, June 11, 2016

So, where do Canadians die?

Yes, this is a start. More funding has been announced in Ontario for residential hospices.

Province Strengthens End-Of-Life Care With $75 Million ... 

This investment would improve community-based hospice and palliative care services including:
  • Supporting up to 20 new hospices across Ontario and increasing the funding for existing facilities
  • Increasing supports for caregivers that will help families and loved ones support palliative patients at home and in the community
  • Promoting advance care planning so that families and health care providers understand patients' wishes for end-of-life care
  • Establishing the Ontario Palliative Care Network, a new body to advance patient-centred care and develop provincial standards to strengthen services.
Sadly, most of us do not want to die in hospital, and hospices are few and far between. Too many die in acute care, or the ER, despite a predictable disease trajectory, and research-based information that would clarify and support the deaths of a loved one in dignity and peace and quiet.

My husband, who volunteers with Meals on Wheels, gets mileage when he delivers meals. I, as a hospice volunteer providing respite, do not. There isn't enough money for this, despite the need for caregivers to get respite, and volunteers whose  mileage costs could be $65,000. I am rarely aknowledged, nor do clients offer to donate to my hospice group. We are never mentioned in obituaries as good places to donate in memory of a loved one.

It depends on where you die! Settings of care in Canada

Jun 18, 2012 - Currently, only 16-30% of Canadians have access to hospice palliative care.[ii]
 It is essential to understand the places in which Canadians are dying before we can improve the access to and quality of hospice palliative care.
  1. Acute Care. Most Canadians are dying in acute care hospital settings[iii].  Too many people who are dying end up in emergency departments during the last months and weeks of life, an indicator of poor quality end-of-life care.[iv] 
  2. Long Term Care (LTC). Some LTC have hospice palliative care training for staff, but many LTC residents also end up visiting the emergency room in the last weeks of life. Having a formalized palliative care program is not mandatory under the LTC act. Almost 50% of residents in LTC Homes are dying in the facility each year.
  3. At home. Home care costs in the last six months of life are roughly double what are required for all other home care recipients, and not all of these costs are covered by Medicare or private insurance plans.[v] A recent Ontario study showed that people with life-limiting illnesses who receive care at home early and receive more hours of care at home, are less likely to visit emergency rooms in the last weeks of life.[vi]
  4. Residential Hospice. Only 16 - 30% of us have access.
  5. In shelters/on the street. There is a marginalized homeless population who die in shelters or on the streets, with little care. There are now a small number of hospice programs for the homeless in Canada. 

Ontario is giving more money to publicly-funded hospices, adding $4.9 million to the $26 million a year it already gives them, a big increase to a budget that's still much smaller than ... Ontario is giving more money to publicly-funded hospices, adding $4.9 million to the $26 million a year it already gives them, a big increase to a budget that’s still much smaller than it ought to be. So the government is increasing funding to adult hospices by $15,000 a bed and to children’s hospices by $22,400 a bed. A decade ago, the government didn’t fund hospices at all. Now it’s promising to help build 20 more besides the 39 hospices Ontario already has, in addition to Friday’s by-the-bed funding increase.
StatsCan
4. The category "Place of death, non-hospital" includes deaths that occurred in private homes, in health care institutions such as nursing homes and other long-term care facilities, nursing stations and other short-term care facilities and other health care facilities not licensed to operate as hospitals by provincial, territorial or federal governments and at other specified sites.

Health Council of Canada. Seniors in need, caregivers in distress. April 2012http://www.healthcouncilcanada.ca/tree/HCC_HomeCare_FA.pdf

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