Improving death care is a topic no one wants to talk about, but patients who will not survive their illnesses also need medical care and supportive services.
The need for quality palliative care is overwhelming:
- In 2014-15, just under half of all patients (47.9 per cent) began receiving palliative care in their last month of life.
- Nearly two-thirds (64.9 per cent) died in hospital.
- Less than half (43.3 per cent) received palliative home care services in their last month of life.
- About one-third (34.4 per cent) received a home visit from a doctor in their last month of life.
COVID-19 has had an unprecedented impact on palliative care. As more families opt to avoid hospitals for fear of COVID-19 exposure, there is even more need for support for hospice or home-based palliative care.
Bill 3, a Private Member’s bill that was sponsored by MPP Sam Oosterhoff and approved Dec. 2, calls for a provincial framework to support improved access to hospice palliative care provided through hospitals, home care, long-term care homes and hospices. This is a good start but we need to do more.
Firstly, we need more direct government support for hospices. Only about 40 per cent of hospice funding comes from government with hospices left to fundraise for the rest. Even before the pandemic and despite their best fundraising efforts, hospices could not begin to meet their needs. Now, COVID-19 has forced the cancellation of fundraising events and put hospice services in jeopardy.
The lack of hospice services particularly affects homeless people and other marginalized groups who often have no other option but to die in hospital. The government should support and expand programs such as PEACH (Palliative Education and Care for the Homeless) in downtown Toronto.
Expanding palliative hospice care not only allows people to die with dignity but also eases the burden on the healthcare system. When a hospice bed costs about 40 per cent less than a hospital bed – $470 a day versus $1,100 – hospice care makes even more sense.
We also need to extend that same service to patients who decide to die at home. These patients need palliative care doctors who ensure they have the medications they need to be comfortable, nurses who can monitor them and their needs and personal support workers to take some burden of care from family members who have no training in appropriate personal care. It is estimated that providing home care for terminally ill patients costs 10 times less than care for a patient in an acute-care hospital.
It is astounding that with a population of more than 14 million, Ontario has only 258 palliative medicine specialists. We need more and better training for physicians in palliative care, both in medical school and in residency training. This would also help attract physicians to pursue palliative medicine as a specialty and help ensure we have enough specialists to meet the need. However, it is equally important to develop capacity for the provision of palliative care among all physicians as our population ages. Specialties such as family medicine, nephrology, cardiology and oncology can add value by incorporating basic palliative care skills into their practices.
The Community Palliative Care On-Call (CPOC) program offers 24-hour, 365-day-a-year on-call coverage for community-based palliative care patients but there has been a years-long freeze on the number of palliative care physicians able to enroll to provide this service. This freeze needs to be lifted to help keep patients at home and out of the hospital.
The adoption of virtual care has been beneficial for home-bound, frail patients at the end of life. It has allowed caregivers to more readily access their care-teams. It has enabled physicians to be more accessible and it needs to remain permanent. Unfortunately, palliative care specialist fees were left behind in the process and need to be updated in a robust COVID-response plan as we continue to fight wave after wave of the pandemic.
We also need to develop a provincial strategy for palliative care in rural and remote communities and ensure enhanced palliative care is included as part of integrated health services offered through Ontario Health Teams.
Patients can’t wait to access palliative care. The time is now to address equitable access to care for those with life-limiting illnesses and at the end of life.