Lessons from Down Under – Eight pillars to support palliative care

These days, it seems like Australia is getting a lot of things right. And it can make what we are doing in Canada look real bad by comparison.

Take COVID. Australia’s approach has been superb. It closed its borders and pursued a COVID-Zero strategy that has for the most part eradicated the virus in the country. While life has not returned to the previous normal, life in Australia looks more normal than the rest of the world.

Contrast this with Canada. Our borders have been porous and variants from around the world are now driving yet another wave that threatens to cripple our health-care system. Our quarantine program is substandard and our vaccine procurement strategy has been fraught with delays, setbacks and missteps. As of the April 30 Public Health Agency of Canada report, only 3.1 per cent of Canadians are fully vaccinated against COVID-19.

While many parts of Canada are under lockdown, Australians are going to sporting events and attending concerts. So, you could say that as Canadians, we could learn a thing or two from our friends Down Under. This includes important lessons on palliative care.

Ontario Auditor General Bonnie Lysyk’s recent report on the pandemic response in long-term care (LTC) homes was predictable – we were “not prepared or equipped” to handle the pandemic. Sadly, the tragedy that unfolded in our LTC homes was decades in the making.

Amit Arya, a palliative care physician, outlined the neglect that our LTC homes have faced in a 2020 Policy Options article: “In Ontario, the average resident of a nursing home dies within 18 months. For many of us, these are the places we will go to die, yet palliative care is not something people in these homes predictably receive. In fact, only six percent of residents in a nursing home have a record of receiving palliative care in the last year of life.”

I have written previously about a report from Palliative Care Australia (PCA) that demonstrates the economic argument for improving access to palliative care. This report, compiled by KPMG, shows that investments in palliative care save money in the greater health-care system through more appropriate care in more appropriate settings at more appropriate times.

Now, PCA has released another report. “Ensuring Palliative Care is Core Business for Aged Care” makes the case that palliative care should be “the standard” for care in LTC homes and care of the elderly.

PCA’s plan has a catchy name (Palli8) for the eight pillars supporting the plan. They are:

• A person-centred approach to palliative care in aged care;
• Clear quality standards that MUST include palliative care;
• Palliative care training for EVERY health-care worker providing aged care;
• A palliative care National Minimum Data Standard (NMDS);
• FULL FUNDING – we can’t implement if we don’t invest;
• Ensure equitable access;
• Support death literacy;
• Palliative care as a priority for ALL levels of government.

In Canada, some of these “pillars” already exist at either the provincial level (i.e., the Ontario Palliative Care Network has a Competency Framework for health-care providers and Health Quality Ontario has produced a Quality Standard that describes high quality palliative care) or the national level. But, Palli8 clearly and concisely articulates what must be done for Australia to improve care for LTC residents and frail, elderly seniors

Thankfully, Australia’s timing is impeccable.

The Standards Council of Canada (SCC), Health Standards Organization (HSO) and Canadian Standards Association (CSA Group) are working collaboratively on developing national standards for LTC that will be shaped by the needs of residents, families and Canada’s LTC workforce. The Canadian Society of Palliative Care Physicians has also convened a working group to look at improving access to palliative care in LTC homes. The PCA document could inform both of these endeavors. The opportunity to imbed and implement the PCA’s eight pillars is there if we have the collective will to act.

Now, contrast this opportunity with the recent federal budget, which has committed $29.8 million over six years toward improving palliative care in LTC homes. This might seem like a lot of money but it works out to $5 million a year for the 2,039 care homes in Canada, or $2,452 per home. Considering that there are about 160,000 LTC residents in Canada, this works out to $31.25 per resident, despite massive amounts of new spending in Budget 2021.

Despite the evidence that shows investments in palliative care save money in the health-care system, it continues to be, at best, an afterthought and at worst ignored. Based on the fifth pillar of PCA’s plan, this budget was disheartening, to say the least. 

Pamela Liao, chair of the Ontario Medical Association Section on Palliative Medicine, recently wrote that the pandemic has highlighted the need for a serious conversation about palliative and end-of-life care. “At the outset of the pandemic, resources were directed to acute care with the anticipation of overflowing ICUs and ventilator shortages. The mass casualty experience, unfortunately, was seen in our LTC and retirement homes and other congregate-care facilities, but we were slow to reinforce these facilities the same way we did with hospitals at the outset. I often reiterate that not all the sickest patients were in ICUs. Interestingly, the resources allocated to a patient dying at home pale in comparison to those allocated to a death within a hospital.”

Poor access to care and our current “postal code lottery” is simply not acceptable.  Thus, we cannot fall into the trap of ignoring the need for a palliative approach to care in our LTC homes. Unfortunately, the 2021 budget seems to do just that.

We must demand better for our LTC homes. This starts at the top. No matter how many reports we publish, they are just words if we do not act on them.

I’ll give Dr. Liao the last words on the matter.

“Life won’t be the same post pandemic. End-of-life and palliative care shouldn’t be either.”

This article reflects the views and conclusions of the author and does not necessarily reflect those of Ontario Health. No endorsement by Ontario Health is intended or should be inferred.