Improving Hospice Palliative Care Across Waterloo Wellington


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Guest Blog – Emmi Perkins, Director, Regional Hospice Palliative Care Program

As demographics shift and our population ages, hospice palliative care is becoming more and more important to local residents. Observing this shift, the Waterloo Wellington LHIN continues to improve access, supports and resources to make sure the right care is available when residents need it.

The first question you might ask is – what exactly is hospice palliative care?

Hospice palliative care aims to relieve suffering and improve the quality of living and dying.

Hospice palliative care strives to help patients and families:

  • address physical, psychological, social, spiritual and practical issues, and their associated expectations, needs, hopes and fear.
  • prepare for and manage self-determined life closure and the dying process
  • Cope with loss and grief during the illness and bereavement.

Hospice palliative care is appropriate for any patient and/or family living with, or at risk of developing, a life-threatening illness due to any diagnosis, with any prognosis, regardless of age, and at any time they have unmet expectations and/or needs, and are prepared to accept care.

Over the last few years we have developed and implemented new strategies to improve the hospice palliative care patient experience. A great example of this is our successful Coordinated Bed Access Program.

The Coordinated Bed Access Program is a collaborative program, developed by hospice palliative care providers to communicate both demand for and availability of hospice palliative care beds throughout the region in a timely manner.  Depending on a patient’s needs, providers work together to match patients with available beds, which means patients are getting the care they need, faster.

Time is incredibly important in all aspects of a patient’s care, but especially in end-of-life care. It can mean the difference between honoring a patient’s preferred end-of-life care plan and having them pass away in a place that wouldn’t have been their first choice. Fortunately, 83% of local residents are able to pass away in their preferred place. But we still have more work to do to make this a reality for all residents.

Supporting residents to die in their preferred place is enabled through strong partnerships amongst hospice palliative care providers in each community.  These dedicated hospice palliative care teams are skilled and knowledgeable about palliative care and local resources and are therefore able to ensure the needs of patients with complex pain and symptom management issues are addressed in the setting of their choice.  Additionally,  these teams promote and support other providers in each community to identify patients who would benefit from a palliative approach to care and to deliver this comprehensive approach to addressing the needs of patients who are in their last year of life (and their caregivers).  A recent key enhancement to these teams is a standardized role for the hospice palliative care nurse practitioners to support primary care providers who are caring for patients with palliative care needs.

We are also undertaking planning activities to understand our current hospice palliative care resources and to plan for services that will be required in each sub-region to support equitable access to high quality hospice palliative care and in anticipation of greater future demand for hospice palliative care. Relative to other regions in Ontario, Waterloo Wellington is well resourced with respect to residential hospice and other end-of-life care beds.  In light of anticipated demographics shifts, we do need to better understand resources required to ensure high-quality care for patients whose preferred place of death is home.

But supporting care at end-of-life is only one component of hospice palliative care. As patients near end-of-life, we also need to develop supports to make the transition to hospice palliative care easier for patients and their families. One of the ways we will do this is to embed Advance Care Planning into all care settings.

It is difficult to know what to do when a loved one is diagnosed with a life-limiting illness. One of the best ways to prepare for this stage in life is to have a conversation about Advance Care Planning. Advance Care Planning is communicating your wishes, values and beliefs to your substitute decision maker (SDM) in the event you are incapable of making health care decisions for yourself. In order to assist and encourage patients to talk openly about their wishes we are supporting care providers and other community members to encourage individuals to identify their SDM and to have these conversations.

Overall, we have made many improvements to hospice palliative care in Waterloo Wellington. And as we continue to improve care, the patient experience will be our main focus. We want to create an equitable, accessible and experience focused health care system, and in order to achieve these goals we have to put the patient at the heart of everything we do, and this includes hospice palliative care.

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