Ontario Needs a Coordinated End-of-Life Care Policy

Posted by Jeff Durish

Thu, Jan 8, 2015

Health Quality Ontario recently published a report that says Canada ranks 5^th out of 40 countries on a quality-of-death index. Thats the good news; the bad news is that the Canadian health care system lacks a national strategy for end-of-life (EoL) care and depends on hospitals to provide most of that care.

If you ask Canadians where and how they would prefer to die, most will tell you they want to die at home surrounded by their loved ones, being given care to make them comfortable, rather than trying to prolong life. Yet almost 70% (almost 60% in Ontario) die in the hospital, more than half of those in intensive care units, where the cost, both economic and personal, is staggering.

Health care has reached the point where most Canadians die of advanced chronic disease rather than acute illness. Only an estimated 30% of patientsCoordinated End of Life Care have access to coordinated EoL care, and most of those have cancer. As the population ages, the number who die each year will increase 40% by 2026. This will put an enormous burden on an already overwhelmed healthcare system if we dont develop public policy to handle the needs of those with advanced Alzheimers, heart disease, stroke, COPD, and kidney disease, as well as those who are old and frail, but do not have a defined disease that will cause death.

The factors that influence where and how people die include:

• Lack of access to coordinated end-of-life care ” Those who live in rural areas and those with slow-progressing diseases such as kidney, pulmonary, and heart disease may find it difficult to find EoL care except in a hospital.
• Not completing an advance directive ” Government regulations require life-saving measures unless the patient has specifically stated that they do not want them in certain circumstances. Many people dont even know what an advance directive is or how to complete one, and many confuse advance directive with power of attorney. [See our blog post on this subject.]
• Not communicating their wishes to family members and doctors “Only 45% have spoken with their families about their wishes for EoL care; fewer than 20% of patients have spoken with their doctors about it.

Its a difficult subject, dying. Its hard to sit down and talk calmly and compassionately about a loved ones death when its not even on the horizon, and when it is imminent, it may be too late. The cost of not doing so is immeasurably higher, both in terms of dollars and more importantly, in terms of human emotion, when its delayed too long. [See our series of posts (part 1, part 2, and part 3) for tips on how to handle the the conversation.]

A separate report by Health Quality Ontario listed a number of recommendations:

• Every Ontarian should have access to specialized, team-based (coordinated), end-of-life care
• Doctors, patients and family caregivers should discuss advance care planning early and as circumstances change
• Home may not be the appropriate place of death. Patients, family caregivers and health care providers should determine and discuss the best place on an individual basis.
• Patients and caregivers need to be better educated. Such subjects as symptom management and coping strategies, as well as how to prepare documents such as advance directives and powers of attorney, should be part of ongoing education for patients and caregivers.
• Health care providers should be educated specifically in end-of-life before and after being licensed, including how to provide supportive care to family caregivers.

Qualicare Toronto has always provided specialized palliative care with a team-based approach. Our RN case managers and PSWs work as a team with your palliative doctor to give patients and their families physical and emotional support. Call us to discuss your options, at no cost and no obligation.