Transforming Our Understanding of Hospice Palliative Care

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Transforming Our Understanding of Hospice
Palliative Care
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Acknowledgements This slideshow is a compilation
of information/slides from a number of experts in
hospice palliative care

• the Palliative Pain and Symptom Management
  Consultants Cathy Joy, Janet Noble, Marie
  Palmer, Diane Reid, Chris Sherwood, and Marsha
  Wolowich
• Canadian Hospice Palliative Care Association and
  the Pallium Project

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Agenda

• View Dying For Care Towards Quality End-of-life
  Care (16 minutes)
• Review of CHPCA Model to Guide HPC
• Debrief about common myths, barriers and issues
  impeding quality care

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View Dying For Care

• A compilation of insights with Hospice Palliative
  Care leaders conducted in late 2005
• Reflects perspectives from a cross-section of
  professions and leaders from coast-to-coast.
• Provides insights into some of the things that
  might impede our abilities to work effectively
  with health care professionals in Hospice
  Palliative Care work.

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Prior to Antibiotics
Slide compliments of Dr. Frank Ferris Oct 2005
High

• Sudden, Unexpected
• infections
• accidents
• adults lived into their 60s

Health Status
Death
Low
Time
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1940s 1980s
Slide compliments of Dr. Frank Ferris Oct 2005
High
Decline

• Prolonged Dying
• predictable decline

Health Status
Death
Low
Time
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Disease, Aging in 2006

• Sometimes cured
• Most often controlled
• Life expectancy 10 - 20 yr.
• Canada 80 yr.
• USA 78 yr.
• India 64

Frank Ferris Oct 2005
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Hospice Palliative Care in Non Cancer Illness

• Few of us will die acute deaths
• 90 of us will die with one or more chronic
  illnesses
• 29 of us will die of cancer
• 36 will die of heart or vascular disease
• By age 85, 47 of us will suffer from dementia
• 2004 Dr. Larry Librach

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Exacerbations and Sudden Dying
High
Mostly Chronic Heart and Lung Failure
Function
Death
Low
Time
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Prolonged Dwindling
High
Frailty and Dementia
Function
Death
Low
Time
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Traditional Model
 
 
Curative
Palliative
Death
Active
Terminal
Earliest Model of Palliative Care developed Dame
Cicely Saunders 1960s 1970s
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Current Model
Frank Ferris Oct 2005
End-of-lifeCare
Therapies tomodify disease
Hospice Palliative Care
Presentation
Death
Therapies to relieve suffering and / orimprove
quality of life
BereavementCare
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Hospice Palliative Care

• Hospice Palliative care is not
• A person/resident/patient
• A place
• A program

C. Sherwood, PPSMC, 2004
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Hospice Palliative Care

• Hospice Palliative care is
• provided to a person/resident/patient
• provided in a place
• provided by health care practitioners, program,
  service etc.

C. Sherwood, PPSMC, 2004
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Hospice Palliative Care (HPC)

• A philosophy of care and range of active,
  supportive services provided across several
  settings of care (home, hospital, hospice, LTC/CC
  and settings of marginalization) to enhance the
  quality of living, dying and surviving.
• 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.

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Start with the end in mind

• What are we trying to achieve?
• Canadians should be able to live well and die as
  free of pain and suffering as possible in the
  setting of their choice, surrounded by loved
  ones.
• Adapted from Quality End of Life
  Coalition of Canada Care

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Rethinking Palliation

• Need to broaden our understanding of palliation.
• Hospice Palliative Care (HPC) as introduced in
  2002 Model provides a pathway for improving care
  which addresses Chronic Progressive Illness.
• HPC as a philosophy/model of care is broader than
  the earlier palliative care services provision
  model.
• Each dying process/death event impacts at least 8
  others directly considerable hidden health
  risks/costs.
• Emerging opportunities to provide different
  supports at the community-level (e.g., practical/
  advanced care planning transportation
  bereavement support).

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A Growing Need

• Around 250,000 Canadians will die this year as
  many as 165,000 could use hospice palliative care
  services.
• Not just about cancer, but other major causes of
  expected death including
• End-stage organ failure (e.g., heart, lung,
  renal)
• Neurological illness (e.g., Alzheimers, ALS, MS)
• Immunological illness (e.g., HIV/AIDS)
• Many people are living much longer with illnesses
  which will lead to an expected death, often with
  pain/suffering.
• At present less than 15 of Canadians have access
  to hospice palliative care services in Canada.
  Rural and remote Canada is generally doing much
  worse than most cities.

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The Current Reality

• Canadians are living longer, Baby Boomers are
  aging if we arent meeting the needs today what
  will we do in 20 years?
• 33 more deaths by 2020
• Most Canadians say they would like to die at home
  or stay at home as long as possible yet 75 die
  in acute care beds or long term care homes(2000)
• Increased use of acute beds, unnecessary pain and
  suffering, and misuse/overuse of health delivery
  system when families are not supported with
  quality services.

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Specific Things We Can Do

• Recognize that living well until death is not
  black and white it is often many shades of
  grey involving complex care and needs provided by
  many.
• Recognize that many health care professionals
  might find these issues difficult
• Learn to reframe hope for the long-view.
• As Family Council members????

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A Starting Point for Resources

• HNHB Hospice Palliative Care Network
• http//www.hnhbhpc.net/
• Canadian Hospice Palliative Care Association
  (CHPCA)
• www.chpca.net (see CHPCA Marketplace link)

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Thank You

• Diane Reid, Palliative Care Consultant Niagara
• Diane.reid_at_hospiceniagara.ca