News

While most Canadians harbour romantic notions of dying peacefully at home surrounded by their loved ones, the cruel reality is that only one in seven actually do so.

Instead, the vast majority - and the elderly in particular - are dying in the antiseptic surroundings of hospitals and nursing homes, according to a new study by the Canadian Institute for Health Information.

The research, conducted in the four Western provinces, shows that 58 per cent of deaths occurred in hospital while about 25 per cent occurred in long-term care facilities, and 15 per cent at home.

"It's quite appalling, really," said Sharon Baxter, executive director of the Canadian Hospice Palliative Care Association, in an interview.

Ms. Baxter said that not only are people dying in hospitals, they are doing so in acute care beds, which is a tremendous waste of resources.

According to the report, fewer than 15 per cent of people who die in hospital receive palliative care. It is unclear what percentage of those in nursing homes or in home-care programs receive palliative care because data are not collected. (The CHPCA says about 60 per cent of people who die each year require palliative care.)

"End-of-life care is not comprehensive, co-ordinated or integrated into the health system," Ms. Baxter said. "It's treated as an afterthought."

Stewart McMillan, head of family medicine in the Regina Qu'Appelle Health Region and a long-time palliative care physician, said the principal message that emerges from the report is that "as a health system, we're not addressing the desires of patients who want to be cared for at home."

There is no simple explanation, he said, but generally speaking, the system is focused on treating the symptoms of acute care patients, and not on palliative care or supporting families.

"Dying at home is a team event," Dr. McMillan said. "A lot of support and resolve is required and the support is not always there."

He said the CIHI report also shows that there are significant regional variations in how end-of-life care is delivered. For example, patients with terminal illnesses are far less likely to be hospitalized in British Columbia than in other Western provinces. But patients who are dying are far more likely to get pain medication in Saskatchewan than in neighbouring jurisdictions.

The 115-page report is based on data from 65,000 deaths in Western Canada - British Columbia, Alberta, Saskatchewan and Manitoba - from 2003 to 2004. That represents about one-quarter of annual deaths in Canada.

Anne McFarlane, executive director for Western Canada at CIHI, said the study is the first to examine how Canadians use health services at the end of life. The report shows, not surprisingly, that people are heavy users of health services in their last months of life.

About 58 per cent were hospitalized in the last six months of life, and 37 per cent were admitted to hospital in the last 30 days before they died.

In that last month, however, hospital stays varied from an average 4.5 days in B.C. to 8.7 days in Manitoba.