How Canadians age and die has changed dramatically in recent decades, with the resulting shift emphasizing growing needs to rethink the ways and places care is delivered.
Just a generation or two ago, death usually came suddenly, the result of an acute cardiac event or illness. Today, more people are living longer than ever with chronic diseases (80 per cent of seniors over the age of 65 have at least one chronic disease), yet our health care system still works on the old acute care model.
“We need to shift our philosophy about setting of care to think beyond acute care hospitals,”
says Sharon Baxter, executive director of Canadian Hospice and Palliative Care Association (CHPCA).
Home care offers an alternative that not only benefits patients, but is also more cost-effective than hospital-based care. “Well-supported home care enables people to be discharged from hospitals earlier, delays admission to long-term care facilities and allows individuals to live with dignity and independence,” says Nadine Henningsen, executive director of Canadian Home Care Association (CHCA).
For those with terminal illnesses, hospice palliative care helps patients die the way the majority of Canadians say they would prefer: at home. “We believe that everyone has the right to die with dignity, free of pain, surrounded by their loved ones, in the setting of their choice,” says Ms. Baxter.
Funding for and availability of these services varies widely across the country, however. “If you want to die at home, you need home care. But you may or not be able to get home care, and it may or may not be funded, depending on where you live,” says Ms. Baxter. Even where services are available, terminally ill patients sometimes remain in hospital because they do not receive timely referral to palliative program. “We need to train health care workers how to talk to patients about end-of-life issues,” she says.
Availability of home care and hospice palliative care services are also being strained by increasing demand and limited resources. CHCA estimates that more than 800,000 seniors with chronic conditions will require home care services in 2017.
“The lack of qualified human resources is a significant challenge all home care providers face. It is difficult to recruit and retain health professionals, and our current workforce is aging. The demand for home care services will soon outstrip our human resources,” says Ms. Henningsen. The results are waitlists for services, an increasing burden on family caregivers and continuing reliance on hospitals.
Both CHCA and CHPCA want to see the federal government commit increased financial, human and technology resources to home and palliative care services. “We want to guarantee a minimum standard of resources across the country so that you can spend the last years of your life at home if that’s what you want,” says Ms. Baxter.
