As the Canadian health care system expands to incorporate the demands of an increasing population, so do the expectations of Canadians. The shift from infectious to chronic illnesses over the past two decades has meant that more and more patients are being admitted into, and sometimes dying, in intensive care units or long term care at hospitals. A higher life expectancy and an aging population has also contributed to more care being provided in hospitals (CHPCA). Many people would rather spend their last few months at home or in a place that promotes a quality death as they spend time with loved ones and reflect on their past. In Canada every citizen has a right to quality end of life care that allows them to die free of pain and with dignity while surrounded by their loved ones in the setting of their choice (Health Canada). A way to achieve this is through palliative care, also known as end of life care or hospice care. There is an urgent need to advance hospice palliative care (HPC) services and planning. Even though Canadians have access to palliative care, many people choose not to take advantage of the service. This is due to some weaknesses that Canada’s health system has when it comes to end of life care. Some of the flaws that affect palliative care in Canada that should be given attention to are access to end of life care facilities and services, hospice home care, insurance coverage for medications, as well as eradicate gender differences within hospice palliative care. In this paper, I will explain the reasons why Canadians do not take advantage of hospice palliative care and how Canada can improve its palliative health care program.
In order to deal with the problem of palliative care in Canada, we must understand what palliative care is and what it offers. The Canadian hospice palliative care society defines palliative care as “whole person health care that aims to relieve suffering and improve the quality of living and dying”. Hospice palliative care is for any individual that has or is at risk of developing a life threatening illness without the prognosis of getting better regardless of age (CHPCA). The care services range from treating the patient’s physical suffering and if the illness has progressed further, then the aim is to focus on care (CHPCA). In order for a person to be admitted into hospice palliative care, they need to be suffering from a life threatening illness and have about six months to live (Shadd, et al. 2008). The main focus of palliative care is to achieve comfort, increase the quality of life, and ensure that the patient is able to fulfill as many hopes and dreams they may have in a short amount of time (Shadd, et al. 2008). Palliative care focuses on providing emotional, spiritual, and social support for the patient and his/her family. It also provides counseling for the family after the patient has deceased (Holtslander, 2008). These issues that palliative care addresses are very important for the health and happiness of the patient in his/her last days as well as the health and well being of the family. Many people who are admitted into palliative care are undergoing different emotions when they realize that they might not be around for a very long time (Maida, 2008). Many family members are aware that the patient will pass away eventually but it is sometimes hard to accept that they have actually left the world (Holtslander, 2008). This can then affect the family in emotional and psychological ways. In order to help the family out during rough times, nurses and palliative professionals work together with grief counsellors to ensure that they have a better understanding of life (Holtslander, 2008). Research has shown that patients and families who have had access to palliative facilities got the opportunity to share quality time and allow for quality death of their loved ones (Maida, 2008). Many patients have referred to palliative care as “an experience that allowed them to fulfill their expectation of life before passing away” (Maida, 2008 ). In the eyes of the dying patient, palliative care allows them to optimize the quality of life and promote death with dignity (Maida, 2008 ).
Palliative care is a necessity and should be a right to all Canadians. Every resident in Canada should be entitled to a peaceful passing no matter what the situation may be. Even though there is a growing need are more elderly people in need of end of life care, Canada does not seem to have the establishments to care for the dying patients and their families.
One of the major problems of palliative care in Canada is the limited number of facilities and services available for those who need it. There is a turn in the era as infectious diseases decrease and the advances in the medical field increase (Bruera, 2002 ). Today’s population is living longer and therefore diagnosed with a chronic disease at a later age (Bruera, 2002 ). As there are more people with heart diseases, cancer, and other life threatening illnesses, the need for palliative care is increasing dramatically. The Canadian hospice palliative care association (CHPCA) estimates that over the next forty years the demand for hospice palliative care services will continue to increase (CHPCA). The awareness of the “right of every Canadian to die with dignity, and free of pain” is rising and the health care of Canada is required to implement methods within palliative care to match the needs of society (Collier, 2011). To meet the demands of the population, palliative services should incorporate levels of end of life care amongst the facilities that are specific to patient’s health status (Collier, 2011). For example, Canada should include inpatient palliative units as well as hospice homecare; hospitals should offer consultation services, expand outpatient clinics and provide bereavement support (Collier, 2011). As stated in the article by Schroder and Van, there should be three levels of palliative care to make sure the right to end of life care to every Canadian is ensured. The primary level would consist of general health professionals who can treat patients with chronic diseases without being referred to a specialist (Schroder, 2010). The secondary level would consist of specialist who has experience in palliative care as well as other health professionals such as psychologists and counselors to enhance the management of psychosocial or spiritual needs for patients in hospitals (Schroder, 2010). The tertiary level would consist of specialist health care professionals who take part in maintaining palliative medicine (Schroder, 2010). These physicians and nurses would have more complex training to keep up with the demands of end of life care needs (Schroder, 2010).
Another way to increase the number of facilities and services is by educating more people to become palliative physicians and nurses (Schroder, 2010). Hospice palliative care is delivered by an interdisciplinary team of health care providers regardless of status (Gibson, 1995). Currently Canada has over two hundred palliative care physicians working either full time or part time and about ten of fourteen medical schools have optional undergraduate elective rotation in palliative care (Schroder, 2010). If palliative rotations were to become mandatory, and then we would have more people interested in pursuing a career in palliative medicine (Schroder, 2010). The quality end of life care coalition of Canada mentions that over the next ten years, education will be more important in hospice palliative since Canadian will want to receive quality care in the hospital setting where they will die (Schroder, 2010). Since palliative care consists of more than just physicians; nurses, psychologists and counselors should also receive more education and designations as palliative care health professionals (Gibson, 1995). The more health professionals there are the more facilities and services we’ll have and hence increased access of every Canadian to a quality death.
The Canadian health care industry should also look into improving palliative home care services. Many people in their last days wish to spend it with their family and friends at the comfort of their own home however, very few people are able to afford home care services. When Canadians are limited with the financial resources and cannot afford to pay for medications, and equipment such as pain pumps, oxygen and other services, they are forced to seek admission in the hospitals. The delivery of home care funding is relied on the public; as the population increases, the demands of palliative home care increases as well but the funding for programs do not (Guerriere, et al. 2010). One of the reasons of the shortage in home care services is because of the shortage of home care workers (Oudshoorn, et. al. 2007). There isn’t much of a demand of physicians and nurses offering home care services (Oudshoorn, et. al. 2007). Through Canadian health trends, it is indicated that an effective home care plan can eventually contribute to decreased costs of the health care system hence the health care of Canada should take some initiatives to cover home care services (Guerriere, et al. 2010). Some provinces have organized reforms which have started to take place to improve home care for elderly people and those with chronic condition. For example, in Quebec, a new reform strategy called PRISMA has started to be put in place (MacAdam, et. al, 2008). PRISMA’s goals are to improve the health, empower and satisfy people with chronic diseases as well as modify their health and social service utilization without increasing the burden on their caregivers (MacAdam, et. al, 2008). The following shows how the needs of populations are met through a screening process that would distinguish the fate of the individual.
PRISMA reform strategy above (MacAdam, et. al, 2008): The person will be screened for the chronic disease and illness. Once the illness has been confirmed, the patient will then be referred to a case manager who will do a series of diagnostic tests and examinations to refer them to the appropriate sector for maintenance of their health as presented above (MacAdam, et. al. 2008).
Research has also proven that patients who do end up taking part in palliative home care tend to live longer than actually anticipated because they are spending time with their loved one (Oudshoorn, et. al. 2007). Just because medical reasons have failed to cure the illness doesn’t mean that the person’s happiness should be taken away. Many patients come to accept their illness and realize that there is no reason to why they should not value the last few months of their life. If Canada is to implement a better home care program, then more people would be able to pass away with no regrets. This would also give the family an opportunity to bond and spend time with the patient which can then also delay the death (Oudshoorn, et. al. 2007). If home care coverage is enabled, more patients would benefit from Canada’s palliative policy as well as decrease health care costs in the long run (Guerriere, et al. 2010). .
Another issue of palliative care in Canada is the concern of insurance and coverage for services and medication that are offered. The cost of end of life care varies from the services that the patient may use to the amount of medications they may take (Johnson, et. al. 2009). These costs are covered by the provincial government and each province has its own jurisdictions of what and how much is covered (Johnson,. et. al, 2009). At the moment, the cost of palliative care that is offered in a hospital is covered by individuals provincial health care plans but the cost of home care is not covered (Heyland, et. al. 2010) Since funding into palliative care is low, hospices rely on volunteers to help run the care facilities (Heyland, et. al. 2010) Some costs are often taken up by patients, families, charities or donations as well as visiting nurses and doctors (Heyland, et. al. 2010). Similar to the services offered at hospitals, Medicare covers the same services in hospice care and will pay for any health problems that are not related to the illness (Heyland, et. al. 2010). Among the hospice benefits, the services included are similar to those offered in hospital services (Heyland,et. al. 2010). The patients have access to physician services, nursing care, medical equipment and supplies, medication for symptom control, social worker services, and counselling to help the patient and the family with grief and loss (Heyland, et. al. 2010) Another situation to consider is if a family cannot afford a private room, the patient will not want to be admitted to a hospice and rather spend their last days at home with their families (Johnson, et. al, 2009). Unfortunately, home care as mentioned above is not covered unless the patient has private insurance (Heyland, et. al. 2010).
Even though Medicare covers many services offered for palliative care, there are a few areas where it lacks insurance (Dumont, et. al. 2010). Once you switch from hospital care to palliative care, it will not pay for treatment of your disease or illness (Dumont, et. al. 2010). The entire purpose of palliative treatment is to get the patient comfort care to help them cope with the illness but not cure it (CHPCA). This is the one aspect that many patients and families are not ready to consider (Siden, et. al. 2008). Many people have the hope that their loved ones will get better and they feel that with proper treatment that is possible. In a society perspective, the Canadian government should be doing everything in its power to save people’s lives and support a death with dignity if treatment fails to help out (Siden, et. al. 2008). Many provinces have taken the initiative to implement programs to improve palliative care (Siden, et. al. 2008). In British Columbia for example, the government has proposed a “framework for End of Life care” to improve benefits, decrease costs, improve the services and the environment and offer the best kind of comfort so patients can pass away with dignity (Siden, et. al. 2008). This framework also includes the goal to improve home care services so people can have a respected death at home without being stressed out about medical bills (Siden, et. al. 2008).
Other means of improving palliative care is by promoting the program. Even though, Canadians have access to hospices and end of life care, very few people tend to take advantage of it because they may not be aware of the services offered or are are not able to pay for it (Chloe. E. et al). When people are approached with the term “end of life care”, many of them are not interested because they think that it would be dark and depressing (Chloe. E. et al). Canada should improve its way in promoting that palliative care is a place where people can pass away with dignity and peace (Chloe. E. et al). It is important for the public to be aware of the major difference in the number of males and females that are in the care facilities (Brazil, et. al. 2009). In general, more females tend to take advantage of hospice care facilities than males do (Brazil, et. al. 2009). Much of those differences accounts for the fact that more females are usually diagnosed with chronic disease than males are (Brazil, et. al. 2009). Additional reasons to why women are more likely to take advantage of palliative care is because females are known to be “vulnerable”, ”fragile” and need to be looked after (Brazil, et. al. 2009). Whereas males are superior and are supposed to be independent hence they should be able to look after themselves (Brazil, et. al. 2009). Since males have the tendency to choose not to get help from other strangers, they stay home and prefer palliative home care over a facility (Brazil, et. al. 2009). This lead to one of the major contributors to gender difference in end of life care either it be in a facility or at home (Holtslander, 2008). Older men are more likely to be cared by their wives hence die at home than compared to older women who choose not to burden their loved ones and be admitted to a palliative centre (Holtslander, 2008). Over all, women represent the majority of care recipients at palliative care facilities as well as the majority of caregivers in home care (Brazil, et. al. 2009). Palliative care should be promoted so both males and females have a positive outlook upon palliative care as well as decrease home care which often becomes a burden to the loved ones (Holtslander, 2008).
In conclusion, the generations of the “baby boomers” have aged and therefore there is an increase in the elderly population. Among that, the era of infectious diseases has decreased and hence, chronic illnesses have made a prevalent entrance. As the trend of health care continues to expand, Canada has to adapt to a new setting of care for the elderly and the sick. A way to do this is by reforming palliative and hospice end of life care. Many people with cardiovascular and chronic diseases tend to die in dark settings such as hospitals. This is due to Canadians not having proper access to palliative facilities, do not have the luxury to be able to afford home care, are not aware of the facilities and services that palliative care has to offer as well as not being informed about the insurance cover Canada offers with end of life situations. The provincial governments should organize strategies to reform palliative care within women and men like Quebec has implemented. Once the health care industry tackles those problems, we can then expand the network of palliative medicine by promotion and awareness within society. The more people who are aware of palliative care, the higher the value of life will be. It should be targeted towards both males and females so they have an equal opportunity to reflect on their past in a peaceful setting.
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