Hospice Palliative Care
Report to Central LHIN Board
May 31, 2011
Dr. Nancy Merrow
Chair, HPC Network for CLHIN
Definition of Hospice Palliative Care1
Hospice palliative care aims to relieve suffering
and improve the quality of living and dying.
Hospice palliative care strives to help patients
and families:
• address physical, psychological, social,
spiritual and practical issues, and their associated
expectations, needs, hopes and fears
• prepare for and manage self-determined life closure and
the dying process
• cope with loss and grief during the illness and
bereavement.
1. Canadian Hospice Palliative Care Association Norms of Practice 2002
Who Needs Hospice Palliative Care?1
Hospice palliative care is 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.
1. Canadian Hospice Palliative Care Association Norms of Practice 2002
What kind of care is it?
Hospice palliative care aims to:
• treat all active issues
• prevent new issues from occurring
• promote opportunities for meaningful
and valuable experiences, personal and
spiritual growth, and self-actualization
Canadian Hospice Palliative Care Association Norms of Practice 2002
When do we start Hospice Palliative Care?
FOCUS OF CARE
Therapy to Modify Disease
Hospice Palliative Care
Therapy to relieve suffering
& improve quality of life
DIAGNOSIS
ACUTE
CHRONIC
ADVANCED LIFE THREATENING
DEATH
BEREAVEMENT
PROGRESSION OF DISEASE
End of Life Care
Current State of HPC in CLHIN
6 hospitals
2 networks
CCAC
7 Nursing
Agencies
1,651,681 people
5 Cancer
programs
Umpteen pharmacies
Funeral Homes
EDITH
PROTOCOL
46 Long Term
Care Homes
3 bed
residential
hospice
Temmy
Latner
Centre
12 visiting
hospices
Family
Doctors
HPC
Teams
EMS
Faith Based
Groups
Typical Patient Journey
More Chemo?
Radiation?
What
dose?
What is
Hospice?
DNR?
Who will
Take care
of me?
Who should
I refer to?
What is
cremation?
How much does
a funeral cost?
Can I die at home?
Brief History of the Network
HPC Network was created in 2007 as part of
the provincial End of Life Strategy
“To plan, oversee and evaluate
comprehensive hospice palliative care for
the residents of the Central Local Health
Integrated Network”
Volunteer Steering Committee with paid
coordinator
Budget $70,000
Challenges
•
•
•
•
Voluntary membership
Voluntary leadership
Limited budget
Coordinator position was hard to recruit and
maintain
• No “presence”
• No accountability from or to members for action
or involvement
• No data
Successes
•
•
•
•
Strategic Plan
Environmental Scan
3 Annual Networking Education Days
Consultation body for various projects
including the Hospice Palliative Care
Teams for CLHIN Aging at Home funded
program
HPC Teams
• Funded by Aging at Home in 2008
• Expanded in 2010
• Partnership between CCAC, Southlake
Regional Health Centre, and Temmy
Latner Centre for Palliative Care
• Integrated the pre-existing Regional Pain
& Symptom Management Consultation
Team
HPC Teams continued
• Housed with small admin office at
Stronach Regional Cancer Centre
• Program Lead, Nurse Manager, admin
assistant
• 5 Clinical Nurse Consultants
– Work out in community
– Consulting with providers and clients
– Providing education
HPC Team Products
•
•
•
•
•
•
•
Website
Average new referrals 75 per month
Average 300 patients on caseload at all times
90% of patients dying in setting of choice
Average 40 ER Visits avoided per month
Analysis of reasons for transfer to ER
Analysis of reasons preference for place of
death not met
• In home chart
HPC Teams
Knowledge Transfer & Exchange
• Weekly case consultation meetings at
local hospices
• Education sessions at long term care
homes
• Cancer Care Ontario Symptom Guides
training in collaboration with CCO
• Expected Death in the Home Protocol
• Symptom Relief Kit
Next Steps for HPC Teams –
One time funded projects
• Comprehensive team based education for
primary care and long term care providers
• Case based real time teaching and
mentoring
• 24 hour response to avoid transfer to ER
• Research study on barriers to primary care
involvement in HPC
• Research study on outcomes of mentoring
Long Term Goals for HPC Teams
• Physical location
• Add physicians and psychosocial
expertise to teams
• Integrate physician teams
• Enhanced 24x 7 crisis response* (story)
• Expand teams to improve access – need 8
Clinical Nurse Consultants for full
geographic coverage
Successes in other LHINs
• Champlain LHIN network recognized the
need for a comprehensive integrated
program for the Ottawa area.
• Undertook an extensive planning and
engagement process over one year.
– On line survey
– Facilitated sessions
– Email feedback
Outcomes in Champlain LHIN
1. Establishment of a regional HPC program
accountable to the LHIN
2. A Leadership Council to over see the program
3. Formal agreements with service providers to
o
Support the objectives of the program
o
Incorporate standards and competencies
o
Establish performance indicators for
evaluation and program planning
A HPC Program for CLHIN
•
•
•
•
•
Strategy, planning and research
Management of the HPC Program
Access, Performance and Accountability
Clinical Excellence
Person and Family Advisory Group
– Community Engagement
• Provider care and Development
– Education and knowledge translation, capacity
building
• Public reporting
Hospice Palliative Care for CLHIN
CENTRAL LHIN
BOARD
HPC
PROGRAM
COUNCIL
MANAGEMENT
COMMITTEE
PLANNING
STRATEGY &
RESEARCH
ACCESS &
PERFORMANCE
COLLABORATIVE
CLINICAL
EXCELLENCE
COLLABORATIVE
PERSON &
FAMILY ADVISORY
GROUP
PROVIDER CARE
& DEVELOPMENT
GROUP
Model for HPC in CLHIN
CLHIN
HOSPICES
HOSPITAL
PCUs
CONSUMERS
IN
HOME
CARE
TEAMS
EXPERT
TEAMS
HPC
Program
CLHIN
LONG
TERM
CARE
HOMES
PALCARE
NETWORK
PRIMARY
CARE
CCAC
CANCER
CLINICS
CIRCLE OF
ACCOUNTABILITY
The Future of
Hospice Palliative Care for CLHIN
Cancer centre
Complete
Care
Plan
Long term care
A
Good
Death
CCAC
Hospital
HPC
Teams
Hospice
Bereavement
care
Primary care
Home
Transport DNR
EDITH Protocol
Home Care
LHIN Support
The Central Hospice Palliative Care
Network steering committee unanimously
recommends that the Central LHIN
dissolve the network and approve the
formation of a Transition Strategy Team to
lead a planning and engagement process
to create a comprehensive Hospice
Palliative Care Program for the LHIN
Thank
you !